Up & Running: Lessons Learned from the Implementation of the National Diabetes Prevention Program with an Aging Population in Rural Maine

Background: In rural Maine, MaineGeneral Medical Center (MGMC) implemented the National Diabetes Prevention Program (NDPP), an evidence-based lifestyle change program to delay the onset of type-2 diabetes. While targeted at the general population, 75% of the 470 individuals served by NDPP were over fifty years of age. There is a dearth of research on the impact and challenges associated with implementing lifestyle change programs with the aging population in rural settings.

Methods: Participant-level outcomes were collected on number of core sessions completed, increased physical activity, weight loss, and health-related quality of life. Results were cross-tabulated by gender, age, and number of sessions completed. Chi-square analyses were used to determine the relationship between number of sessions completed and program outcomes. Data on challenges and lessons learned were collected from surveys and interviews with staff and coaches.

Results: After two years, only 23% of participants completed all sixteen core sessions. Number of sessions completed was statistically significantly associated with a higher percent of weight loss, higher number of self-reported minutes of physical activity, and improvement in health-related quality of life. There are significant challenges associated with engaging the aging rural population, including socially normative health behaviors, barriers to health communication, and built environment and geographical considerations.

Conclusions: More research is needed to understand how successful outcomes for the aging rural population can be achieved. Lifestyle change programs targeting this group should consider: ongoing engagement strategies; adapting communication and language to meet population needs; capitalizing on group successes to encourage individual behavior change.