Prediabetes and type 2 diabetes have increased in the United States. Locally, in Los Angeles County, the adult prediabetes and diabetes prevalence rates are approximately 40% and 10%, respectively. While evidence-based programs such as the National Diabetes Prevention Program (National DPP) and Diabetes Self-Management Education and Support (DSMES) services can help reduce the risk of developing diabetes and its complications, engaging and retaining participants remain challenging. For example, participation in these programs is frequently mired by enrollment barriers, individual misperceptions, and structural factors that are beyond the control of prospective participants. Characterizing these challenges can better inform quality improvement efforts in health systems, especially for increasing access, participation, and completion of these evidenced-based programs.

Methods

This study synthesizes results from semi-structured interviews with 63 participants and nonparticipants of the National DPP (n=32, 15 participating, 17 not) and DSMES (n=31, 15 participating, 16 not). It compares the perceptions and facilitators and barriers as reported by the two groups being compared for each of the programs. Interviews were conducted between June and September of 2023. For each program, participants versus nonparticipants were matched based on language, gender, age category, and race/ethnicity, to the extent feasible.

Results

Thematic analysis identified key individual and structural factors that affected participation. These included perceived benefits of participating, the program delivery mode, scheduling convenience, referral method preference, and healthcare provider engagement. Overall, participants were more likely than nonparticipants to feel a sense of urgency to enroll. Many nonparticipants stated that they would have enrolled if their healthcare provider had strongly encouraged them to.

Conclusion

Study findings suggest that, to facilitate meaningful quality improvement in these programs, health systems should tailor their programming to meet prospective participants’ needs and preferences, and address system-level processes that can impede recruitment, service delivery efficiency, and enrollee retention.