Background

Lifestyle change programs, such as the National Diabetes Prevention Program and Diabetes Self-Management Education and Support, can help reduce diabetes risk as well as disease complications. Cultural and social factors are critical considerations for facilitating individual access and participation in these programs. Understanding these factors may help program implementers mitigate challenges to engagement and program uptake.

Methods

In fall 2024, the Los Angeles County Department of Public Health and Innovation & Intersection and Associates LLC partnered to conduct 11 listening sessions with 82 individuals diagnosed with diabetes, prediabetes, or gestational diabetes from four racial/ethnic groups: Black/African American, Hispanic/Latino, Cambodian, and Chinese. Data were analyzed using thematic analysis. Results were used to identify program access and utilization barriers and strategies for overcoming them.

Results

Key barriers identified included: culturally-specific dietary needs, emotional distress from diagnosis, economic constraints, and desire for culturally-appropriate diabetes education. Family support frequently emerged as a facilitator to overcoming these barriers. Notably, while some barriers were universally shared, others were more common among certain racial/ethnic groups. For example, Black/African Americans and Hispanics/Latinos expressed distrust and negative experiences with the healthcare system, whereas Chinese and Cambodian participants did not.

Conclusion

Clinicians and diabetes program providers can help reduce disparities in program access and participation by addressing cultural and social factors that can impede program use. Mitigating strategies may include providing clear guidance at diagnosis, fostering a non-judgmental space for discussing traditional remedies, offering culturally-relevant diabetes education, and connecting patients to resources that address their social needs.

Background

Rural populations face significant health disparities and social determinants of health (SDOH) that increase their risk for type 2 diabetes. Barriers such as limited healthcare infrastructure, provider shortages, transportation challenges, and digital divide issues hinder the expansion of evidence-based programs like the CDC’s National Diabetes Prevention Program (DPP). The Pennsylvania Department of Health (PADOH) has worked to expand DPP access statewide, but significant gaps persist across the Commonwealth. This study explores barriers and facilitators to rural DPP expansion through key informant interviews and provider surveys.

Methods

The Research & Evaluation Group at Public Health Management Corporation, the external evaluator for the PADOH DPP initiative, is conducting qualitative interviews and surveys with DPP providers and stakeholders across Pennsylvania to assess:
• Barriers to rural DPP expansion
• Strategies to increase access
• The role of SDOH in implementation
• Policy and funding needs for sustainability

Anticipated Results

Preliminary findings suggest infrastructure limitations and transportation barriers significantly affect recruitment and retention in rural DPPs. Many residents lack access to in-person or virtual DPP offerings due to internet constraints and transportation gaps.

Discussion

To promote health equity, findings will inform:

1. Rural-specific policy recommendations, including funding for in-person sites

2. Digital equity efforts to improve broadband access

3. Workforce strategies to train and retain rural DPP providers

4. Partnerships to address local transportation needs

This research will guide actionable strategies to reduce chronic disease risk and improve DPP accessibility in underserved rural communities.

Amidst the national discourse regarding equity, obesity and Type 2 diabetes continue to pose significant public health challenges, with persistent racial/ethnic disparities. Black adults have the highest obesity prevalence (48.9%), nearly double the Type 2 diabetes rates of White (12.1%: 6.9%); and achieve the least weight loss when participating in group-based interventions. Early weight loss predicts post-treatment outcomes, but little research examines personalized support for Nonresponders (defined as 4-wk loss ≤ 1%). We tested a motivational interviewing (MI) telephone intervention for Nonresponders.

In a cluster randomized community-engaged study among 20 churches, participants were offered a 24-week group-based Diabetes Prevention Program. At intervention week 4, Nonresponders were identified and those randomized to the intervention group received a brief weekly MI call from Community Health Workers to explore barriers and develop personalized weight loss strategies.

Among 374 participants (N=374) (87.1% female, 54.3 years, (SD=13) mean baseline weight 229 lbs. (SD=50) weight change from baseline to 12 and 24 weeks was examined using repeated measures mixed modeling with separate models for Responders and Nonresponders. Responders (n=250) showed significant effects for time and classes attended (p<.010). Nonresponders (n=124), significant time*treatment interaction and classes attended (p=.021 and.0071). While control group Nonresponders had no significant weight change, intervention Nonresponders lost significant weight from baseline to 12 weeks and maintained it 24 weeks.

Identifying Nonresponders early and adding personalized attention enhance the effectiveness of group-based interventions; thus providing a scalable public health model to improve weight loss and prevent diabetes among disparate populations in real world settings.