Accepted for/Published in: JMIR Formative Research
Date Submitted: Dec 20, 2024
Date Accepted: May 9, 2025
Assessing the Fit of Digitally Delivered National Diabetes Prevention Program Among Rural Living Adults: A Qualitative Study
ABSTRACT
Background:
Rural living adults are disproportionately affected by type 2 diabetes, compared to their urban counterparts. The Center for Disease Control and Prevention’s National Diabetes Prevention Program (National DPP) is an evidence-based intervention that reduces the risk of type 2 diabetes through increased physical activity and modest weight loss, but overall reach remains limited, specifically in rural communities.
Objective:
This qualitative study aimed to examine the fit of the National DPP delivered digitally using Zoom or Facebook to rural living adults at risk for type 2 diabetes.
Methods:
Guided by the Practical Robust Implementation and Sustainability Model (PRISM), focus group scripts assessed the characteristics and perceptions of rural adults at risk for type 2 diabetes, infrastructure supports for implementation and sustainability, and external factors that could influence program fit. A thematic analysis was conducted separately on coded transcripts for each focus group. Themes were then deductively linked to PRISM domains.
Results:
Two focus groups were conducted with 14 participants after participating in the National DPP for six months delivered through Zoom® (n=9) or Facebook® (n=5). Participants highlighted positive relationships between PRISM constructs related to participant characteristics (i.e., value of health improvements, weight loss, and reduced medication dependence as primary motivators) and perceptions of compatibility (i.e., content alignment with participant needs) as well as infrastructure (i.e., digital platforms provided better access) with program success in reach and engagement. Conversely, both formats were negatively impacted by external factors such as interruptions in internet connectivity. External factors such as referral pathways from local healthcare providers could improve program reach. When considering differences between implementation infrastructure represented by Zoom® versus Facebook® platforms, Zoom® facilitated greater social engagement and accountability compared to Facebook®.
Conclusions:
This study identified contextual factors influencing the fit of digitally delivering the National DPP to rural living adults, including opportunities for utilizing existing connections and health motivations to help improve acceptability, while tailoring curriculum, modality and technology may improve appropriateness for rural populations. Clinical Trial: NCT 0538743
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