JMIR Publications

ABSTRACT

Background:

The National Diabetes Prevention Program (DPP) has been shown to delay or prevent progression to type 2 diabetes, yet most people at risk do not enroll. In Hawaiʻi, Native Hawaiian and Other Pacific Islander (NHOPI) and Filipino adults experience disproportionately high rates of prediabetes and diabetes but have low DPP enrollment. To encourage urgent preventative action, the Hawaiʻi Department of Health launched Beat Diabetes, a statewide media campaign (July–October 2024) encouraging DPP enrollment among adults at risk, with a focus on NHOPI and Filipino communities.

Objective:

This evaluation assessed whether campaign exposure increased the likelihood of joining a DPP among Hawaiʻi adults at risk for diabetes, in particular NHOPI or Filipino adults.

Methods:

From October to December 2024, a post-campaign cross-sectional online survey was conducted with Hawaiʻi residents ages 35 to 64 who reported at least one diabetes risk factor. NHOPI or Filipino adults were oversampled to determine campaign effectiveness among the target audience. The survey measured campaign exposure, self-reported likelihood of joining a lifestyle change program, demographic characteristics, diabetes risk factors, and beliefs that could affect the likelihood of enrolling in a DPP, including intrinsic motivation, perceived inevitability of developing diabetes, and perceived health benefits of DPP participation. Three general linear regression models examined the association between campaign exposure and DPP enrollment likelihood ratings, adjusted for demographic characteristics, diabetes risk factors, and belief variables.

Results:

A total of 860 adult respondents completed the survey, with 46.9% (403/860) self-identifying as NHOPI or Filipino. Forty percent (346/860) reported campaign exposure. Exposed individuals had higher mean DPP enrollment likelihood ratings and higher inevitability belief scores than those not exposed. A large proportion of exposed respondents reported that enrolling in a DPP would “improve their health a lot." No significant differences in campaign exposure were observed between NHOPI or Filipino adults and other ethnicities. All three regression models showed a significant positive association between campaign exposure and DPP enrollment likelihood ratings. In the final adjusted model controlling for all covariates, significant predictors included campaign exposure (β=0.52, P<.001), male gender (β=0.33, P=.009), residence outside Honolulu County (β=0.32, P=.02), motivation index scores (β=0.38, P<.001), inevitability belief (β=0.20, P<.001), and the belief that DPP improves health “a little” (β=0.75, P<.001) or “a lot” (β=1.63, P<.001).

Conclusions:

Exposure to Beat Diabetes was associated with a higher likelihood of enrolling in a DPP, indicating the campaign may help motivate adults at risk for diabetes to take preventative action. Perceived positive health impact of DPP participation was the strongest contributor to DPP enrollment likelihood ratings. Future campaigns aiming to increase DPP enrollment should promote DPP effectiveness and continue to address the urgency of preventative action, while considering barriers to enrollment.