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Abstract
Translation of the CDC’s evidence-based Diabetes Prevention Program (DPP) lifestyle change program from the clinic to other settings such as communities can increase public health impact of type 2 diabetes (T2DM) prevention efforts among the 1/3 of the U.S. population with prediabetes. However, adaptations are often made during translation due to real-world challenges faced during implementation in community contexts, like Cooperative Extension Services (CES). This dissertation explores outcomes of DPP participants in the context of a state CES, as well as barriers and facilitators to implementing the program as intended. Three studies were conducted and focused on: 1) DPP participant health outcomes (weight, physical activity, diet quality, health-related quality of life) and the relationship of engagement in a social media enhancement with participant outcomes; 2) the relationship of participants’ social support and food security status with health outcomes; and 3) barriers to and facilitators of DPP implementation outcomes in the context of CES, as well as strategies to promote implementation. Overall findings were that participants lost a clinically meaningful amount of weight on average (5.2% ± 5.0% of initial body weight lost [N = 60]) and increased their physical activity, with few changes in diet quality and no relationship to engagement in the social media group. Participants’ social support fromfamily and friends for healthy eating influenced weight loss and some components of diet quality, while the sample size of food insecure participants was too small to detect many relationships. Evaluation guided by the Consolidated Framework for Implementation Research revealed numerous facilitators, as well as some barriers, to Reach, Effectiveness, Adoption, Implementation, and Maintenance of the DPP in CES. At the conclusion of the present study, eight CES professionals had already begun or had plans to begin a second DPP cohort within the next 6 months. Together, these studies provide insight into the effectiveness of the DPP in CES, as well as facilitators to capitalize on and barriers to address to promote implementation of the DPP in the community setting of Cooperative Extension Services.