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DISSEMINATION OF DIABETES PREVENTION INTERVENTION IN THE COMMUNITY: DEVELOPMENT AND IMPLEMENTATION OF A SURVEY FOR
LIFESTYLE COACHES WORKING IN THE TRENCHES
by
Anna Elizabeth Gongaware
BA, Allegheny College, 2014
Submitted to the Graduate Faculty of
Epidemiology
Graduate School of Public Health in partial fulfillment
of the requirements for the degree of
Master of Public Health
University of Pittsburgh
2016
ii
UNIVERSITY OF PITTSBURGH
GRADUATE SCHOOL OF PUBLIC HEALTH
This essay is submitted
by
Anna Elizabeth Gongaware
on
April 27, 2016
and approved by
Essay Advisor:Nancy W. Glynn, PhD ______________________________________Assistant ProfessorDepartment of EpidemiologyGraduate School of Public HealthUniversity of Pittsburgh
Essay Reader:Mary Kaye Kramer, DrPh ______________________________________Assistant ProfessorDepartment of EpidemiologyGraduate School of Public HealthUniversity of Pittsburgh
Essay Reader:Elizabeth Felter, DrPH ______________________________________Visiting Assistant ProfessorDepartment of Behavioral and Community Health SciencesGraduate School of Public HealthUniversity of Pittsburgh
iii
Copyright © by Anna Elizabeth Gongaware
2016
ABSTRACT
In the U.S., approximately 78.6 million adults are categorized as obese and over 29
million have type 2 diabetes. The high prevalence of these conditions is a pressing public health
issue. The Diabetes Prevention Program (DPP), a research study funded by the National Institute
of Health (NIH), demonstrated that type 2 diabetes could be prevented or delayed through weight
loss and physical activity. To provide this lifestyle intervention education in the community
setting, the Diabetes Prevention Program Group Lifestyle Balance Program (DPP-GLB) was
adapted from the DPP. This program, delivered by trained lifestyle coaches, has been shown to
successfully reduce diabetes and cardiovascular risk factors for at-risk adults. Coaches are
trained by the Diabetes Prevention Support Center (DPSC), which also offers support for these
coaches as they deliver the program in their own settings across the nation. The purpose of this
project was to contact these trained coaches in order to 1) track implementation of the DPP-GLB
program in the community, 2) improve training, and 3) enhance DPSC support for delivery of
the program in the community. A team effort was utilized to create a survey that was distributed
to the DPSC network of over 2,000 trained DPP-GLB coaches. Survey content was adapted
from a previously used DPSC survey, and was transferred from the SurveyMonkey program to
the Qualtrics system. This 52-question survey was sent via email to 1,509 active members of the
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Nancy W. Glynn, PhD
DISSEMINATION OF DIABETES PREVENTION INTERVENTION IN THE
COMMUNITY: DEVELOPMENT AND IMPLEMENTATION OF A SURVEY FOR
LIFESTYLE COACHES WORKING IN THE TRENCHES
Anna Elizabeth Gongaware, MPH
University of Pittsburgh, 2016
DPSC coach network and gathered information about the effectiveness of training workshops,
implementation of GLB in the community, challenges of program execution, and support needed
for the coaches. From a public health perspective, the data collected will improve diabetes
prevention efforts through improvement in the delivery of the DPP-GLB program.
v
TABLE OF CONTENTS
1.0 INTRODUCTION.........................................................................................................1
1.1 OBESITY..............................................................................................................1
1.2 TYPE 2 DIABETES.............................................................................................3
1.3 DIABETES INTERVENTION PROGRAMS...................................................6
1.4 BARRIERS TO PROGRAM IMPLEMENTATION.......................................9
1.5 PUBLIC HEALTH SIGNIFICANCE..............................................................11
2.0 OBJECTIVES.............................................................................................................12
3.0 METHODS..................................................................................................................13
3.1 SURVEY FOR COACHES...............................................................................13
3.2 DATA ANALYSIS..............................................................................................14
4.0 RESULTS....................................................................................................................15
5.0 DISCUSSION..............................................................................................................25
APPENDIX A – SURVEY QUESTIONS..................................................................................30
BIBLIOGRAPHY........................................................................................................................43
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LIST OF TABLES
Table 1. Questions were deleted or added to the previously-used survey for DPP-GLB coaches.
.......................................................................................................................................................13
Table 2. Professional affiliations among survey respondents who served as DPP-GLB coaches.16
Table 3. Geographical location of survey respondents who served as DPP-GLB coaches...........17
Table 4. Military affiliations of survey respondents who served as DPP-GLB coaches...............18
Table 5. Location of DPP-GLB programs and percent of respondents that reported each location.
.......................................................................................................................................................19
Table 6. Marketing/recruitment methods used to recruit participants into DPP-GLB programs..19
Table 7. Average attendance of DPP-GLB participants................................................................20
Table 8. Percentage of DPP-GLB participants who reached at least the 5% weight loss goal by
six months......................................................................................................................................20
Table 9. Reasons that coaches are not currently offering the DPP-GLB program........................21
Table 10. Summary of ranked barriers to program implementation as perceived by DPP-GLB
coaches...........................................................................................................................................22
Table 11. Rating of how well DPP-GLB training prepared coaches for implementing the
program..........................................................................................................................................23
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1.0 INTRODUCTION
Obesity and diabetes are serious health conditions that lead to negative complications for
many people. Fortunately, there are risk factors that can be modified to reduce the effects on
health. The Diabetes Prevention Program is an intervention program that was developed to help
individuals lose weight and lower their risk for diabetes. This program began in the clinical trial
phases and has been successfully implemented in the community through the Group Lifestyle
Balance program. Group coaches are trained by a central organization, the Diabetes Prevention
Support Center at the University of Pittsburgh. The center has trained over 2,000 individuals,
and has an active network of 1,509 coaches. These coaches were asked to participate in a survey
to examine barriers to program implementation to facilitate improvements in program delivery
and community dissemination.
1.1 OBESITY
Obesity is a common health condition faced by many Americans. Many factors can lead
to excess weight including diet, physical inactivity, a person’s environment, genetics,
pharmaceuticals, health conditions, and age (NHLBI, 2012a). Often, this imbalance is
determined by an equation of energy consumed by an individual versus energy expended
1
(NHLBI, 2012a). Having a chronic surplus of calories consumed compared to those used in
physical activity and daily life functions can lead to added weight (NHLBI, 2012a).
Body mass index (BMI) is a standard equation used to estimate a person’s body fat and
weight category (CDC, 2015a). Although used as a common indicator of fat due to the
straightforward and inexpensive nature of the measurement, the formula has weaknesses due to
its reliance solely on a person’s height and weight (CDC, 2015a). Obesity in adults is
specifically defined as having a BMI of at least 30 kg/m2 (Ogden, Carroll, Kit, & Flegal, 2014).
Results from the 2011-2012 National Health and Nutrition Examination Survey (NHANES)
revealed that just under 35% of American adults and approximately 17% of American children
fall under the obesity category (Ogden et al., 2014). When including both the overweight and
obese segments of the population, NHANES reported that almost 69% of adults fall within these
two categories (Ogden et al., 2014). These numbers have remained generally consistent with the
statistics from the early 2000s (Ogden et al., 2014).
Many ill-health effects can arise as a consequence of being overweight or obese such as
cardiovascular issues (stroke, hypertension, heart disease), some cancers, osteoarthritis, infertility
in women, sleep apnea, mental health issues, and type 2 diabetes (NHLBI, 2012b; Kumanyika,
Jeffery, Morabia, Ritenbaugh, & Antipatis, 2002). The former International Obesity Task Force
(now called World Obesity / Policy & Prevention) identified major causes and possible solutions
for the growing prevalence of obesity worldwide (WOPP, 2015; Kumanyika et al., 2002). One
major cause involved the shift of some cultures to calorie- or energy-dense diets that focus on
foods with higher amounts of sugars and saturated fats (Kumanyika et al., 2002). Another issue
arises when cultures become more developed and increasingly sedentary, which leads to overall
lower average calorie expenditures (Kumanyika et al., 2002). The task force strongly
2
emphasized that “societal solutions are critical, especially for the long term” (Kumanyika et al.,
2002).
There are many factors that contribute to the obesity problem in the U.S., some of which
are related to the setting in which we live. The changing food environment is one such factor
(Hill & Peters, 1998). Specifically, a growing availability of food as well as recently larger
portion sizes and higher concentrations of fat in the diet are believed to have an impact on the
obesity epidemic (Hill & Peters, 1998). In addition, humans have become increasingly sedentary
due to technological advances, reduced need for physical labor, and societal dependence on
transportation (Hill & Peters, 1998). These are difficult issues that require multiple strategies to
address.
1.2 TYPE 2 DIABETES
One condition related to obesity, type 2 diabetes, is a disease in which the body develops
insulin resistance, leading to elevated blood glucose levels (ADA, 2016a). In time, this
ineffective use of insulin leads to the onset of the disease and its symptoms (NIDDK, 2014).
Risk factors for type 2 diabetes include obesity, genetic predisposition, physical inactivity, and
age (NIDDK, 2014). While type 2 diabetes was mainly observed in middle-aged to older adults
in the past, it is being seen increasingly in younger populations (NIDDK, 2014). Other risk
factors include concentration of adipose around a person’s center, or “belly fat,” race, and having
other medical conditions such as prediabetes, cardiovascular disease, or metabolic syndrome
(NIDDK, 2014).
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Metabolic syndrome is a condition that places individuals at higher risk for health issues
such as diabetes and cardiovascular problems (AHA, 2014). People with sedentary lifestyles,
insulin resistance, and a large waistline have a greater chance of developing metabolic syndrome
(NHLBI, 2015). This health problem affects about 34% of U.S. adults and is defined as having
three or more of the following risk factors: abdominal obesity, high blood pressure, fasting
glucose greater than 100mg/dL, high triglycerides, and low HDL cholesterol (AHA, 2014).
Certain segments of the population are at increased risk for metabolic syndrome, including
women, people with a personal family history of diabetes, and women with a history of
polycystic ovarian syndrome (NHLBI, 2015).
Type 2 diabetes can cause multiple health complications, such as neuropathy, skin
problems, kidney disease, hypertension, digestive system problems, stroke potential, and vision
problems (ADA, 2016b; ADA, 2014). Within the U.S., approximately 21 million individuals
have been diagnosed with diabetes, and another 8.1 million are thought to be undiagnosed
(ADA, 2014), representing approximately 12% of the U.S. population (CDC, 2014). As of 2014,
just over 1.4 million Americans become newly diagnosed with type 2 diabetes every year, a
statistic that has declined from the rate of almost 1.7 million new cases per year in 2010 (CDC,
2015b). During this same time window, age-adjusted incidence of diabetes for adults
(specifically ages 18-79) dropped from 8.1 to 6.6 per 1,000 population (CDC, 2015c). In regard
to distribution within the population, diabetes disproportionately affects people from varying
ethnic and racial backgrounds. American Indians and Alaskan Natives have the highest rates of
diabetes (15.9%), followed by non-Hispanic blacks (13.2%), Hispanics (12.8%), Asian
Americans (9%), and non-Hispanic whites (7.6%) (ADA, 2014).
4
Symptoms of diabetes may be mild or non-existent in some individuals, but may include
blurry vision, frequent urination, fatigue, excessive hunger or thirst, slow-healing wounds, and
numbness and tingling of extremities (ADA, 2016c). Diagnosis can be made through a variety
of medical tests that examine an individual’s level of blood glucose (ADA, 2016d), and is
defined as an A1C test result of greater than or equal to 6.5%, a Fasting Plasma Glucose test
result of greater than or equal to 126 mg/dl, or an Oral Glucose Tolerance Test result of greater
than or equal to 200 mg/dl (ADA, 2016d). If a tested individual is found to have high blood
glucose, yet their values are not high enough to be considered diabetic, their condition is
categorized as “prediabetes” (ADA, 2016d). Although having prediabetes puts an individual at
higher risk of developing type 2 diabetes, overall health and test results can be improved through
lifestyle changes such as physical activity and losing weight (ADA, 2016d).
Type 2 diabetes can be treated by a variety of pharmaceuticals including Metformin,
sulfonylureas, meglitinides, thiazolidinediones, DPP-4 inhibitors, GLP-1 receptor agonists,
SGLT2 inhibitors, and injections of insulin (Mayo Clinic Staff, 2016). These medications aim to
either intensify an individual’s sensitivity to insulin, increase their body’s insulin output, lower
blood sugar, or provide insulin to the body from an external source (Mayo Clinic Staff, 2016).
As with many other chronic conditions, diabetes can lead to increased health care costs
because of continual need for medications and treatment. In regard to economic impact, diabetes
adds approximately $245 billion between both health care costs and impact of lost productivity
(ADA, 2014). Overall costs for the average diabetes patient in the U.S. are more than double the
healthcare costs of a person without the disease (ADA, 2014).
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1.3 DIABETES INTERVENTION PROGRAMS
Diabetes and obesity have become a significant health burden in the U.S. and throughout
the world. These disease statistics, as well as their impending health challenges and
complications, demonstrate the immense need for public health action. In the past few decades,
many successful programs have surfaced to help combat these problems.
The Diabetes Prevention Program (DPP), a National Institutes of Health funded
randomized clinical research trial, began in 1996 and involved 3,234 people in 27 centers across
the United States (DPP Research Group, 2002). Eligibility criteria defined the study population
as non-diabetic, overweight individuals with elevated glucose levels (DPP Research Group,
2002). This study randomized participants into one of three arms: 1) standard lifestyle
recommendations and placebo pills, 2) standard lifestyle recommendation and metformin
medication, or 3) behavioral lifestyle modification program (DPP Research Group, 2002). The
lifestyle modification intervention arm was completed through 16 core sessions of one-on-one
interaction between a case manager and a study participant over a six month period, followed by
post-core support (DPP Research Group, 2002). These individuals were assigned a weight loss
goal of 7% which was to be accomplished through a reduced calorie and fat diet as well as
through achievement of the physical activity goal of 150 minutes per week of moderate-intensity
physical activity (DPP Research Group, 2002).
After following participants for an average of almost three years, the DPP found that the
lifestyle intervention group had a 58% lower incidence of diabetes compared to placebo, whereas
within the metformin group, incidence was reduced by 31% compared to the placebo group
(DPP Research Group, 2002). The lifestyle arm, in comparison to both the metformin and
placebo arms, had the greatest increase in physical activity, the lowest fasting plasma glucose
6
and glycated hemoglobin levels, as well as the greatest reduction in caloric intake, weight, and
incidence of diabetes (DPP Research Group, 2002). Because of the high success rate in diabetes
reduction, the study was terminated in 2001, a year earlier than planned in order to begin
disseminating the intervention in the community setting (DPP Research Group, 2002).
The Diabetes Prevention Support Center (DPSC) was established in 2006 by DPP
researchers at the University of Pittsburgh to translate the successful DPP lifestyle intervention
to the community (DPSC, 2016). The DPSC offers training and support for health providers for
community delivery of an adapted DPP lifestyle intervention, called the Group Lifestyle Balance
(DPP-GLB) program (DPSC, 2016). Specifically, they have conducted over 50 two-day DPP-
GLB training workshops with an active network of 1,509 DPP-GLB coaches trained across the
US and internationally (DPSC, 2016).
To bring the benefits of the DPP to the community, the curriculum was updated and
adapted in to a translational program to be delivered in a group setting (Kramer et al., 2015).
The cost of the DPP, as well as feasibility for program delivery in the community, motivated the
change from an individual, or one-on-one, delivery to a group format (Kramer et al., 2009). The
DPP-GLB program involves 22 one-hour sessions delivered by trained coaches over the course
of one year. The behavioral lifestyle intervention includes the same goals as the original DPP, to
achieve and maintain a goal of 150 minutes of physical activity per week as well as to reach a
goal of 7% weight loss (DPSC, 2016). Participants are asked to monitor their dietary intake,
physical activity, and weight for the duration of the program (Kramer et al., 2015). Several
effectiveness studies found that DPP-GLB participants lost an average of 7.4 pounds, and had
reductions in risk factors for cardiovascular disease, including decreased body mass index
(BMI), waist circumferences, cholesterol levels, blood glucose, and blood pressure (Kramer et
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al., 2009). Another translation of DPP to a group setting was evaluated in worksites, and gave
participants the option of attending in-person sessions or watching a DVD with program contents
and telephonic coach support (Taradash et al., 2015). The DPP was also brought to an online
social network with participants receiving digital program content as well as contact with
coaches (Sepah, Jiang, & Peters, 2014).
Other translational efforts that used the DPP-GLB program included testing the lifestyle
intervention when delivered by a community health worker, in a primary care clinic, and in
different delivery modalities. The Promotora Effectiveness Versus Metformin Trial
(PREVENT-DM) is currently using community health workers to deliver DPP curriculum and
then compare outcomes to other participants who were given either metformin or placebo (Perez
et al., 2015). The target population included Latina, prediabetic women (Perez et al., 2015).
Another study called Weight Loss through Living Well (WiLLoW) transformed the DPP to a
primary care setting and used a nurse educator to deliver curriculum from the GLB (McTigue,
Conroy, Bigi, Murphy, & McNeil, 2009). The WiLLoW program clinic charged a fee for
program participants in order to cover costs that were rejected by insurance companies (McTigue
et al., 2009). Participants were followed for an average of almost 358 days and program
participants lost a more clinically-significant amount of weight compared to non-participants
(McTigue et al., 2009). The Rethinking Eating and Activity (REACT) study examined the
difference between participants who had the GLB curriculum delivered by a variety of methods
(Piatt, Seidel, Powell, & Zgibor, 2013). Methods involved identical content delivered through
either face-to-face contact, internet, DVD, and “self-selection” (participant’s choice) (Piatt et al.,
2013).
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1.4 BARRIERS TO PROGRAM IMPLEMENTATION
Despite the importance of the role of the lifestyle coach in DPP translation efforts in the
community, there are few reports found in the literature regarding barriers to program
implementation. Based on the design of the DPP-GLB program, there are a few potential
sources of barriers or challenges that coaches might face. Specifically, such programs require a
variety of resources including meeting space for the hour-long weekly sessions, printing
capabilities for participant handouts, booklets for nutrition and activity monitoring, a reference
book to find fat and calorie content of food, as well as pedometers (Kramer et al., 2009). The
cost of training and employment of a coach to provide the program must also be considered.
During the initial creation and evaluation of the DPP-GLB program, it was estimated that to offer
the one-year DPP-GLB program, the cost would be approximately $300 for each of the DPP-
GLB participants, which covered prevention professional payment, program materials, food (for
tasting during sessions), and incentive items (Kramer et al., 2009). The Healthy Living
Partnerships to Prevent Diabetes (HELP PD) was another effort in bringing the DPP to the
community, and found a program cost of $850 per participant compared to $142 for participants
receiving the placebo, or “usual care” (Lawlor et al., 2013).
Drop-out rates were noted in many studies that examined the community-based
application of the DPP program (Jackson, 2009). In one meta-analysis, intervention programs
were held at a variety of locations including YMCAs, churches, hospitals, and worksites, which
had varying outcomes regarding weight loss and drop-out rate (Jackson, 2009). The highest
drop-out rate (43.3% at 6 months) was found in a non-randomized study in a medically
underserved population (Jackson, 2009).
9
Another study evaluated the translation of the DPP as well as another diabetes
intervention, the Healthy Living Program, to a primary care setting (Carroll et al., 2015). With a
low-income, urban study population, recruitment posed a problem due to potential participants’
job insecurity and “life issues,” as well as screening complications, time and resource intensity of
recruitment, and wait time between screening and program start (Carroll et al., 2015). Program
sites faced challenges involving use of resources, management of participant records, and staff
capabilities (Carroll et al., 2015).
Participants in a weight loss study called Be Fit, Be Well (BFBW) received self-
monitoring educational materials, pedometers, and contact with a community health worker
(Warner et al., 2013). With a targeted study population of low-income, minority participants,
researchers in BFBW overcame recruitment and retention challenges through strong
relationships with clinic staff and continuous improvement of methods based on program
progression (Warner et al., 2013).
Obtaining training may be another challenge that potential coaches face. The DPSC
hosts annual, two-day trainings in Pittsburgh, Pennsylvania with a participation cost of $499
(DPSC, 2016). The American Association of Diabetes Educators also hosts a two-day training
program and charges $749 and $849 for members and non-members, respectively (AADE,
2016). The Emory Centers for Training and Technical Assistance, within Emory University,
offers similar training for $750 per attendee (Emory University, 2016). Challenges may arise
because training attendance could require travel to Pittsburgh, taking time off work, and covering
the cost of attending training. Thus, issues of budget, resources, and previously-noted drop-out
rates are potential barriers faced by coaches who are working in DPP translation efforts. It is
10
important to identify and understand these barriers in order to address them and determine
possible strategies for better facilitation of these types of programs in the community.
1.5 PUBLIC HEALTH SIGNIFICANCE
Because of the high rates of obesity and diabetes within the United States, the delivery of
diabetes prevention programs/healthy lifestyle interventions is important to reduce the impact of
these health conditions. These health issues can lead to complications, comorbidities, and
increased health care costs. An individual’s lifestyle, specifically their dietary intake and level of
physical activity, can impact their likelihood of developing such health issues. Effective diabetes
prevention programs have been created to help reduce the burden of diabetes and obesity in the
population. These programs, which started in a clinical setting, have been adapted to be
delivered to the general population by trained health providers. By understanding the barriers
that coaches face in program operation, such challenges can be addressed and reduced in order to
increase the success with DPP-GLB implementation. Ultimately, this heightened success will
lead to a reduction in public health burden due to both obesity and diabetes.
11
2.0 OBJECTIVES
The main objective of this project was to examine barriers for DPP-GLB program
implementation in the community. Additionally, this project aimed to track DPP-GLB program
delivery, improve DPP-GLB coach training, and enhance DPSC support for community program
delivery. Based on prior experience and the resources needed to implement the DPP-GLB
program, it was hypothesized that DPP-GLB coaches face barriers associated with participant
attendance and interest and/or involvement in the program.
12
3.0 METHODS
3.1 SURVEY FOR COACHES
A previously-used DPSC survey was adapted from Survey Monkey and transferred to
Qualtrics, an online survey distribution system that is provided through the University of
Pittsburgh (Appendix A). Survey content was adapted from the 2012 version based on what
information the DPSC staff needed to gather. Some questions were re-worded to be more
precise, answer options were added for some multiple choice questions, and some were removed
as per DPSC request (Table 1).
Table 1. Questions were deleted or added to the previously-used survey for DPP-GLB coaches.
Question Topic Action NotesWhen they began providing DPP-GLB Deleted ---
How they marketed the program Deleted Due to redundancy in a following question about which method was most effective.
Whether they have made program modifications Deleted
Whether they used the DPP-GLB DVD Deleted Due to the next questionreferring to how it was used
If, how, and how often post-core support was provided Deleted ---
If translations of the DPP-GLB to languages other than Spanish would be helpful to the coaches and their settings.
Deleted ---
Whether they attended the most recent DPSC training Added ---
In what ways the DPSC can be of more assistance Added ---
Additional comments or suggestions. Added ---
13
The survey was distributed via email to the DPSC’s database of 1,509 active trained
DPP-GLB coaches. There were three emails sent in total, the initial request and two reminder
emails. Specifically, the survey addressed contact information for current DPP-GLB programs,
coaches’ use of DPP-GLB within community settings, barriers or challenges of program
execution, opinions about effectiveness of training workshops, and support needed for coaches to
continue to effectively carry out their programs. As an incentive for participation, coaches who
completed the survey were entered into a raffle for a healthy cookbook. The participation goal
was to have 10-12% of surveys returned to the DPSC from the DPP-GLB coaches. Survey
contents can be found in Appendix A.
3.2 DATA ANALYSIS
Once the survey was closed to respondents, results were tabulated by the Qualtrics
system. Of the fifty-two questions included in the survey, frequency distributions were
examined for questions involving recent or past DPP-GLB implementation, recruitment methods,
common locations of programs, participant attendance, and barriers to program implementation.
14
4.0 RESULTS
The survey was submitted to the University of Pittsburgh’s IRB in September of 2015.
Modifications were requested and a re-submission occurred in October. An “Exempt” status was
granted by October 8, 2015. The original message was sent out on December 17, 2015, and two
reminder request messages were sent out on January 25 and February 29, 2016, for a total of
three e-mail contacts. The target goal for returned surveys was 10-12% for those who have valid
contact information. The survey was closed on March 13, 2016.
A total of 92 individuals (6%) began the survey, and of that number 69 (75%) completed
all questions. However, eight individuals entered the survey twice and four individuals entered
three times, which reduced the total to 61 useable responses. The data was exported from
Qualtrics to Microsoft Excel and then individuals with multiple entries were examined. Since it
is likely that the most recent entry would reflect the most up to date responses, the most recent
entry for each was kept to be used in analysis, and the others were discarded.
Respondents included coaches from a variety of professional affiliations, geographical
locations, and military associations (Tables 2, 3, and 4). A majority of respondents were
Diabetes Educators, Registered Dietitians/Nutritionists, and Registered Nurses, and the most-
recorded geographic locations were Texas and West Virginia. Eleven (15%) of respondents
were affiliated with the military, a majority of whom were contractors within the military (Table
4).
15
Table 2. Professional affiliations among survey respondents who served as DPP-GLB coaches.
Professional Affiliation Responses (n) %
Certified Diabetes Educator/Diabetes Educator 22 19Registered Dietitian/Nutritionist 19 17Registered Nurse 17 15Other 17 15Health Educator 15 13Exercise Specialist 5 4Health and Wellness Center Staff 4 4PhD, DrPH 3 3Social Worker 3 3Researcher 2 2Physician 2 2Medical Technician 1 1Physical/Occupational Therapist 1 1Psychologist 1 1Student 1 1Physician Assistant 0 0Nurse Practitioner 0 0Total 113 100
16
Table 3. Geographical location of survey respondents who served as DPP-GLB coaches.
Geographic Location Responses (n) %
Alaska 1 1Alabama 1 1Arizona 4 6Bahamas 1 1California 2 3Florida 2 3Georgia 1 1Idaho 2 3Illinois 2 3Indiana 2 3Jamaica 1 1Massachusetts 2 3Maryland 2 3Montana 1 1North Carolina 1 1New Mexico 2 3Nevada 1 1Ohio 3 4Oklahoma 1 1Ontario 1 1Pennsylvania 6 9Rio Grande do Sul 1 1Tennessee 3 4Texas 13 19Utah 1 1West Virginia 10 15Total 67 100
Table 4. Military affiliations of survey respondents who served as DPP-GLB coaches.
Military Affiliation Responses %
17
(n)Contractor 8 73Active Duty Air Force 1 9Civilian working for military 1 9Reserve 1 9Active Duty Marine 0 0Active Duty Army 0 0Active Duty Navy 0 0National Guard 0 0Government 0 0Veterans Administration Staff 0 0Other 0 0Total 11 100
Of the survey respondents, 80% have implemented a DPP-GLB program, either currently
or in the past. Approximately 18% of coaches have implemented the program once, 36% have
implemented it two to four times, and 41% have led the program ten times or more. Most of the
implementation settings included a hospital (23%), worksite (16%), community or senior center
(16%), or military primary care clinic (14%) (Table 5).
Table 5. Location of DPP-GLB programs and percent of respondents that reported each location.
Program Location Responses (n) %
Hospital 10 23
18
Worksite 7 16Community or Senior Center 7 16Military Setting – Primary Care Clinic 6 14Other 6 14Out-patient Hospital Clinic 3 7Primary Care Practice 3 7Fitness Center/YMCA 1 2Military Setting – Health and Wellness Center 1 2Military Setting – Endocrinology Practice 0 0Church 0 0School/College/University 0 0Insurance Provider 0 0Total 44 100
In regard to recruitment, the methods deemed most effective included word of mouth,
flyers, and recommendation by physician or other health care provider (Table 6).
Table 6. Marketing/recruitment methods used to recruit participants into DPP-GLB programs.
Marketing Method Responses (n) %
Word of mouth 27 21Flyers 25 20Physician/Health care provider 21 17Newspaper 10 8Email 9 7Newsletter 8 6Health fairs 6 5Direct mailing 6 5Other 6 5Social media (Facebook, Twitter, etc.) 4 3Telephone 3 2Did not market 2 2TV advertisement 0 0Total 127 100
Out of 43 respondents to the question on finances, 35 reported charging a fee to
participants, and 16 reported that over 75% of their programs were funded through grants or
research funds. One coach noted that “Tricare,” the health insurance provided by the U.S.
Military, covers costs, but was otherwise unsure of specifics. Another coach listed “Caresource”
19
as third party reimbursement, but also noted that the participant in question paid $50 to cover
material costs.
Attendance of program sessions varied, but 63% of respondents stated that more than
50% of their participants attended at least half of the core DPP-GLB sessions (Table 7).
Table 7. Average attendance of DPP-GLB participants.
Average Attendance Responses (n) %
Less than 25% 2 525% - 49% 6 1450% - 74% 13 3075% - 100% 14 33Not sure 8 19Total 55 100
Percentages of participants who reached at least 5% weight loss at the six months varied
across groups. Most coaches (30%) were unsure of the percentage, and 26% of coaches reported
that between 10-24% of participants reached this goal (Table 8).
Table 8. Percentage of DPP-GLB participants who reached at least the 5% weight loss goal by six months.
Percent Who Reached Goal Responses (n) %
0% - 9% 3 710% - 24% 11 2625% - 49% 4 950% - 74% 7 1675% - 100% 5 12Not sure 13 30Total 43 100
Coaches provided a variety of reasons for not currently offering the DPP-GLB program
(Table 9). Many indicated that they were unable to recruit or felt a lack of community interest,
as well as having a lack of time, funding, and staffing. The “other” option had the majority of
responses. When asked to specify, most responses involved a form of “Not applicable”
20
(specifically due to starting a program soon, have plans to start in the near future, and currently
implementing the program), as well as needing a refresher or having the program implemented
by a different part of their organization. Similar responses were provided when asked why they
felt it unlikely that they will provide the program in the future, and included a change in job
position, lack of eligible or interested participants, lack of funding, and needing a refresher or
training for new coaches.
Table 9. Reasons that coaches are not currently offering the DPP-GLB program.
Reasons Responses (n) %
Other 14 26Unable to recruit or lack of community interest 8 15Lack of time 6 11Not confident participants would commit to length of program 5 9
Lack of funding 4 8Lack of staffing 4 8Lack of supervisor interest 3 6Feel unprepared 2 4Job responsibilities have changed 2 4Attending DPSC training for other reasons 2 4Lack of meeting space 1 2Using different DPP curriculum 1 2Deployment 1 2Feel program is not needed 0 0Inability to earn RVUs 0 0Total 53 100
When asked about barriers and how they affected the administration and/or effectiveness
of the program, challenges were rated on a scale of 1-3: 1 indicates “Not a barrier,” 2 indicates a
“Minor barrier,” and 3 indicates a “Major barrier.” Averages of these ratings were taken by
weighting the tally of scores in each rating category, and dividing by the total number of ratings
for that question (excluding the “Not applicable” scores). The most common challenges were
21
participant drop-out and participant motivation with mean responses of 2.19 and 2.12,
respectively, which suggests that these items are slightly more than “minor barriers” (Table 10).
The barriers with the next highest ranking of impact were time and inadequate meeting space,
with mean responses of 1.61 and 1.55, which equate to between “Not a barrier” and a “Minor
barrier.” The lowest-ranking barriers and their mean responses were language-related challenges
(1.10), inadequate preparation for program delivery (1.12), and parking or transportation (1.28),
which all equate to either “Not a barrier” or just slightly more than “Not a barrier.”
Table 10. Summary of ranked barriers to program implementation as perceived by DPP-GLB coaches.
Barrier Not a Barrier
Minor Barrier
Major Barrier
Total Responses Mean
Participant drop out 8 18 16 42 2.19Participant motivation 8 21 13 42 2.12Lack of time 19 19 3 41 1.61Inadequate meeting space 23 12 5 40 1.55Lack of funding 26 10 5 41 1.49Inclement weather 22 15 2 39 1.49Lack of organizational support 26 12 4 42 1.48Lack of trained available staff 29 11 1 41 1.32Parking/transportation issues 29 9 1 39 1.28Inadequate preparation for DPP-GLB delivery
36 5 0 41 1.12
Language barriers 36 4 0 40 1.10* Barriers were ranked with the following values: 1=Not a barrier; 2=Minor barrier; 3=Major barrier.
The survey also evaluated the value of DPSC’s training for new DPP-GLB coaches.
When asked to rate how well DPP-GLB training prepared them for implementing the program,
respondents could answer on a scale of Very Well to Very Poor (Table 11). When values of
ratings were weighted by response and averaged, each topic had a mean of less than two points.
This indicates that responses averaged between “Very Well” and “Well” for all topics of the
training. The following question asked for components of training that coaches felt were
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missing. Responses included: wanting to learn more about the behavior component, physical
activity, ethnic diversity, and budgeting. Some felt that role playing and increased opportunity
for discussion or feedback would improve the program.
Table 11. Rating of how well DPP-GLB training prepared coaches for implementing the program.
Question Very Well (n) Well (n) Fair (n) Poor (n) Very
Poor (n) Mean
Implementing in the local setting 21 26 11 0 0 1.83Leading group sessions 20 30 5 0 1 1.79Behavioral component 25 24 8 1 0 1.74Nutrition component 23 29 6 0 0 1.71Physical activity component 26 24 7 0 0 1.67Evidence and rationale for the GLB program 37 19 2 0 0 1.40
* Mean score is calculated by averaging responses based on the following scale: 1=Very Well; 2=Well;
3=Fair; 4=Poor; 5=Very Poor.
The final question of the survey provided space for coaches to write additional
comments, suggestions, or thoughts regarding the program and/or the DPSC. Fifteen coaches
used this space to provide input, and responses often involved how they felt it was a good/great
program that accomplishes its goals. Quotes include “Love the program and am looking forward
to expanding it in our community!” “It is a wonderful program” and “I found the training overall
I attended in Pittsburgh was excellent.” One coach stated interest in the DPSC despite not
knowing what the organization is, and another noted having trouble getting other staff members
(who attended the DPSC training) involved. This posed a problem for that coach due to an
overload of work, tight schedule, and a complication of site funding. A comment was submitted
asking about “update classes” for coaches already providing the DPP-GLB program and another
noted interest in the online program.
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5.0 DISCUSSION
The survey for DPP-GLB coaches was administered over a period of three months with a
total of 92 overall responses and 61 complete and useable responses, after accounting for
duplicate and blank entries. Out of the DPP-GLB current contact list of 1,509 coaches, the total
of 61 responses equates to a response rate of 4.04%, which was lower than the targeted rate.
Commonly noted barriers included participant drop-out, participant motivation, lack of time, and
inadequate meeting space. Frequent program locations included hospitals, worksites, and
military primary care clinics, and methods of recruitment reported as most effective were word
of mouth, flyers, and physician recommendation.
At the present time information regarding implementation barriers for DPP translation is
lacking; however, some literature does exist regarding barriers to delivery of similar health and
wellness programs in the community. For example, one wellness program in Los Angeles
reported difficulty with participant recruitment and retention (Yancey et al., 2006), which is also
reflected in the current DPP-GLB coach survey through the question regarding why coaches are
not currently offering a program. The inability to recruit was among the most frequently selected
answers for this question, along with a lack of confidence that participants would commit to the
program’s length of time. Poor participation, a possible indicator of retention, was similarly
noted in the survey results as a “participant motivation” barrier. The Los Angeles program also
found that poor participation was specifically thought to be an effect of limited resources or
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ability of groups to host programs rather than a lack of interest (Yancey et al., 2006). This,
however, is not mirrored in the DPP-GLB survey results. Lack of funding, organizational
support, meeting space, and trained staff were ranked between 1.32 and 1.61 on the barrier scale,
indicating that they were either slightly more than “Not a barrier” or slightly less than “A minor
barrier.”
Although participant motivation and drop-out were ranked highly on the list of barriers,
attendance seemed to be a strong point for many coaches. Of survey respondents, 63% reported
having more than 50% of their participants attend at least half of the core DPP-GLB sessions.
Only 19% reported not knowing their program’s attendance rates. Participant weight seemed to
be less well-documented, and 30% of coaches were unsure what percentage of their participants
reached the targeted weight loss goal. More than a quarter (23%) reported that 10-24% of
participants reached the goal, and 16% reported that 50-74% reached the goal. The weight loss
results did not reveal an overall pattern, so no trend could be identified.
The DPSC training was generally well received by coaches, some of whom commented
that they “loved” the program and were looking forward to bringing it to their community.
When asked how well the training prepared them for certain aspects of the program, all topics
averaged scores between “Very Well” and “Well.” The topic with the highest ranking
(indicating room for improvement) was implementation in the local setting. In contrast, the topic
with the lowest ranking (indicating that they felt the best prepared in that area) was surrounding
the evidence and rationale for the DPP-GLB program.
In regard to survey implementation, studies have found that electronic surveys provide
higher response rates compared to surveys that are sent through the postal service (Kiernan,
Kiernan, Oyler, & Gilles, 2005). Although the DPP-GLB survey did not have a mailed, paper
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survey to compare response rates, the emailed DPP-GLB survey for coaches was very low (with
61 respondents from a contact list of 1,509 coaches). Due to resource availability, mailed and
face-to-face surveys are not feasible for the DPP-GLB survey’s purposes. Similar to an
Australian university’s study, reminder emails may have increased responses, and the potential
of winning the healthy cookbook raffle may have provided additional incentive to participate in
the survey (Nulty, 2008).
Limitations of the survey largely surround its response rate. Although the Diabetes
Prevention Support Center has a contact list of 1,509 DPP-GLB coaches in its network, only 61
individuals completed the survey. Furthermore, twelve individuals started or completed the
survey two or three times. The overall low response rate indicates the lack of generalizability of
survey data and requires replication to ensure that the population of DPP-GLB coaches is
appropriately represented. Specifically, the limited number of responders from a restricted
number of sectors suggests that the data should be evaluated with caution. A majority of
respondents were from Texas and West Virginia (19 and 15%, respectively), whereas the next
most common state was Pennsylvania with 9% of respondents. Almost a quarter (23%) held
their programs in a hospital location, and 15% of respondents were affiliated with the military in
some capacity. Of those within the military, almost three quarters (73%) were contractors, and a
majority of coaches reported careers of diabetes educators, dietitians/nutritionists, and registered
nurses. If there are differences in barriers faced by each sector, program location, geographic
location, or professional affiliation of coaches, then their responses will reflect these
dissimilarities and will not be representative of the DPP-GLB coach network as a whole. These
associations and potential differences of the small group of respondents limit the data’s
generalizability.
26
Response rate may be affected by multiple factors. Specifically, response bias may have
an effect in that coaches may be more likely to complete the survey if they are currently leading
a DPP-GLB program, have had successful groups in the past, or have a higher interest level in
health care topics. Individuals may be less likely to complete the survey if they took the DPP-
GLB training course or led a group in the distant past, or have since moved careers and are no
longer in a related field. Coaches may or may not be paid to lead the program, which could
provide incentive if they are able to complete the survey while at work. Additionally, the survey
was only offered via email, which excludes coaches who do not have email or access to the
internet.
The survey for DPP-GLB coaches had strengths in that it aimed to capture barriers faced
by DPP-GLB coaches. The survey was originally designed to gather an understanding of the
experiences of DPP-GLB coaches in the community and to determine what challenging aspects
of program implementation might lead to limited success of the program and of the individual
participants. Although a small percentage of the coach network responded to the survey request,
the results provided some insight to what coaches experience in terms of barriers to survey
implementation. The survey also provides feedback about the DPSC training, information which
can be used to improve future training workshops.
The next steps involve determining how to distribute the survey more effectively to
improve the overall response rate. Surveys can be administered in many forms, ranging from
mailed paper copies, telephone calls, in-person interviews, or online surveys. The advancement
of computers, tablets, and smartphones increases the opportunity and ease for survey
implementation due to the ability of the target audience to access the internet from almost any
location as well as the decreased need for personnel and physical paper copies to conduct in-
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person surveys and mailed surveys. The online method was used for the DPP-GLB coaches
survey due to the vast number of trained coaches in the network and resource efficiency.
Although reminder emails were sent to the coaches and an incentive raffle was provided, the
final response rate did not meet the desired value. The exploration of other survey
implementation methods would be determined by the availability of DPSC resources (both time
and tangible resources), although alternative approaches may be unrealistic due to the
widespread geographical locations of the network coaches.
One suggestion to increase survey response rate is to mention the upcoming survey at the
annual DPSC two-day training workshops, or to provide the link at each workshop and allow the
survey to be continuous instead of only open for a short time. Additionally, more reminder
emails at closer time intervals may help increase the response rate. Although hard copy methods
may be becoming outdated, there may be coaches who do not regularly check email and thus
may have been missed during the time the survey was available. This may prompt consideration
of the option of sending hard copies to coaches, resources permitting.
Results of this year’s survey will be given to the Diabetes Prevention Support Center, to
be used as they see fit. The survey may be continued in the future to gather information about
the barriers faced by DPP-GLB coaches and improvement of the annual training. This will
enable the DPSC to maintain up-to-date records of current DPP-GLB programs as well as
contact information for the active coaches. Access to this information will enable the DPSC to
improve upon future DPP-GLB coach trainings and increase support and resources to overcome
program implementation barriers. Enhancing coaches’ abilities to successfully carry out the
programs needs to be priority to benefit future program participants and reduce the public health
burden of both obesity and diabetes.
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Appendix A– SURVEY QUESTIONS
Group Lifestyle Balance Coaches
Q1 Please provide your name, current address, e-mail, and phone number below so that the Diabetes Prevention Support Center (DPSC) has the most up-to-date information on file. Your information will not be shared or used for other purposes. NOTE: If you would prefer to complete the evaluation anonymously, please enter "none" in the text boxes where appropriate.
NameCompanyAddress 1Address 2City/TownState/ProvinceZIP/Postal CodeCountryEmail AddressPhone Number
Q2 Is the contact information provided for home or work? Home Work Do not wish to provide contact information
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Q3 Please indicate your professional affiliation (check all that apply). Certified Diabetes Educator/Diabetes Educator Exercise Specialist Health and Wellness Center (HAWC) Staff Health Educator Medical Technician Nurse Practitioner PhD, DrPH Physical Therapist/Occupational Therapist Physician Physician Assistant Psychologist Registered Dietitian/Nutritionist Registered Nurse Researcher Social Worker Student Other (please specify) ____________________
Q4 Are you currently affiliated with the military? Yes No
Answer If Are you currently affiliated with the military? Yes Is SelectedQ5 What is your military affiliation? Active Duty Air Force Active Duty Army Active Duty Marine Active Duty Navy Civilian working for military Contractor Government National Guard Reserve Veterans Administration Staff Other (please specify) ____________________
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Q53 Did you complete Diabetes Prevention Program (DPP) Group Lifestyle Balance (GLB) training between 2012 and 2015? Yes NoIf No Is Selected, Then Skip To Since attending the GLB training work...
Q6 How well do you feel the Group Lifestyle Balance (DPP-GLB) training workshop prepared you for implementation of the DPP-GLB program in each of the following categories?
Very Well Well Fair Poor Very Poor
Evidence and rationale for the GLB program
Nutrition Component
Physical Activity Component
Behavioral Component
Leading Group Sessions
Implementing in the Local Setting
Q7 Considering the DPP-GLB training that you received, please describe any components that were lacking or could have been improved upon:
Q8 Please provide your primary reason(s) for attending the DPP-GLB training workshop (check all that apply). Leadership identified need for diabetes prevention or weight loss program Planning to implement the DPP-GLB program at my site Personal interest in topic Obtainment of continuing education or school credit Involved in research project using DPP-GLB program Other (please specify) ____________________
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Q9 To date, have you implemented the DPP-GLB program in any capacity (either currently or in the past)? Yes NoIf No Is Selected, Then Skip To Please provide the reason(s) below th...
Q10 When did you begin providing the DPP-GLB program? (If you are not sure, please approximate.)
Date (MM/DD/YYYY)
Q11 When did you conclude your most recent DPP-GLB program? Within the past 3 months 3-6 months ago 6-9 months ago 9-12 months ago 1-2 years ago Over 2 years ago
Q12 Please indicate the settings in which you have implemented the DPP-GLB program (check all that apply). Church Community or Senior Center Fitness Center/YMCA Hospital Insurance Provider Military Setting - Endocrinology Practice Military Setting - Health and Wellness Center (HAWC) Military Setting - Primary Care Clinic Out-patient Hospital Clinic Primary Care Practice School/College/University Worksite Other (please specify) ____________________
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Q13 Which of the following marketing methods have you found to be most effective in recruiting participants (check all that apply). Did not market DPP-GLB program Direct mailing E-mail Flyers Health fairs Newsletter Newspaper Social media (Facebook, Twitter, etc.) Telephone Through physician/health care provider TV advertisement Word of mouth Other (please specify) ____________________
Q15 What general eligibility criteria is used for participant enrollment in the DPP-GLB program? BMI > 25 kg/m2 and pre-diabetes BMI > 25 kg/m2 and the metabolic syndrome BMI > 25 kg/m2, pre-diabetes, and/or the metabolic syndrome BMI > 25 kg/m2 and other risk factors (not specifically pre-diabetes and/or the metabolic
syndrome) BMI > 25 kg/m2 only BMI > 25 kg/m2 and large waist measurement Large waist measurement only Other (please specify) ____________________ None
Q16 Please describe the mode you have utilized for delivery of the DPP-GLB Program (check all that apply). One year, DPP-GLB curriculum delivered via face-to-face group meetings One year, DPP-GLB curriculum delivered via DVD with coach support One year, DPP-GLB curriculum delivered via face to face group meetings and/or DVD 12 session core only delivered via face to face group meetings 12 session core only delivered via DVD with coach support 12 session core only delivered via face to face group meetings and/or DVD Other (please specify) ____________________
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Q17 Have you made any modifications to the DPP-GLB program? Yes (if yes, please describe) ____________________ No
Q18 Since the time that you began providing the DPP-GLB program, how many times have you personally delivered the program (either individually or team-taught, including programs that you are currently providing)? 1 time 2-4 times 5-9 times 10 or more times Not sure
Q19 If you are part of a group DPP-GLB delivery system, i.e., hospital health insurer, etc., approximately how many times has the program been delivered within a system? I am not part of a group delivery system 1-5 6-20 21-50 51-100 100+ Not sure
Q20 What is the TOTAL number of participants who have taken part in your DPP-GLB program(s)? 1-10 11-20 21-50 51-100 100+ Not sure
Q21 On average, what percentage of participants attend at least half of the core DPP-GLB sessions? Less than 25% 25% - 49% 50% - 74% 75% - 100% Not sure
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Q22 Other than weight and physical activity, which are collected at each DPP-GLB session, please indicate the clinical outcome measures that are/were collected for GLB participants (check all that apply). Fasting glucose Fasting lipid profile HbA1c Height Waist circumference Other (please specify) ____________________
Q23 Please indicate at what time points these measures are/were collected (check all that apply). Baseline 3 months 6 months 9 months 12 months Other (please specify) Do not collect any additional measures.
Q24 Please indicate what type of database you maintain (if none, please indicate).
Q25 Please rate the following barriers as to how much they affected the administration and/or effectiveness of your program:
Not a barrier Minor barrier Major barrier N/A
Inadequate preparation for DPP-
GLB delivery
Lack of organizational support
Participant drop out
Lack of time
Inclement weather
Language barriers
Lack of trained available staff
Lack of funding
Inadequate meeting space
Parking/transportation
35
issues
Participant motivation
Q26 Please indicate any significant barriers to implementation that were not included above:
Q27 In general, what percentage of your participants reach at LEAST a 5% weight loss at 6 months? 0% - 9% 10% - 24% 25% - 49% 50% - 74% 75% - 100% Not sure
Q28 Have you utilized the DPP-GLB DVD (Initial 12 Session Core)? Yes No
Answer If Have you utilized the GLB DVD (12 Session Core)? Yes Is SelectedQ29 How have you utilized the DPP-GLB DVD? (Check all that apply.) DPP-GLB DVD is utilized for make-up sessions. Participants attend group sessions to watch the DVD Participants complete each session individually Participants complete some of the sessions individually and some of the sessions in a group
meeting Other (please specify) ____________________
Q33 What percentage of the DPP-GLB programs that you have provided were funded through grant and/or research funds? 0% 1% - 25% 26% - 50% 51% - 75% 76% - 100% Not sure
36
Q34 Please indicate a response regarding charging a fee for the program: A fee is charged to take part in the DPP-GLB program (please specify amount).
____________________ No fee is charged for the program.
Answer If Please indicate a response regarding charging a fee for the program: No fee is charged for the program Is SelectedQ35 Since you do NOT charge a fee for this program, how are the costs of the DPP-GLB program covered? (If not sure, please enter "not sure" in the box.)
Q36 Have you been able to obtain third-party/insurance reimbursement for DPP-GLB program delivery? Yes No
Answer If Have you been able to obtain third-party reimbursement for GLB program delivery? Yes Is SelectedQ37 Please describe the third party reimbursement you have received:
Q38 The DPSC is interested in keeping our list of current DPP-GLB programs up to date. Please respond regarding current programs being offered: I am currently offering the DPP-GLB program. I am not currently offering the DPP-GLB program.If I am currently offering the... Is Selected, Then Skip To Is your program and contact informati...
Q40 Is your program and contact information the same as what you entered at the beginning of the survey? Yes No
37
Q39 Please provide the reason(s) below that you have not or are not currently offering the DPP-GLB program: (Check all that apply.) Attended the training workshop for reasons other than DPP-GLB program implementation Deployment Feel program is not needed Feel unprepared for DPP-GLB implementation Inability to earn RVUs Lack of funding for program Lack of interest from supervisor Lack of meeting space Lack of staffing Lack of time My job responsibilities have changed such that I am not able to provide the program Not confident participants would commit to the length of the program Unable to recruit participants or lack of community interest Using a different DPP curriculum Other (please specify) ____________________If Attended the training works... Is Selected, Then Skip To How likely is it that you will provid...If Deployment Is Selected, Then Skip To How likely is it that you will provid...If Feel program is not needed Is Selected, Then Skip To How likely is it that you will provid...If Feel unprepared for GLB imp... Is Selected, Then Skip To How likely is it that you will provid...If Inability to earn RVUs Is Selected, Then Skip To How likely is it that you will provid...If Lack of funding for program Is Selected, Then Skip To How likely is it that you will provid...If Lack of interest from super... Is Selected, Then Skip To How likely is it that you will provid...If Lack of meeting space Is Selected, Then Skip To How likely is it that you will provid...If Lack of staffing Is Selected, Then Skip To How likely is it that you will provid...If Lack of time Is Selected, Then Skip To How likely is it that you will provid...If My job responsibilities hav... Is Selected, Then Skip To How likely is it that you will provid...If Not confident participants ... Is Selected, Then Skip To How likely is it that you will provid...If Unable to recruit participants Is Selected, Then Skip To How likely is it that you will provid...If Using a different DPP curri... Is Selected, Then Skip To How likely is it that you will provid...If Other (please specify) Is Selected, Then Skip To How likely is it that you will provid...If Other (please specify) Is Not Empty, Then Skip To How likely is it that you will provid...
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Q41 Please enter your Group Lifestyle Balance Program location and contact information.NameCompanyAddress 1Address 2City/TownState/ProvinceZIP/Postal CodeCountryEmail addressPhone number
Q42 Please enter the name of a contact person for your DPP-GLB program.
Q43 Would you like your DPP-GLB program and contact information listed on the DPSC website? Yes No
Q44 How likely is it that you will provide the DPP-GLB program within the next year? Very Likely Likely Unlikely Very UnlikelyIf Likely Is Selected, Then Skip To The DPSC website includes a password ...If Very Likely Is Selected, Then Skip To The DPSC website includes a password ...
Q45 Please indicate the primary reason you feel it is unlikely that you will provide the DPP-GLB program in the upcoming year: Administration is not interested/supportive Feel the DPP-GLB program is too labor intensive I am not interested in providing the program I will be deploying Lack of eligible/interested participants Lack of funding Lack of space to hold program My job position has changed Previous attempt at GLB implementation was not successful Other (please specify) ____________________
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Q46 The DPSC website includes a password protected Health Professionals Portal that is available only to those who have completed DPP-GLB training, and contains support materials for program implementation. Please provide your response below regarding the DPSC website Health Professionals Portal. I have not accessed the DPSC website Health Professionals Portal. I have not accessed the DPSC website Health Professionals Portal because I need a
username and password. I have accessed the DPSC website Health Professionals Portal and found it to be useful. I have accessed the DPSC website Health Professionals Portal and found it was NOT useful.
Q47 The DPSC is committed to meeting your DPP-GLB program implementation needs. Please let us know of any additional ways that we might be of assistance to you or what resources would be of value.
Q48 The Centers for Disease Control and Prevention Diabetes Prevention Recognition Program (CDC-DPRP) has been developed to recognize organizations that have shown their ability to effectively deliver a lifestyle change intervention program (lifestyle intervention) to prevent type 2 diabetes.Do you plan to apply or have you already applied to the CDC-DPRP using the DPP-GLB program curriculum? Yes. If yes, please provide the date (or planned date) of application for DPRP
(MM/DD/YYYY). ____________________ NoIf Yes. If yes, please provid... Is Selected, Then Skip To Would you and/or your organization ha...
Q49 Please indicate the reason(s) you do not plan to apply for CDC-DPRP using the DPP-GLB curriculum: (Check all that apply.) Do not feel DPRP is important to our organization Do not intend to provide the DPP-GLB program Do not understand DPRP instructions Have applied to the DPRP using a curriculum other than DPP-GLB Plan to apply to DPRP at some point in the future but not sure when Process for application to the DPRP is too complicated Was not aware of the DPRP Other (please specify) ____________________
Q50 Would you and/or your organization have interest in an online DPP-GLB program for your participants? Yes No Maybe
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Q52 Please add any additional comments, suggestions or thoughts regarding the DPP-GLB program and/or the DPSC.
41
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