Why Do People Choose to Enroll or Not Enroll in the National Diabetes Prevention Program Lifestyle Change Program? A Mixed-Methods Analysis From a Sample of Adults With a Prediabetes Diagnosis

Abstract

Introduction: The Diabetes Prevention Program (DPP) is effective; enrollment is low. Little research has examined factors driving individuals’ enrollment decisions. Methods: In our final survey of a randomized trial comparing methods to increase enrollment in the DPP, we asked participants about factors impacting enrollment. We conducted interviews with a subgroup. Results: Participants who completed the survey (n = 299) were primarily female (96 male); middle-aged (mean 52.9, SD = 14.7); white (86%); non-Hispanic (85%). Only 19% reported awareness of the DPP prior to the study. Cost, online availability, and behavior-change motivation were the most highly rated factors influencing enrollment. The median amount participants were willing to pay for the program was $66.50. Phone interviews included 17 individuals who were/were not interested in receiving a referral to the DPP. Those interested described risk awareness, family history, social support, and healthcare-provider influence as facilitating enrollment. Cost, time, travel, unsupportive family, incomplete knowledge about the program’s impact and low self-efficacy were barriers. Among those uninterested, some were already engaging in lifestyle change, and some didn’t see a benefit. Conclusions: Results suggest that, even among high-risk individuals, efforts to increase awareness and benefits of the DPP are needed, as are efforts to address cost of enrollment and low motivation. Trial Registration: ClinicalTrials.gov protocol ID: 00132307. The Effect of 360 Video and MAPS on Enrollment in the DPP. URL: https://www.clinicaltrials.gov/study/NCT04746781?id=00132307&rank=1 .