Objective: History of stroke increases risk for diabetes, which is of great concern for stroke survivors. The Diabetes Prevention Program (DPP) is an effective lifestyle modification intervention for ameliorating diabetes and cardiovascular risk factors. Participation in the DPP for stroke survivors could be challenging, however, due to stroke-related impairments. The purpose of this study was to determine appropriate adaptations to the DPP for stroke survivors.
Design and Methods: Qualitative description using focus groups. Fifteen community-dwelling stroke survivors and 10 caregivers participated. Focus groups were recorded and transcribed. Inductive content analysis was used to identify key themes to inform appropriate DPP adaptations.
Results: Three themes were identified. First, several stroke-specific impairments were identified that could influence DPP participation: hand and arm impairment, mobility impairment, impaired memory and attention, changes in taste and vision, and depression. Second, facilitators of existing group-based DPP models were identified and included small group discussion for peer support and physical activity and nutrition-related content repeated across sessions for reinforcement and repetition. Third, adaptations were suggested that included caregiver participation for the provision of physical and cognitive assistance; a need for stroke-specific physical activity and nutrition-related recommendations such as adapted gym and cooking equipment; and modified session content, including shorter, simplified session handouts and addition of online content to complement session handouts.
Conclusion: Current DPP content and structure are insufficient to meet the unique needs of stroke survivors. The suggested adaptations should be incorporated into a stroke-specific curriculum and tested for efficacy and eventual implementation into community-based programs to promote lifestyle modification and diabetes risk reduction among stroke survivors.
R.R. Bailey: None. J.L. Stevenson: None. N.H. Serrano: None.
National Institutes of Health (P30DK092950, 5T32HL130357)