Background: Lifestyle change programs based on the National Diabetes Prevention Program (DPP) are associated with clinically significant weight loss and decreases in cardiometabolic risk factors. However, these benefits depend on successful implementation in the real world. Studies have examined implementation in community settings, but less is known about integration in healthcare systems. We examined the barriers and facilitators to successful DPP implementation in a large multi-site healthcare system.

Methods: Using purposive sampling, we conducted semi-structured interviews with past and present DPP lifestyle coaches in the healthcare system. Qualitative data were analyzed using deductive and inductive techniques to identify themes, which were organized into a conceptual framework using an iterative consensus process.

Results: We conducted 33 interviews across 19 clinics serving 10 counties. Six interrelated themes and subthemes were identified: 1) Broader context, including the surrounding physical and demographic context; 2) Institutional setting, including finances, infrastructure, and personnel; 3) Program characteristics, including curriculum, administration, cost, goals, and visibility; 4) Participant recruitment, including screening and referrals; 5) Lifestyle coaches’ role, including their characteristics, behaviors, and morale; and 6) Participants’ characteristics, including attention, retention and group dynamics. Each theme and subtheme describes a key factor that served as a barrier and/or facilitator in the implementation process depending on the site-specific context and on each lifestyle coach’s approach to implementation.

Conclusion: The study highlights the complexities associated with implementing a group-based DPP in a large healthcare system and emphasizes the key role of lifestyle coaches in overcoming site-specific barriers to implementation and adapting the program to the local context.


M. Halley: None. C. Nasrallah: None. N.K. Szwerinski: None. J.P. Petersen: None. R.J. Romanelli: None. K. Azar: None.


National Institute of Diabetes and Digestive and Kidney Diseases

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