# Engagement in the National Diabetes Prevention Program Among Hispanic Men

## TL;DR

This study explores why Hispanic men have low engagement in a diabetes prevention program and identifies key barriers like lack of awareness and financial issues.

## Contribution

The study provides new insights into the unique barriers faced by Hispanic men in engaging with the National Diabetes Prevention Program.

## Key findings

- Limited awareness of prediabetes diagnosis and skepticism about diabetes risk were major barriers for low engagement.
- Financial barriers and restricted program access also contributed to low participation among Hispanic men.
- Improving engagement may require addressing knowledge gaps and perceptions of program relevance.

## Abstract

This qualitative study evaluated reasons for Hispanic men’s low engagement in the National Diabetes Prevention Program (NDPP) compared with those with high engagement.

What factors in the National Diabetes Prevention Program (NDPP) are associated with in low engagement among Hispanic men?

The qualitative study of 32 men revealed 3 major themes and 11 subthemes aligning with the major components of behavioral change and theoretical domains framework. Barriers discussed included limited prediabetes diagnosis awareness, lifestyle change self-sufficiency, skepticism around diabetes risk, and the NDPP’s benefits outweighing its risks, financial barriers, and limited program access.

These findings suggest improving engagement among Hispanic men in the NDPP may require addressing perceptions about program relevance, financial limitations, and gaps in knowledge around diabetes prevention before, during, and after enrollment.

Hispanic men experience higher rates of diabetes compared with non-Hispanic White men but remain underrepresented in preventive lifestyle interventions.

To identify unique reasons for Hispanic men’s low engagement in the National Diabetes Prevention Program (NDPP) compared with those with high engagement to inform strategies for improving participation.

This qualitative study recruited Hispanic men aged 18 years and older and at risk for diabetes per electronic medical records from June 2023 to February 2024 from primary care sites affiliated with hospital-associated Montefiore Health Systems related to an ongoing clinical trial called Power Up. Patients were invited to participate in one-time phone interviews. Interviews were analyzed deductively, guided by behavior change frameworks.

Participant’s level of engagement varied with representation balanced between those demonstrating low and high engagement in the NDPP (attendance at <4 and ≥4 sessions, respectively).

Planned study outcomes included NDPP notable factors associated with low engagement.

Of 32 Hispanic men who completed interviews (20 patients [62.5%]aged >50 years), 15 had low engagement in the NDPP, 13 (87%) were not born in the US, 12 (80%) had limited English proficiency, and 8 (53%) did not complete high school. Three major themes and 11 subthemes emerged. Hispanic men with low engagement discussed limited awareness of their prediabetes diagnosis, lifestyle change self-sufficiency, and skepticism about their diabetes risk and the benefits of NDPP. Also mentioned were financial barriers, restricted access to the program, and the perceived negatives of participation outweighing potential benefits.

Addressing the unique barriers faced by Hispanic men in engaging with the NDPP is critical to reducing diabetes-related inequities and may require tackling knowledge gaps, financial barriers, and perceptions of program relevance before, during, and after enrollment. Future research should explore how to tailor recruitment strategies and program content to Hispanic men’s specific identities, motivations, and challenges.