# Assessing the Fit of a Digitally Delivered National Diabetes Prevention Program Among Rural Living Adults: Qualitative Study

## TL;DR

This study explores how well a digital diabetes prevention program works for rural adults, finding that digital delivery improves access but faces challenges like internet issues.

## Contribution

The study identifies contextual factors affecting the fit of a digital diabetes prevention program in rural communities.

## Key findings

- Digital platforms like Zoom and Facebook improved access to the diabetes prevention program for rural adults.
- Internet connectivity issues negatively impacted both Zoom and Facebook delivery formats.
- Zoom facilitated greater social engagement and accountability compared to Facebook.

## Abstract

Rural living adults are disproportionately affected by type 2 diabetes compared to their urban counterparts. The Centers for Disease Control and Prevention’s National Diabetes Prevention Program (National DPP) is an evidence-based intervention that reduces the risk of type 2 diabetes through increased physical activity and modest weight loss, but overall reach remains limited, specifically in rural communities.

This qualitative study aimed to examine the fit of the National DPP delivered digitally using Zoom or Facebook to rural living adults at risk for type 2 diabetes.

Focus group scripts assessed the characteristics and perceptions of rural adults at risk for type 2 diabetes, infrastructure supports for implementation and sustainability, and external factors that could influence program fit. A reflexive thematic analysis was conducted separately on coded transcripts for each focus group. Themes were then deductively linked to the Practical, Robust Implementation and Sustainability Model domains.

Two focus groups were conducted with 14 participants after participating in the National DPP for 6 months, delivered through Zoom (n=9) or Facebook (n=5). Participants highlighted positive relationships between Practical, Robust Implementation and Sustainability Model constructs related to participant characteristics (ie, value of health improvements, weight loss, and reduced medication dependence as primary motivators) and perceptions of compatibility (ie, content alignment with participant needs) as well as infrastructure (ie, digital platforms provided better access) with program success in reach and engagement. Conversely, both formats were negatively impacted by interruptions in internet connectivity. External factors, such as referral pathways from local health care providers, could improve program reach. When considering differences between implementation infrastructure, Zoom facilitated greater social engagement and accountability compared to Facebook.

This study identified contextual factors influencing the fit of digitally delivering the National DPP to rural living adults, including opportunities for using existing connections and health motivations to help improve acceptability, while tailoring curriculum, modality, and technology may improve appropriateness for rural populations.

ClinicalTrials.gov NCT05387434; https://clinicaltrials.gov/study/NCT05387434