--- title: "Barriers, facilitators-Diabetes Prev Program implementation. | Sutter Health" description: "Key factors that could serve as barriers or facilitators in the implementation of DPP in large healthcare systems, from the perspective of lifestyle coaches." url: "https://www.sutterhealth.org/research/publications/barriers-facilitators-diabetes-prev-program-implementation-1055312731" --- 1. [Home](https://www.sutterhealth.org/) / 2. [Research](https://www.sutterhealth.org/research) / 3. [Research publications](https://www.sutterhealth.org/research/publications) / 4. Barriers, facilitators-Diabetes Prev Program implementation. # Barriers and facilitators to real-world implementation of the Diabetes Prevention Program in large healthcare systems: lifestyle coach perspectives. Halley MC, Petersen J, Nasrallah C, Szwerinski N, Romanelli R, & Azar KMJ. _J Gen Intern Med. doi: 10.1007/s11606-020-05744-y. \[Epub ahead of print\]_ 2020-04-06 ## Abstract BACKGROUND: Group-based lifestyle change programs based on the Diabetes Prevention Program (DPP) are associated with clinically significant weight loss and decreases in cardiometabolic risk factors. However, these benefits depend on successful real-world implementation. Studies have examined implementation in community settings, but less is known about integration in healthcare systems, and particularly in large, multi-site systems with the potential for extended reach. OBJECTIVE: To examine the barriers and facilitators to successful DPP implementation in a large multi-site healthcare system. DESIGN: Semi-structured interviews, based on the RE-AIM framework, were conducted in person for 30-90 min each. PARTICIPANTS: Past and present DPP lifestyle coaches in the healthcare system identified using purposive sampling. APPROACH: Thematic analysis of qualitative data to identify key factors influencing the success of DPP implementation. An iterative consensus process was used to model the relationships among factors. KEY RESULTS: We conducted 33 interviews across 20 clinic sites serving 12 counties. Participants described six key factors as potential barriers or facilitators to implementation, including (1) Broader Context, including the surrounding physical and sociodemographic context; (2) Institutional Context, including finances, infrastructure, and personnel; (3) Program Provision, including curriculum, administration, cost, goals, and visibility; (4) Recruitment Process, including screening and referrals; (5) Lifestyle Coaches, including their characteristics, behaviors, and morale; and (6) Cohort, including group attrition/retention and interpersonal dynamics. These factors were both highly interconnected in their impact on implementation and widely variable across sites within the healthcare system, as illustrated in our multi-level conceptual framework. CONCLUSIONS: This study identified key factors that could serve as barriers or facilitators in the implementation of DPP in large healthcare systems, from the perspective of lifestyle coaches. With further examination, the conceptual model presented here may be used for planning and managing the implementation of group-based behavioral interventions in these settings. [PubMed abstract](https://www.ncbi.nlm.nih.gov/pubmed/32291720) ![Kristen M J Azar, RN, MSN, MPH](https://dyn.mktgcdn.com/p/rFmyR1kiX8JzE5-XNwup0gVC1GRaVTlH7oSDlG0Tr5A/fit=crop,gravity=auto,dpr=2,width=188,height=250,quality=100) Kristen M J Azar, RN, MSN, MPH Principal investigator [View profile](https://www.sutterhealth.org/research/investigators/kristen-m-j-azar-rn-msn-mph-1049680985) ## Research topics - [Diabetes, Insulin Resistance and Metabolic Syndrome](https://www.sutterhealth.org/research-search-results?query=%22%5C%22Diabetes%2C+Insulin+Resistance+and+Metabolic+Syndrome%5C%22%22) - [Disease Management](https://www.sutterhealth.org/research-search-results?query=%22%5C%22Disease+Management%5C%22%22) - [Food and Nutrition](https://www.sutterhealth.org/research-search-results?query=%22%5C%22Food+and+Nutrition%5C%22%22) - [Health Services](https://www.sutterhealth.org/research-search-results?query=%22%5C%22Health+Services%5C%22%22) - [Obesity](https://www.sutterhealth.org/research-search-results?query=%22%5C%22Obesity%5C%22%22) ## Related publications [View all publications](https://www.sutterhealth.org/research-search-results?verticalKey=research_publication) - Publication ### [Translating an evidence-based lifestyle intervention program into primary care: lessons learned.](https://www.sutterhealth.org/research/publications/translate-lifestyle-program-in-primary-care-1055312592) Blonstein AC, Yank V, Stafford RS, Wilson SR, Rosas LG, Ma J. Health Promot Pract. 14(4):491-7. doi: 10.1177/1524839913481604. Epub 2013 Mar 28. 2013 Jul 01 - Publication ### [Behavioral lifestyle interventions for moderate and severe obesity: a systematic review.](https://www.sutterhealth.org/research/publications/beh-lifestyle-interventions-mod-severe-obesity-1055312350) Lv N, Azar KMJ, Rosas LG, Wulfovich S, Xiao L, Ma J. Prev Med. pii: S0091-7435(17)30142-1. doi: 10.1016/j.ypmed.2017.04.022. \[Epub ahead of print\] 2017 Apr 24 - Publication ### [HOMBRE: A randomized controlled trial to compare two approaches to weight loss for overweight and obese Latino men (men with choices to improve well-being and decrease chronic disease risk).](https://www.sutterhealth.org/research/publications/hombre-rct-weight-loss-approaches-latino-men-1055312293) Rosas LG, Lv N, Azar KMJ, Xiao L, Hooker SP, Lewis MA, Zavella P, Venditti EM, Ma J. Contemp Clin Trials. pii: S1551-7144(17)30629-8. doi: 10.1016/j.cct.2018.02.019. \[Epub ahead of print\] 2018 Mar 02 - Publication ### [Virtual small groups for weight management: an innovative delivery mechanism for evidence-based lifestyle interventions among obese men.](https://www.sutterhealth.org/research/publications/virtual-small-groups-weight-mgmt-in-obese-men-1055312966) Azar KM, Aurora M, Wang EJ, Muzaffar A, Pressman A, Palaniappan LP. Transl Behav Med. 5(1):37-44. doi: 10.1007/s13142-014-0296-6. 2015 Mar 01 - Publication ### [A Latino Patient-Centered, Evidence-Based Approach to Diabetes Prevention.](https://www.sutterhealth.org/research/publications/latino-pt-centered-evidence-based-approach-to-dm-prevention-1055312326) Rosas LG, Lv N, Lewis MA, Venditti EM, Zavella P, Luna V, Ma J. J Am Board Fam Med. 31(3):364-374. doi: 10.3122/jabfm.2018.03.170280. 2018 May 01 [View all publications](https://www.sutterhealth.org/research-search-results?verticalKey=research_publication) ```json {"@context":"https://schema.org","@type":"MedicalOrganization","name":"Sutter Health","@id":"https://www.sutterhealth.org/#medicalorganization","url":"https://www.sutterhealth.org","logo":"https://www.sutterhealth.org/static/images/sutter-health-logo.svg","address":{"@type":"PostalAddress","streetAddress":"2200 River Plaza Drive","addressLocality":"Sacramento","addressRegion":"CA","postalCode":"95833","addressCountry":"US"},"areaServed":{"@type":"AdministrativeArea","name":"California"},"sameAs":["https://www.facebook.com/SutterHealth","https://www.instagram.com/sutterhealth/","https://x.com/SutterHealth","https://www.youtube.com/sutterhealth","https://www.linkedin.com/company/sutter-health","https://en.wikipedia.org/wiki/Sutter_Health"]} ``` ```json {"@context":"https://schema.org","@type":"BreadcrumbList","@id":"https://www.sutterhealth.org/research/publications/barriers-facilitators-diabetes-prev-program-implementation-1055312731#breadcrumblist","itemListElement":[{"@type":"ListItem","position":1,"name":"Home","item":"https://www.sutterhealth.org/"},{"@type":"ListItem","position":2,"name":"Research","item":"https://www.sutterhealth.org/research"},{"@type":"ListItem","position":3,"name":"Research publications","item":"https://www.sutterhealth.org/research/publications"},{"@type":"ListItem","position":4,"name":"Barriers, facilitators-Diabetes Prev Program implementation."}]} ``` ```json {"@context":"https://schema.org","@type":"MedicalScholarlyArticle","@id":"https://www.sutterhealth.org/research/publications/barriers-facilitators-diabetes-prev-program-implementation-1055312731#medicalscholarlyarticle","name":"Barriers and facilitators to real-world implementation of the Diabetes Prevention Program in large healthcare systems: lifestyle coach perspectives.","headline":"Barriers, facilitators-Diabetes Prev Program implementation.","abstract":"BACKGROUND: Group-based lifestyle change programs based on the Diabetes Prevention Program (DPP) are associated with clinically significant weight loss and decreases in cardiometabolic risk factors. However, these benefits depend on successful real-world implementation. Studies have examined implementation in community settings, but less is known about integration in healthcare systems, and particularly in large, multi-site systems with the potential for extended reach. OBJECTIVE: To examine the barriers and facilitators to successful DPP implementation in a large multi-site healthcare system. DESIGN: Semi-structured interviews, based on the RE-AIM framework, were conducted in person for 30-90 min each. PARTICIPANTS: Past and present DPP lifestyle coaches in the healthcare system identified using purposive sampling. APPROACH: Thematic analysis of qualitative data to identify key factors influencing the success of DPP implementation. An iterative consensus process was used to model the relationships among factors. KEY RESULTS: We conducted 33 interviews across 20 clinic sites serving 12 counties. Participants described six key factors as potential barriers or facilitators to implementation, including (1) Broader Context, including the surrounding physical and sociodemographic context; (2) Institutional Context, including finances, infrastructure, and personnel; (3) Program Provision, including curriculum, administration, cost, goals, and visibility; (4) Recruitment Process, including screening and referrals; (5) Lifestyle Coaches, including their characteristics, behaviors, and morale; and (6) Cohort, including group attrition/retention and interpersonal dynamics. These factors were both highly interconnected in their impact on implementation and widely variable across sites within the healthcare system, as illustrated in our multi-level conceptual framework. CONCLUSIONS: This study identified key factors that could serve as barriers or facilitators in the implementation of DPP in large healthcare systems, from the perspective of lifestyle coaches. 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