National Health Outreach and Engagement Conference 2024

Christina Holmes, Kansas State University, K-State Research and Extension
Elaine Johannes, Kansas State University, K-State Research and Extension

The National Diabetes Prevention Program (NDPP) lifestyle change program has been effective at preventing type 2 diabetes across the U.S. however there is a significant inequity of available programs in rural compared to urban communities due to the limited healthcare infrastructure. The Cooperative Extension System (Extension) employs local Extension professionals such as Extension Health, Community Health and  Family and Consumer Science (FCS) agents/educators delivering health promoting programs within the community and can improve the reach and accessibility of the NDPP to rural populations. After a  2019 publication regarding the lack of National DPP availability in rural areas, researchers at the University of Kansas Medical Center (KUMC) contacted colleagues at Kansas State University about partnering with K-State Research and Extension (KSRE) to address this disparity in rural Kansas. A pilot study was conducted to assess the feasibility and effectiveness of the NDPP delivered through KSRE. This feasibility study, where participants were randomized to a Zoom® group where programming was delivered by a local Extension agent/educator, or by our research staff using Facebook®, had a duration of six months and included 31 participants (Zoom = 16, Facebook = 15). Subsequently, focus groups, one for the Zoom group and another for the Facebook group, were conducted to gather participant feedback of their experience with the program. Results of these interviews highlighted opportunities to further involve health clinics in participant recruitment and health promotion, as well as participant desire for additional materials on how to eat healthier. Participants noted a preference for Zoom rather than the asynchronous delivery, highlighting the social connections that the Zoom platform allows. We additionally conducted structured interviews with KSRE Extension agents/educators to assess factors influencing health promotion program implementation success and areas for improvement. These interviews sought to further investigate agent/educator capacity to deliver a program such as the NDPP and identify the factors that can help or hinder the delivery of such programs.
Agents/educators noted recruitment barriers such as program relevance and timing while recruitment facilitators included providing incentives and leveraging community partners. These community partners were found to be critical for the successful implementation of programming, including recruitment and delivery. Program location and incentives were key facilitators while language barriers, accessibility concerns in the physical space where programming was delivered, and difficulties in recruiting and retaining adequate participants were noted as limitations.
During this time, the Cooperative Extension NDPP Working Group has provided substantial support to this collaboration. The Working Group aims to reduce the prevalence of diabetes by strengthening Extension’s capacity to deliver the NDPP and increase the number of Extension services recognized as NDPP providers. This group is composed of over 15 recognized NDPP providers across the U.S. and provides technical assistance for Extension services to deliver the NDPP. Extension is a viable model for delivering the NDPP in rural areas where healthcare resources are limited. Future work should assess policy implications of reimbursement for Extension implementing the NDPP.