Tailoring Diabetes Prevention Messages for Health Care Providers and Business Professionals

Background:  In 2010, the Centers for Disease Control and Prevention (CDC) began rolling out the National Diabetes Prevention Program (National DPP), a partnership to bring evidence-based structured lifestyle change interventions to communities. The lifestyle change intervention was developed to help prevent or delay type 2 diabetes for people with prediabetes (higher than normal blood sugar, but not high enough to have type 2). An estimated 79 million Americans have prediabetes, and are 5-15 times more likely to develop type 2 diabetes in their lifetime. Weight loss of 5 to 7 percent, achieved by reducing calories and increasing physical activity, reduces the risk of type 2 diabetes by 58% in people with prediabetes.

Program background:  A major goal of the National DPP is to enroll people at risk for type 2 diabetes in local interventions. Social Cognitive Theory suggested addressing individuals directly, but also including social influence, specifically from health care providers (HCPs) through referral, and activities to address cost through covering the lifestyle change intervention. HCPs are consistently reported to be among the most trusted sources for health information and are uniquely positioned to refer patients to a lifestyle change program. Because cost is among the most commonly cited barriers to health care use, the National DPP model calls for employers to offer the program as a covered benefit to their employees. Formative research was conducted with these audiences to inform development of messages and materials to engage them in promoting the lifestyle change program and expanding its reach.

Evaluation Methods and Results:  Between 2010 and 2013, 3 focus groups, 6 small-group interviews and 16 in-depth interviews (IDIs) were conducted with primary care physicians, nurses, nurse practitioners, and physician assistants; each type of HCP group was interviewed separately. Fifteen IDIs were conducted with senior representatives in self-insured companies and regional offices of major insurance companies. HCPs were aware of prediabetes—but didn’t always see it as urgent. While some HCPs were receptive to the crafted messages that were part of the discussion for the National DPP, others wanted “just the facts.”  Employers and insurers were aware of the impact of diabetes on their workforce, but not the impact of prediabetes. Most employers wanted information about the condition—and like many HCPs, they wanted information tailored to their situation. They also wanted to know how the lifestyle program differs from other diabetes programs. All thought the CDC association conveyed objectivity and quality; endorsements from relevant people/groups were viewed as helpful.

Conclusions:  Physicians and other HCPs had similar but distinct preferences regarding the materials designed for them. Employers were interested in prevention messages but needed disease-related information as well as localized, specific solutions. They wanted to know why this issue matters to them and their employees. All professional groups wanted direct messages—“no fluff.”

Implications for research and/or practice:  Homogeneity cannot be assumed within professional group segments. Messages can be similar but language, focus, and approach needs to be adjusted for each audience.  We will discuss what we found to resonate with each group.