Pilot Feasibility Study for Implementing a Peer-Facilitated Diabetes Prevention Program With Homeless Men: Significant Weight Loss and Improved Health Behaviors Despite Employment Barriers and Limited Access to Healthy Foods.

Abstract

Background: Diabetes lifestyle interventions can prevent type 2 diabetes (T2D), the leading cause of death and disability, especially among marginalized populations. Preventing or delaying the progression of T2D involves modification of high-risk behaviors. Peer educators and lay health workers can effectively implement Diabetes Prevention Program (DPP) interventions. Objective: The objective of the study was to adapt and deliver an evidence-based, nurse-led, peer-facilitated DPP for homeless men with substantial risks for T2D. Methods: This pilot project utilized a phased approach for implementation science. It was implemented with formerly homeless men enrolled in a residential employment center within an urban environment. Results: Significant improvements were observed for meal-time portion control, daily physical activity, replacement of sugar-sweetened beverages with water, cutting back on cigarettes, and weight loss from baseline to week 12. Conclusion: Despite significant achievements in meeting their personal health behavior goals, the men revealed serious competing concerns. The peer facilitators (PF) and participants were concerned about the need for sustained employment so that they could meet their basic needs (i.e., income, food, housing, etc.). Implications for Nursing: The men found performing as PF beyond 12 weeks without pay to be unreasonable, although they were enthusiastic about improving their own health, as well as the health of their friends and family.