Leveraging Technology and Theory to Change Health Behaviors, Close Gaps in Health-Related Social Needs, and Increase Enrollment in the National Diabetes Prevention Program.

Abstract

Purpose and objectives: Although progress has been made in scaling up the National Diabetes Prevention Program Lifestyle Change Program (National DPP LCP), innovative engagement strategies are needed.

Intervention approach: This implementation evaluation leveraged and combined technology, behavior change theory, and community-based participatory design approaches to develop, deploy, and evaluate a 6-month, bilingual, tailored text message-delivered program (bRIght communities) to increase 1) readiness to engage in key behaviors for diabetes prevention, 2) engagement in services that address health-related social needs to reduce barriers to participation, and 3) readiness to enroll in the National DPP LCP.

Evaluation methods: We implemented a statewide, multichannel recruitment strategy from May through October 2022 and recruited 432 community members (62.3% White, 26.0% Hispanic, 6.2% Black) who received up to 6 months of tailored text messages. Six months postenrollment, 273 participants completed an online follow-up survey. Among those who did not complete the survey, responses from the last texting session were used for pre/post comparisons.

Results: Matched pre/post analyses (using t tests and McNemar tests) indicated that bRIght communities had a significant impact on daily consumption of fruits and vegetables (d = 0.43); weekly physical activity minutes (d = 0.48); resilience (d = 0.26); food insecurity (P < .001); transportation concerns (P < .001); and perceptions of feeling unsafe exercising in one's neighborhood (P < .001). Nearly 68% of participants with or at risk for prediabetes were in the precontemplation stage for enrolling in the National DPP. Overall, 30.3% of participants in bRIght communities moved forward at least 1 stage of change.

Implications for public health: Interactive, theoretically driven tailored text messaging represents a promising approach to increasing awareness of prediabetes risk, readiness to enroll in the National DPP LCP, participant engagement, and health behavior change. Providing links to existing geographically matched community resources reduced health-related social needs that can present barriers to participating in the National DPP LCP. The results also provide insights to inform the design and development of other population-based tailored text-delivered interventions.