Welcome everyone to Adjusting Program Delivery During the COVID-19 Public Health Emergency
Lessons Learned from a National Diabetes Prevention Program Case Study webinar.
Today, we are pleased to share findings from a case study we completed in 2021 to learn more
about how CDC-recognized organizations adapted to the COVID-19 public health emergency and adjusted
program delivery to enroll and retain participants in the National Diabetes Prevention Program - or
National DPP - lifestyle change program.
During today's webinar
we'll introduce CDC's key effort to scale the National DPP in areas that are underserved. We'll briefly discuss the
partners in that effort and provide an overview of the evaluation framework for the project.
Along with some of our partners, we'll present a key case study we conducted in 2021:
Adjusting Program Delivery During the COVID-19 Public Health Emergency to
Enroll and Retain Populations of Focus in the National DPP Lifestyle Change Program.
We'll share approaches from organizations that switched to virtual program delivery during the
COVID-19 public health emergency. This shift presented unique challenges and opportunities
to find creative ways to deliver the program and meet participant needs. The organizations learned
the importance of understanding participant needs and adjusting their program to meet those needs.
Virtual delivery of the program during the public health emergency can be challenging,
and we hope you find the information in today's webinar useful.
While the National DPP has grown
across the nation, there are still many areas with little or no access to the National DPP lifestyle
change program. Additionally, some populations have been under-enrolling in the program relative
to their disease burden and risk factors. Through a project called "Scaling the National Diabetes
Prevention Program in Underserved Areas," or DP 17-1705, CDC's Division of Diabetes
Translation Funds 10 national organizations with affiliate delivery sites in at least
3 states to further build the National DPP infrastructure in underserved areas and increase
the availability of the evidence-based lifestyle change program for adults with pre-diabetes
or at high risk for type 2 diabetes, and with this project there is a particular focus on
certain populations. The populations of focus include Medicare beneficiaries; men;
African American, Asian American, Hispanic, American Indian, Alaska Native, and Pacific
Islander persons; and non-institutionalized people with visual impairments or physical disabilities.
Since 2017, these national organizations have worked with their affiliate delivery sites
to carry out strategies to expand the reach of National DPP. Strategies to support this
expansion include: Increasing the availability of CDC-recognized organizations in underserved areas.
Increasing clinician screening, detection, and referral of adults with pre-diabetes or
at high risk for type 2 diabetes to CDC-recognized organizations.
Increasing awareness of pre-diabetes and enrollment in the lifestyle change program.
Increasing retention rates for participants in the lifestyle change program.
And finally, increasing benefit coverage for participation in the lifestyle change program. The
awardees for this project include: Black Women's Health Imperative, Association of Diabetes Care
and Education Specialists, National Alliance for Hispanic Health, Trinity Health, Balm in Gilead,
Comagine Health, American Diabetes Association, National Association of Chronic Disease Directors,
Association of Asian Pacific Community Health Organizations, and American Pharmacists
Association Foundation. For more information about 1705, you can visit the CDC website.
As part of this CDC project, we conduct a national evaluation. And the main purpose of the national
evaluation is to systematically collect data each year to assess the extent to which awardees and
their affiliate delivery sites, which are defined as CDC-recognized organizations with the DPRP org
code, implement the required strategies indicated in the project Notice of Funding Opportunity.
The national evaluation has 4 components: the first is the Diabetes Prevention Recognition
Program or DPRP reporting for each Individual Organization's Timeline,
Performance Measures, Quantitative Evaluation done via Grantee and Site-level Annual Surveys,
and Qualitative Evaluation through Case Studies and Focus Groups. For today's presentation, we'll
be sharing information and findings from a case study done as part of the qualitative evaluation component.
The purpose of the qualitative case studies is to provide an in-depth evaluation
of promising strategies related to recruitment, enrollment, and retention of populations of focus
in underserved areas. We conduct key informant interviews with staff at the recipient,
affiliate delivery site, and/or partner level and in-depth interviews with program participants.
I will now turn it over to ICF, one of our partners in
conducting the evaluation work for 1705, to present the findings on the case study
on adjusting program delivery during the COVID-19 public health emergency.
I would like to provide some background and context on the public health emergency
and distance learning. Then, we'll cover the purpose of the case study and our methodology.
In March 2020, a public health emergency was declared due to the COVID-19 pandemic.
As a result, many organizations delivering the National DPP lifestyle change program
transition from in-person delivery to distance learning. Distance learning is defined as the
"year-long lifestyle change program delivered 100% by trained Lifestyle Coaches via remote
classroom or telehealth (such as a conference call), where Lifestyle Coaches are present in
one location and the participants are calling in or videoconferencing in from another location."
To adjust program delivery for distance learning, 1705 recipients and affiliate sites adjusted
multiple elements of their programs. Programs transitioned to videoconferencing platforms
or used conference lines to deliver classes. Curricula and materials were converted to virtual
format, and materials and incentives were mailed or delivered. Recruitment and retention strategies
also were adjusted. Marketing efforts focused more on social media, and retention efforts
focused on increased communication and support from Lifestyle Coaches and virtual activities.
Finally, Lifestyle Coach support and training was adjusted to include additional training
and support for Lifestyle Coaches to support them with distance delivery of the program.
In just a minute, I'm going to share more on the purpose of this case study and our methodology.
So, given the background and context on the public health emergency and distance
learning that I just shared, the purpose of this case study was to: Describe how
delivery of the lifestyle change program was adjusted because of the public health emergency,
and to assess the perceived effectiveness of adjustments
to program delivery by identifying facilitators, barriers, and lessons learned in this work.
To gather data for this case study, between May and July 2021, we conducted interviews at the
recipient, affiliate site, and program participant levels. All interviews were conducted virtually,
as data collection happened during the public health emergency and travel was
not possible. At the recipient level, we conducted interviews with representatives from Black Women's
Health Imperative, or BWHI, and the National Alliance for Hispanic Health, or the Alliance.
We also conducted interviews with representatives from five affiliate sites.
Those sites are located in Alabama, California, Florida, and Louisiana. And, lastly, we conducted
interviews with program participants from BWHI affiliate sites located in Alabama and Louisiana
and with program participants from Alliance affiliate sites located in California and Florida.
Two of the participant interviews were conducted in Spanish, and the rest were conducted in English.
Now, I will turn the presentation over to Black Women's Health Imperative to describe their
overall approach to adjusting program delivery during the COVID-19 public health emergency.
BWHI was founded in 1983 in Atlanta, Georgia with the mission to focus on
health and wellness for black women and girls. It is the only national nonprofit organization
dedicated to improving the health and wellness of our nation's 21 million black women and girls
-physically, emotionally, and financially. As a CDC National Diabetes Prevention Program partner,
both as an original recipient and a legacy recipient, we have delivered our program
in 13 states in partnership with 18 program partners, enrolling over 3,500 participants.
BWHI and our affiliate sites adjusted the technology used to deliver the LCP.
Those adjustments included: Transitioning primarily to a video conferencing platform
for program classes. Launching a companion app in October 2020 which includes program content,
can collect participant data (weight and physical activity),
and sends reminders and motivational messages to participants. In making this transition,
we dedicated time for additional training and support to program staff and Lifestyle Coaches.
Our Lifestyle Coaches also have the ability to collect participant data virtually through email,
text, breakout rooms, the BWHI app, and fitness apps, depending on which platform they are using.
In addition, BWHI and our affiliate sites adjusted the program curriculum, content, and materials. We
converted the existing curriculum to a virtual format using Canva, which is a graphic design
software for easy virtual presentation. We emphasize the existing stress management
module to aid participants facing additional stressors related to the public health emergency.
We printed and mailed program materials for participants who could not access them virtually.
We also mailed incentives (like measuring cups and activity bands) to participants.
BWHI also provided supplemental content like helpful articles, encouraging messages,
and program reminders through the BWHI app. We also offered
supplemental activities like cooking demonstrations and game nights virtually.
BWHI and our affiliate sites also made adjustments
to recruitment and retention strategies. To reach potential participants, we increased
the use of social media to announce new cohorts and advertise the program. We also used related
aspects of the public health emergency to increase the relevance of marketing with
slogans like "Have you gained the Quarantine 15? if so, join our lifestyle change program."
BWHI affiliate sites cross-promoted their programs to patients visiting clinics for other reasons.
They also expanded the geographic area of focus used to recruit participants,
which allowed them to recruit from other areas of their states and other states. To aid retention,
we used reminders and encouraging messages in the BWHI app to keep participants engaged.
We included those supplemental activities like those virtual game nights and cooking
demonstrations for participants to attend virtually. We also continue
to offer incentives to participants and mailed those to their homes.
BWHI provided extensive support and training to affiliate sites to deliver the program virtually. This included
training on using videoconferencing technology and strategies for effectively overcoming barriers to
change in a world that is so drastically changed by the public health emergency.
In addition, affiliate sites provided training and support for their Lifestyle Coaches. Our affiliate
sites also allocated additional time for Lifestyle Coaches to deliver the program virtually.
Now I will turn the presentation over to the Alliance to describe their overall approach
to adjusting program delivery during the COVID-19 public health emergency.
The Alliance is a non-profit and nonpartisan advocacy organization founded in 1973.
The mission of the Alliance is to achieve the best health for all. The Alliance works to
improve the life of Hispanic people by ensuring that health incorporates the best of science,
culture, and community. Our focus is investing in community-based organizations,
working with national partners, examining and improving available systems,
and designing solutions to make health an integral part of each person's life.
Our affiliate sites adjusted technology used to deliver the LCP. Affiliate sites provided
individualized technology solutions based on the needs of their population of focus.
They used live meeting platforms and conference phone lines to deliver the program virtually.
They also help participants access free cell phone programs. They also provided
extensive training and support to participants on technology used to deliver the program.
In addition, our affiliate sites adjusted the program curriculum, content, and materials.
They mailed paper copies of the curriculum to participants for those who didn't have
access to them virtually. They added additional content related to the public health emergency
to educate and provide resources to participants.
Some affiliate sites purchased and mailed scales to participants (while remaining in accordance
with CDC guidance) so they could safely and easily provide their weight data. They offered
virtual supplemental activities like virtual cooking demonstrations and online dance workouts
through the videoconferencing platform. They also mailed program incentives to participants.
The Alliance and our affiliate sites also made adjustments to
our recruitment and retention strategies.
To help recruit new participants, we added content on the ability to join and participate virtually
to our marketing materials. We continued marketing in clinics to patients visiting for other reasons.
With CDC's permission and guidance, we also expanded geographic area of focus used to
recruit participants which allowed us to recruit from other areas of our states and other states.
To aid in retention of existing participants, affiliate sites increased communication outside
of regular classes. They expanded their class offerings to offer more classes
and classes at alternative times to accommodate participant schedules. They also connected
participants with helpful community resources, such as food banks and rental assistance.
The Alliance connected affiliate sites to CDC guidance and resources. Affiliate site
staff allocated additional staff time to deliver the program virtually. Lifestyle Coaches spent
considerable amount of time following up with participants to keep them engaged.
We'll go ahead now and jump into findings from our case study. As a reminder,
our findings include facilitators, barriers,
and lessons learned in adjusting program delivery during the COVID-19 public health emergency.
The key facilitators identified for adjusting program
delivery during the public health emergency included: An introductory "technology check"
session to assist participants with accessing and using virtual platforms. Ability to connect
participants with helpful community resources, such as food pantries and rental assistance.
The increased overall focus on health because of the public health emergency.
The convenience, low effort, and low cost of participating in the program virtually.
And the ability of a virtual program to reach participants anywhere.
In terms of barriers related to adjusting program delivery during the public health emergency,
recipients and affiliate site staff shared that participants' lack awareness and discomfort with
technology as well as limitations in participants' internet access and connectivity were a challenge.
They also identified the increased time and demands on Lifestyle Coaches due to a new
delivery mode as a challenge. And, lastly, they identified the increased time and cost associated
with mailing materials and incentives.
Recipient and affiliate site staff shared several lessons
learned from adjusting program delivery during the public health emergency. These included the
importance of providing training and support to participants, especially related to technology
and participating virtually. They shared insights about the importance of considering other virtual
communication methods or mobile apps to help keep participants engaged and offering supplemental
activities virtually, like game nights, cooking demonstrations, or physical activity classes.
Recipient and affiliate site staff also noted the importance of developing and providing a
list of community resources and understanding the cultural and site-specific nuances of your
populations of focus. It's important to note here that while there may be some benefits for certain
participants to switching to virtual delivery - like removing transportation as a barrier - there
may be new challenges that the participants face. It's important to consider the potential
new challenges and apply what you know about the community, and ask what participants need for them to be able to participate.
Additional lessons learned included the importance of: Preparing,
training, and supporting program staff on using the technology. Allowing extra time and resources
to accommodate the increased demand on Lifestyle Coaches and staff to assist participants with
technology. Being flexible and supportive with program staff as they adjust to the program
delivery and face other challenges related to the public health emergency. And, providing
ongoing support and bringing Lifestyle Coaches together to share successes and challenges.
So for additional information on this topic and
other topics that we've studied through the evaluation of 1705,
we've developed Keys to Success tip sheets, emerging practice documents, and webinars. So
we encourage you to please visit the National DPP customer service center at nationaldppcsc.cdc.gov
to access these resources and more.
This concludes today's presentation. Today's webinar will be
recorded and posted on the National DPP Customer Service Center. Thank you so much for joining us!