Highlights

• People with prediabetes have higher than normal blood sugar levels, but they can prevent or delay type 2 diabetes through evidence-based lifestyle change programs (LCPs).
• Many people with prediabetes do not enroll or persist in LCPs.
• Introductory “Discovery Sessions”—informed by behavioral science—can help boost participation in LCPs in a low-cost way by addressing key behavioral barriers to enrollment and retention.

The challenge:

Diabetes is the eighth leading cause of death in the United States. Lifestyle change programs (LCPs) help participants make healthy changes in their diet, physical activity levels, and more. LCPs are effective in reducing the risk of type 2 diabetes, but the people who could benefit from them often don’t enroll, or don’t persist in the program after they start. 

Our approach:

One promising strategy for increasing enrollment in LCPs are informational sessions that introduce potential participants to the program by leveraging insights from behavioral science. Drawing from behavioral science research, we hypothesized potential barriers that could be addressed through the session, and then investigated those hypotheses through interviews with site staff and LCP participants. To address these barriers, we incorporated “nudges” that would be feasible for organizations to implement because they are: 1) small, low-cost tweaks to existing conditions; 2) do not restrict participants’ freedom of choice; and 3) have been successful in diverse areas of behavior change such as consumer finance, medication adherence, and opioid prescription reduction. These nudges were incorporated into materials and facilitators’ guides for in-person and videoconferenced introductory sessions.

The takeaway:

Enrollment and participation were higher among Discovery Session participants, though the difference was not statistically significant. Forty-eight (89%) Discovery Session participants and 32 (68%) comparison group participants registered for an LCP during or after attending their introductory session (p = 0.377). All six sites selected for the project agreed that the Discovery Session was acceptable, as well as indicated a willingness to adopt by following up with further questions and seeking advice. 

This intervention and evaluation demonstrated the value of using behavioral science to address behavioral barriers preventing individuals from enrolling and remaining in the National DPP LCP in a way that requires relatively little staff time and resources compared to current LCP enrollment and retention strategies, which could also serve to improve health equity. The evaluation results suggest that the behaviorally informed Discovery Sessions can improve enrollment and retention, and can be implemented with high fidelity and minimal additional costs and resources.

Read more about this work: Improving Enrollment in Lifestyle Change Programs