Facilitators and barriers to implementing the Diabetes Prevention Program in rural church settings: A qualitative study using the Consolidated Framework for Implementation Research
Open accessAbstract
Purpose: The CDC's Diabetes Prevention Program (DPP) is an effective lifestyle intervention to prevent type 2 diabetes (T2D). However, DPP implementation in rural areas is limited. This study sought to address this gap by implementing DPP in rural church settings through a community–academic partnership and identifying implementation facilitators and barriers. Methods: This was a cross‐sectional qualitative study. Semistructured interviews guided by the Consolidated Framework for Implementation Research (CFIR) assessed church leaders' and lifestyle coaches' perceptions of implementing DPP in rural churches. Thematic analysis was used to identify key themes through an inductive approach; then, these emergent themes were deductively linked to CFIR constructs. COREQ guidelines were used to report study findings. Findings: Twenty‐five stakeholders participated. Facilitators to implementing DPP included its evidence‐based effectiveness in preventing T2D, as well as support from the academic partner in terms of funding, training, and communication. Additionally, DPP's alignment with community needs, along with the active engagement of pastors in participant recruitment, supported implementation. Several barriers hindered DPP implementation, including transportation and childcare issues, as well as program participants' medical conditions/disabilities limiting their participation. Furthermore, rural residents' reluctance to adopt lifestyle changes and loyalty to family churches posed challenges to their engagement in DPP. Conclusions: This study identified contextual factors influencing DPP implementation in rural communities. Findings highlight the importance of tailored strategies that leverage facilitators while proactively addressing barriers, including rural residents' reluctance to attend programs outside their church, resistance to lifestyle changes, and transportation issues to ensure successful DPP implementation in rural areas.
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The Diabetes Prevention Program is known to reduce the risk of progression to diabetes and is covered by major payers, but has not been meaningfully scaled due to regulatory and implementation barriers.
“For example, the Diabetes Prevention Program is known to reduce the risk of progression to diabetes and is covered by major payers, but has not been meaningfully scaled due to regulatory and implementation barriers [105, 106].”
From Nutritional priorities to support <scp>GLP</scp> ‐1 therapy for obesity: A joint Advisory from the American College of Lifestyle Medicine, the American Society for Nutrition, the Obesity Medicine Association, and The Obesity Society (2025) · cites this paper as [106]
The Introduction reports that DPP reduces type 2 diabetes risk and that access is limited in rural counties; it also lists implementation barriers, including CDC recognition processes. It does not establish coverage by major payers or that DPP has failed to scale generally—indeed, it describes DPP as widely adopted across diverse settings. The access finding is specifically about rural counties. (LLM, conf=0.86)
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- Authors
- Rawal, S., Snead, C. A., Soiro, F. D., Lawrence, J., Rivers, B. M., & Young, H. N.
- Affiliations
- University of Georgia (US)
- Interdenominational Ministerial Alliance Georgia USA
- Morehouse School of Medicine (US)
- Corresponding author
- Rawal, Smita
- Venue
- The Journal of Rural Health
- Publisher
- Wiley
- Published
- 2024-10-13
- Volume
- 41
- Issue
- 2
- Pages
- e12888-e12888
- ISSN
- 0890-765X (ISSN-L)
- 1748-0361
- PMC
- PMC11950418
- OpenAlex
- W4403376542
- Cited by
- 7
- References
- 58
- Citations by year
- 2026: 2 · 2025: 5
- FWCI
- 4.11
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- The Journal of Rural Health (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Funders
- Georgia Department of Public Health
- National Institutes of Health (UL1TR002378)
- National Center for Advancing Translational Sciences
- Topics
- Health Sciences › Health Professions › General Health Professions › Health Policy Implementation Science
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Education
- Health Sciences › Health Professions › General Health Professions › Community Health and Development
- Keywords
- Diabetes Prevention Program, type 2 diabetes prevention, rural churches, implementation barriers and facilitators, Consolidated Framework for Implementation Research, university-community collaboration, lifestyle intervention, church officials, pastors, transportation barriers, childcare barriers, rural health, participant recruitment
- MeSH terms
- Adult, Cross-Sectional Studies, Diabetes Mellitus, Type 2, Female, Health Promotion, Humans, Interviews as Topic, Male, Middle Aged, Rural Population, United States, Qualitative Research
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