Encouraging Adults at Risk for Type 2 Diabetes to Enroll in Diabetes Prevention Programs Through a Media Campaign in...

The National Diabetes Prevention Program (DPP) is an evidence-based intervention proven to delay or prevent progression to type 2 diabetes, yet most at-risk people do not enroll. In Hawai'i, Native Hawaiian and Other Pacific Islander (NHOPI) and Filipino adults experience disproportionately high rates of prediabetes and diabetes but have low DPP enrollment. From July to October 2024, the Hawai'i State Department of Health launched Beat Diabetes, a statewide media campaign encouraging DPP enrollment among at-risk adults, with a focus on NHOPI and Filipino communities.

This evaluation assessed whether campaign exposure was associated with self-reported likelihood of joining a DPP among Hawai'i adults at risk for diabetes, particularly NHOPI or Filipino adults.

A postcampaign cross-sectional online survey was conducted from October to December 2024, with Hawai'i residents aged 35-64 years who reported at least 1 diabetes risk factor. NHOPI or Filipino adults were oversampled to determine campaign effectiveness among the target audience. The survey measured self-reported likelihood of joining a lifestyle change program (main outcome), campaign recall (main exposure), demographic characteristics, diabetes risk factors, and beliefs that could affect DPP enrollment likelihood, including intrinsic motivation, perceived inevitability of developing diabetes, and perceived health benefits of DPP participation. Three general linear regression models examined the association between campaign exposure and DPP enrollment likelihood ratings, adjusted for demographic characteristics, diabetes risk factors, and belief variables. A sensitivity analysis among just those diagnosed with prediabetes was conducted.

A total of 860 adults completed the survey, with 34.7% (298/860) and 12.2% (105/860) self-identifying as NHOPI and Filipino, respectively. In total, 40% (346/860) reported campaign exposure. Exposed individuals had higher mean DPP enrollment likelihood ratings and higher inevitability belief scores than those not exposed. A large proportion of exposed respondents reported that enrolling in a DPP would "improve their health a lot." No significant differences in campaign exposure were observed across ethnicities. All 3 regression models showed a significant positive association between campaign exposure and DPP enrollment likelihood ratings. In the final adjusted model controlling for all covariates, significant predictors included campaign exposure (β=.52, P<.001), male gender (β=.34, P=.01), residence outside Honolulu County (β=.31, P=.02), motivation index scores (β=.38, P<.001), inevitability belief (β=.20, P<.001), and the belief that DPP improves health "a little" (β=.76, P<.001) or "a lot" (β=1.63, P<.001). The sensitivity analysis among those diagnosed showed exposure was not associated with likelihood ratings (β=.30, P=.27).

Campaign exposure was associated with higher ratings of likelihood to join a DPP among at-risk adults with no prediabetes diagnosis. Perceived positive health impact of DPP participation was the strongest contributor to likelihood ratings. Campaigns aiming to increase awareness of DPP and intentions to join should promote DPP effectiveness and the urgency of preventative actions.