Predictors of Participation in the National Diabetes Prevention Program Among Hispanics in the U.S.: Estilos 2015-2016

Introduction: Hispanic adults have a higher prevalence of prediabetes than non-Hispanic whites. However, a low percentage of Hispanics (10% vs. 18% Hispanic adults in the U.S.) compared with non-Hispanic whites (62% vs. 61% non-Hispanic whites in the U.S.) have participated in the National Diabetes Prevention Program (National DPP) lifestyle change program (LCP) for prevention of type 2 diabetes. This study aims to determine predictors of participation in the National DPP LCP among Hispanic adults in the U.S.

Methods: This study includes 1,704 Hispanic adults (ages ≥18 years) without diagnosed diabetes who completed the 2015 and 2016 Porter Novelli ESTILOS, a web-based survey of U.S. Hispanic adults that focuses on health-related behaviors, knowledge, and attitudes. The χ2 test was performed to examine the differences in self-reported participation in the LCP by selected characteristics, and multiple logistic regression was used to obtain the adjusted odds ratios after controlling for awareness of the National DPP LCP, age, gender, education, employment, healthcare coverage, and language spoken at home. All analyses were performed using SAS version 9.3.

Results: Overall, 12.6% of respondents were aware of the National DPP LCP and 3.3% participated in the program. In bivariate analysis, those who participated were more likely to have graduated from a 4-year college or higher, to be employed, to have healthcare coverage, and to be bilingual or speak English at home. Multiple logistic regression analyses showed that the odds of participating in a LCP were 25.8 times (95% CI, 10.2-65.6) greater among Hispanics who were aware of the National DPP LCP, and 4.5 times (95% CI, 1.3-15.6) greater among those who had healthcare coverage, compared with those who did not. Hispanics aged 18-44 compared with those aged 65+, and those who graduated from a 2-year college, completed some college, or graduated from a 4-year college or higher, compared with those with a high school diploma or less, were more likely to participate in the program. Respondents who were employed were 5.6 times (95% CI, 1.3-24.2) as likely to participate as those who were not.

Conclusions: This study highlights the importance of increasing awareness of the National DPP LCP among Hispanics with prediabetes or at high risk for type 2 diabetes to encourage participation in the program. There is also a need to make the program accessible for people who have low education, or who are unemployed, without healthcare coverage, and elderly.