A Mixed Methods Study of Initial Engagement in Behaviors to Prevent Diabetes among Employees with Prediabetes

Kullgren JT, Knaus M, Rahrig Jenkins K, Heisler MM. A Mixed Methods Study of Initial Engagement in Behaviors to Prevent Diabetes among Employees with Prediabetes. Paper presented at: Society of General Internal Medicine Annual Meeting; 2016 May 11; Hollywood, FL.

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Background: Many employers use workplace screenings to identify and recommend modifications of employees' health risk factors. Such screenings represent an opportunity to help individuals at risk for chronic conditions like type 2 diabetes mellitus (T2DM) better understand and reduce their risks. However, little is known about how often at-risk individuals subsequently engage in behaviors recommended during such screenings and what factors influence engagement. The objective of this study was to describe the frequency of, facilitators of, and barriers to initial engagement in recommended behaviors to prevent T2DM among employees found to have prediabetes during a workplace screening. Methods: We conducted a mixed methods study of University of Michigan (U-M) employees found to have prediabetes during workplace screenings conducted in early 2014. In the screenings, employees whose fasting blood glucose was in the prediabetes range were counseled by a health coach to reduce their risk for T2DM by losing weight and getting at least 150 minutes of moderate physical activity per week, discussing metformin for T2DM prevention with their primary care provider, or participating in a Diabetes Prevention Program (DPP). We then invited these employees to be surveyed about their demographic characteristics, engagement at 3 months in behaviors to prevent T2DM, and potential behavioral mediators of this engagement. After we collected all survey data, we conducted semi-structured telephone interviews with purposive samples of employees who were and were not initially engaged in a recommended behavior to identify facilitators of and barriers to engagement. For our quantitative analyses, we used Wilcoxon rank-sum tests for continuous variables and Chi-square or Fisher's exact tests for categorical variables to compare demographic characteristics and potential behavioral mediators between participants who had or had not engaged in a recommended behavior. For our qualitative analyses, we transcribed interviews and used modified grounded theory to identify salient themes. Results: Three months after screening, 63% of the 82 U-M employees with prediabetes who we surveyed were attempting to lose weight and getting recommended levels of physical activity, had asked their primary care provider about metformin for prevention of T2DM, or had attended a DPP. These employees had higher median levels of motivation to prevent T2DM (9/10 vs. 7/10, P = 0.01) and lower median estimations of their risk for T2DM (40% vs. 60%, P = 0.04). Among 22 employees who had initially engaged in a recommended preventive behavior, key facilitators of engagement were high motivation and social and external supports. Among 18 employees who had not initially engaged in a recommended behavior, key barriers to engagement were lack of motivation, lack of resources, and competing demands. Conclusions: Most employees found to have prediabetes through a workplace screening initially engaged in a recommended behavior to reduce their risk for T2DM. This engagement could perhaps be enhanced by approaches to optimize motivation and risk perception as well as leverage social networks and external supports. More research is needed to measure longer-term engagement in behaviors to prevent T2DM among employees with prediabetes and test approaches to sustain their ongoing engagement. Word Count: 497