Sustainability → Health Equity and the National DPP → The National DPP and HRSNs
The Connection Between the National DPP Lifestyle Change Program and Addressing HRSNs
The National Diabetes Prevention Program (National DPP) lifestyle change program is uniquely positioned to consider the implications of social determinants of health (SDOH) and address associated health-related social needs (HRSNs) among program participants. This page will discuss how the National DPP lifestyle change program teaches valuable skills that address HRSNs, as well as opportunities to address HRSNs to support participants’ success in the National DPP lifestyle change program. It is divided into the following sections:
- The National DPP Lifestyle Change Program Curriculum Creates Space to Focus on Valuable Skills That Address HRSNs
- Addressing HRSNs Can Support Participant Success in the National DPP Lifestyle Change Program
- Examples of Addressing HRSNs Through the National DPP Lifestyle Change Program
The National DPP Lifestyle Change Program Curriculum Creates Space to Focus on Valuable Skills That Address HRSNs
Research has shown that the National DPP lifestyle change program can prevent the development of type 2 diabetes in adults with prediabetes—resulting in reduced costs and healthier populations (see the Evidence page of the Coverage Toolkit for more details). Research also has demonstrated consistent and significant disparities in diabetes outcomes across populations. Many studies have shown that diabetes impacts racial and ethnic minority and low-income adult populations disproportionately as evidenced by higher risk of diabetes and higher rates of diabetes related complications and mortality (to learn more, see the Connecting SDOH and HRSNs to Prediabetes and Type 2 Diabetes page of the Coverage Toolkit). The National DPP lifestyle change program has the potential to positively impact all racial/ethnic groups by preventing type 2 diabetes.
The value of the National DPP lifestyle change program, however, extends beyond type 2 diabetes prevention. The National DPP lifestyle change program impacts other comorbidities, some of which may disproportionally affect certain populations. Research shows that benefits include reduced risk of cardiovascular disease, as well as weight loss and reduction in sleep apnea.
The curriculum of the program also gives participants the opportunity to focus on skills including decision making, problem solving, and priority setting that can help participants overcome HRSNs. The National DPP lifestyle change program curriculum respects participant dignity and their autonomy to make health behavior changes with support from lifestyle coaches. The relationships between a participant and their lifestyle coach can increase self-efficacy among participants. Likewise, the relationships between participants are beneficial and can provide long-term social support and solidarity as participants seek to make personal health behavior changes.
In addition to these benefits, the National DPP lifestyle change program provides a year-long forum to discuss the complexities of health care, health care providers, and health insurance, ideally leaving participants with a clearer understanding of how to function within the health care system. Due to its multiple touch points over the course of one year, the program can also be used as a referral point to encourage participants to access other community resources or health, behavioral, and social care services or opportunities.
Finally, CDC-recognized organizations and lifestyle coaches can strengthen the innovative role the National DPP lifestyle change program can play in promoting health equity. CDC-recognized organizations are typically located in the community, and may offer other programs and services that promote health equity. Lifestyle coaches are uniquely trained, and can include non-licensed providers, such as community health workers (CHWs), which often are individuals living in the same communities they serve.
Addressing HRSNs Can Support Participant Success in the National DPP Lifestyle Change Program
Participant retention and engagement in the National DPP lifestyle change program can increase as barriers to participation are addressed. The structure of the program provides space for individualized support, as lifestyle coaches are uniquely positioned to work with participants to address their specific HRSNs. When they are from the same community as program participants, lifestyle coaches often understand the barriers faced by and opportunities available to participants.
The Minnesota Best Practices Guide for lifestyle coaches and program coordinators highlights several ways lifestyle coaches can address HRSNs to support participant success in the National DPP lifestyle change program:
- Tailor recruitment outreach to populations of focus.
- Enhance the National DPP lifestyle change program curriculum to increase its effectiveness for a specific cultural community or translate the curriculum into another language. Newly developed curricula must be submitted, reviewed, and approved by CDC prior to use. In addition, organizations that develop supplemental materials for an already approved CDC curriculum must submit those for review and approval. Information on how to do this is available here. Existing curriculum translations can be accessed on the Curriculum page of the Coverage Toolkit.
- Incorporate the use of additional low-literacy materials, such as visuals and materials written at a 6th grade level or below.
- Make it easy to participate in make-up sessions.
- Develop partnerships with other organizations to help address barriers to participation, such as with local food shelters and non-profit organizations.
- Add additional class locations to meet the needs of participants, such as having a class at a church because members of that church are already familiar with the location and meet there regularly.
- Increase access to the National DPP lifestyle change program by offering a combination of in-person, online, distance learning, and/or telephonic delivery of the program.
- Facilitate social connections between program participants.
- Use supplementary experiences to address HRSNs, such as food security.
To learn more about Minnesota’s experience engaging participants and addressing HRSNs, please see this video. To learn more about recruitment and retention strategies for the National DPP lifestyle change program, please visit the Recruitment and Referral page and the Retention page of the Coverage Toolkit.
Examples of Addressing HRSNs Through the National DPP Lifestyle Change Program
The COVID-19 public health emergency exposed existing weaknesses in how HRSNs are addressed and, as such, health equity has become a high priority across the nation. One of CDC’s Healthy People 2030’s five goals is specifically related to SDOH: “Create social, physical, and economic environments that promote attaining the full potential for health and well-being for all.” Likewise, states are engaging in work to address HRSNs through a variety of methods and partnerships.
This section will outline examples from states and organizations that are addressing HRSNs in various ways that impact engagement with the National DPP lifestyle change program.
The Association of Asian Pacific Community Health Organizations (AAPCHO) serves Pacific Islanders by collaborating with local communities, federally qualified health centers (FQHCs), and other organizations to improve the health of Pacific Islanders. Through the Pacific Islander Diabetes Prevention Program (PI-DPP), AAPCHO provides a CDC-recognized diabetes prevention program that is tailored to Pacific Islanders. Within that program, AAPCHO provides participants with assistance and program supports to address HRSNs uniquely faced by this population.
On July 21, 2021, AAPCHO, in collaboration with other partners, held a webinar to explore strategies for HRSNs screening and building effective practices to begin addressing SDOH through outreach and enabling services.
Alaska offers the National DPP lifestyle change program through three delivery modalities: in-person, online, and telephonic. The online and telephonic programs are available to all eligible Alaskans free of cost. The telephonic delivery option through InquisitHealth includes one-on-one phone consultations with a lifestyle coach. This option provides program access to individuals living with limited broadband internet or phone data.
Illinois is advancing Medicaid participant enrollment in the National DPP lifestyle change program by better understanding the challenges beneficiaries have related to participation and retention. Current initiatives include holding listening sessions to better understand what factors would encourage participants to stay in the program and what skills they would like to develop. The Illinois Department of Public Health is also utilizing grant funding to build a community advisory group, which involves selecting National DPP lifestyle change program graduates to serve as community advisors and develop strategies to improve access to the program.
To learn more about Medicaid coverage of the National DPP lifestyle change program in Illinois, see Illinois’ State Story of Medicaid Coverage. For more information on recruitment, referrals, and retention of Medicaid beneficiaries in the National DPP lifestyle change, visit the Recruitment and Referral page and the Retention page of the Coverage Toolkit.
To better address HRSNs, Maryland Department of Health has connected each of their managed care organizations (MCOs) with regional CDC-recognized organizations to discuss and develop plans for collaboration. Together, they are developing an eligibility algorithm and are creating pathways to work with health care providers to adapt initiatives to better align with a patient-centered point of view. This includes developing referrals to community-based organizations that address HRSNs.
In addition to their referral system, Maryland is also using CHWs as lifestyle coaches to deliver the National DPP lifestyle change program. CHWs typically act as a member of the care delivery team supporting health equity by providing care education, social service navigation, and coordination, while also organizing peer support and performing outreach.
For additional information about Maryland’s involvement with the National DPP lifestyle change program, see the Maryland Medicaid Demonstration Project page of the Coverage Toolkit.
Medicaid Demonstration Project
During the Medicaid Coverage for the National DPP Demonstration Project, lifestyle coaches met the needs of program participants by incorporating low-budget recipe suggestions and culturally relevant food and exercise strategies. They also allowed for program flexibility by implementing flexible make-up sessions that were held individually, in small groups, and over the phone; and allowed participants to bring family members or caregivers to class. Finally, the lifestyle coaches coordinated group outings such as fitness classes, group walks/runs, local grocery store tours, and trips to local farmers’ markets.
Some of the participating MCOs and accountable care organizations (ACOs) addressed the needs of Medicaid beneficiaries by providing transportation vouchers, ride-shares, and/or free or reduced-price childcare. CDC-recognized organizations indicated that addressing these HRSNs was more effective at facilitating participant retention than offering monetary program supports.
For more information, see the Medicaid Coverage for the National DPP Demonstration Project Retention Brief.
The Mississippi State Department of Health has collaborated with their Department of Agriculture to expand the Supplemental Nutrition Assistance Program (SNAP) program benefits and deliver additional food to people participating in the National DPP lifestyle change program and other evidence-based programs such as Diabetes Self-Management Education and Support (DSMES). As part of this initiative, Mississippi has worked with farmers’ markets to support locations near community centers and prepare community food subscription programs for individuals in need.
The North Carolina Department of Health and Human Services (NCDHHS) launched its Healthy Opportunity Pilots program in February 2022 through an 1115 waiver. These pilots cover the cost of 29 interventions, including the National DPP lifestyle change program, for select counties enrolled in the regional pilots. These pilots also address other HRSNs such as housing stability, transportation, food security, interpersonal violence, and toxic stress. The goal of the pilots is to create and evaluate a systematic approach to integrate and finance evidence-based, non-medical interventions.
NCDHHS released several resources to learn more about the program including a fact sheet, policy paper, and FAQ document. Additional resources can be found on the Healthy Opportunities Pilots website.
The Rhode Island Department of Health is implementing multiple layers of screening for and addressing HRSNs among National DPP lifestyle change program participants. In partnership with the state’s ACOs and CDC-recognized organizations, it is focusing on addressing HRSN-related factors that impact program participation, as well as needs that go beyond program goals. The Rhode Island Department of Health’s planning team outlined a screening and referral workflow to identify HRSN touch points. For example, Community Health Network (CHN) patient navigators serve a key role in identifying HRSNs during both enrollment and follow-up calls. Rhode Island plans to scale National DPP lifestyle change program access and utilization by increasing the number of CHWs and lifestyle coaches that are trained in these areas.
The Virginia Department of Medical Assistance Services (Virginia Medicaid) has engaged in discussions with MCOs on how individuals with HRSNs can be identified. Virginia Medicaid is also working to identify individuals that are eligible for the National DPP lifestyle change program by linking primary care physicians to National DPP lifestyle change program referrals via automated orders through their electronic health record (EHR). This process allows collaborative partners to access HRSN screenings performed directly by those who care for the individuals.
Within the recruitment process, Virginia Medicaid is also creating initiatives to ask and determine what would prevent participants from participating in the National DPP lifestyle change program. This initiative allows Virginia Medicaid to assess individual HRSNs. This initiative is supported by participating MCOs that want to improve enrollment and retention in the National DPP lifestyle change program.
In addition to this work, Virginia is working to roll out an initiative that provides healthy food vouchers and childcare stipends to participants in the National DPP lifestyle program as they meet predetermined milestones.