Recent research findings confirming the feasibility and effectiveness of interventions to prevent or delay the onset of type 2 diabetes are of keen interest to many stakeholders, including communities from which diabetes exacts a heavy toll. To inform communication and program planners at national and local levels, the Division of Diabetes Translation, Centers for Disease Control and Prevention, turned to people and communities affected by diabetes for their views about diabetes prevention. We review the key themes that emerged across diverse populations and some examples of subthemes relevant to particular groups. Adults at risk for type 2 diabetes and community leaders from five racial and ethnic groups participated in 27 focus groups from five geographic locations across the country. We explored participant's knowledge, attitudes, and beliefs about diabetes and factors that would enable or impede lifestyle interventions at individual and community levels. Multiple analysts categorized responses using the qualitative technique of constant comparison. Many themes, some cutting across groups and some unique to specific groups, emerged about the negative effect of modern lifestyles on the health of adults and children. But positive findings about diabetes prevention generated hope that diabetes was not inevitable. All the focus groups noted that interventions were difficult to initiate and maintain and that social support, modeling stories, and community connections were needed. Listening to community members identified common and group-specific themes. These findings can inform health promotion messages and support adaptive community interventions for diabetes prevention.
The rising trends in the incidence and prevalence of type 2 diabetes (hereafter referred to as diabetes) in the last decade have become newsworthy as public awareness grows that these trends nip at the heels of escalating rates of obesity among Americans. The number of Americans with diagnosed diabetes (including gestational diabetes) increased 61 percent from 1991 to 2001, paralleling a 74 percent rise in the number of Americans over the same years who are obese.1 Furthermore, type 2 diabetes among children and adolescents–previously considered a medical oddity2–is now a growing concern in all U.S. populations.3
New scientific promise for curtailing the diabetes epidemic, specifically among persons at risk for this disease, has been unveiled in clinical trials conducted in recent years.4–6 Participants in these trials (discussed by Bowman and colleagues7) had a preclinical condition known as impaired glucose tolerance. An estimated 12 million overweight Americans aged 45 to 74 years have impaired glucose tolerance or impaired fasting glucose, together known as prediabetes.8 This is a vast audience for messages about the potential for preventing or delaying the onset of diabetes.
The challenges of embedding resonant, population-based messages about diabetes prevention in community and health systems interventions are formidable. Type 2 diabetes is a complex illness involving reciprocal interactions of related factors–acquired patterns of eating and activity, inherent factors (e.g., gender, age, and genetic predisposition), histories of dispossession of land, language, and culture,9 and other sociological factors and environmental factors (e.g., economic status and natural and constructed physical environments).10 Obesity and sedentary living are powerful risk factors for diabetes that cannot be isolated from the context of such “risk conditions” in communities that contribute to the development of diabetes.11,12 Indeed, “the health of the individual is almost inseparable from the health of the larger community.”13 (p. 5)
Therefore, the Division of Diabetes Translation (DDT), Centers for Disease Control and Prevention (CDC), maintaining that the community's voice is essential in matters of its own health,14 initiated a formative evaluation project that sought to “start with what is close to people's hearts”15 (p. 441) regarding the prevention of diabetes. By listening to community representatives in work groups, focus groups, surveys, and other forums, the DDT determined to gain insight about diabetes prevention from persons at risk for type 2 diabetes and community leaders. The project's primary purposes were to influence the design of effective universal and population-specific health promotion messages and to support adaptive community interventions for diabetes prevention. This article is derived from health communications formative evaluation conducted by Westat for the DDT.16