Date of Award

2015

Degree Type

Dissertation

Degree Name

Doctor of Philosophy (PhD)

Department

Nursing

First Advisor

Patricia Burbank

Abstract

Since the Diabetes Prevention Program Research Group (2002) concluded that type 2 diabetes can be prevented or delayed in pre-diabetic individuals, translation of the study's intensive lifestyle intervention has been a research priority. Translational research conducted with the high risk Hispanic population is in its infancy. In general, the needs of this population have been neglected in the development and refinement of interventions to prevent T2D. This qualitative study explored intervention components and the perceived facilitators and barriers to making and sustaining dietary and physical activity behavior changes within the context of a lifestyle intervention program designed for a high risk Hispanic population. This study also explored the impact of the lifestyle intervention program and individual behavior change on the lives of participants. Three focus group interviews and one individual interview was conducted with 17 uninsured, predominantly Spanish-speaking individuals who completed a lifestyle program offered by a free urban community health clinic in the northeast region of the U.S. A moderator's guide with semi-structured interview questions was used. Interviews were translated and transcribed verbatim. Data analysis was conducted using an inductive data-driven approach. Krueger and Casey's (2000) criteria for coding and Sandelowski's (1995) suggestions for qualitative data analysis provided guidance for analysis. A systematic process of data reduction resulted in 24 categories and sub-categories. Participants described the program they attended as 1) a novel learning experience that provided practical and detailed information, 2) a supportive environment that was motivating and encouraging with an emphasis on health and, 3) a catalyst for changing dietary and physical activity behaviors. Participants described rapidly adopting multiple dietary and physical activity behaviors by linking health behavior to health outcomes and self-regulating through cognitive processes. Two facilitators of dietary and physical activity behaviors were identified, 1) physical and emotional benefits, 2) social support and (3) persistence. Barriers identified were physical sensations and social and emotional aspects of everyday life. Program impact included a preference for life after making behavior changes, an increased consciousness that helped sustain behaviors and the desire to continue forward. Participants also recognized the affect their individual changes had on others. In summary, this study found that education, in-person support, and program duration were important components of a lifestyle intervention program for a high risk Hispanic population. Further research is needed to explore tailoring of evidence-based lifestyle interventions and issues related to the sustainability of programs aimed at reducing type 2 diabetes in high risk populations.

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