Current 58 - Tailored Text Messaging to Enhance Diabetes Prevention Program (DPP) Readiness and National DPP Enrollment

Summary

The National Diabetes Prevention Program Lifestyle Change Program (DPP LCP) is a structured, evidence-based initiative designed to prevent or delay onset of type 2 diabetes.¹ Although alleviating health-related social needs can reduce participation barriers, additional obstacles persist, particularly the lack of readiness to adopt the core DPP behaviors (physical activity, healthy dietary patterns, and stress-management strategies) and the variability in an individual’s readiness to engage with the program. A new initiative, the bRIght communities program, has shown promise for increasing readiness for diabetes-preventive behaviors, reducing health-related social needs, and augmenting enrollment in the DPP LCP.²

The program is a bilingual, theory-driven, public health intervention delivered via text messages in Rhode Island. Using community-based participatory methods and the Transtheoretical Model, better known as the ‘Stages of Change’ (precontemplation, contemplation, preparation, action, and maintenance)³, the program delivers dynamically tailored text message modules over a 10-day period with zip code-matched referrals for food, transportation, childcare, and safety concerns, with modules repeated monthly for up to six months.

Of the 432 adults recruited to the program (excluding people with diabetes or who were pregnant), 273 (68.7%) completed a six-month follow-up (mean age: 40.1 years; 70.3% classified as overweight/obese).² Primary outcomes showed 30.3% of participants with or at risk for prediabetes advanced ≥1 Stage of Change toward National DPP LCP enrollment. Additionally, reported enrollment or waitlist status rose from 9.6% to 20.2%. Secondary outcomes demonstrated medium effect sizes for increased fruit and vegetable intake and weekly physical activity among participants who were previously inactive. There were also significant reductions in food insecurity, transportation barriers, and perceptions of feeling unsafe while exercising in one’s neighborhood.

Sources

1. Centers for Disease Control and Prevention. National Diabetes Prevention Program. https://www.cdc.gov/diabetes-prevention/index.html. Accessed September 22, 2025.

2. Johnson SS, Castle PH, Bosack S. Leveraging technology and theory to change health behaviors, close gaps in health-related social needs, and increase enrollment in the National Diabetes Prevention Program. Prev Chronic Dis. 2025;22:E10. doi:10.5888/ pcd22.240284.

3. Prochaska JO, Velicer WF. The transtheoretical model of health behavior change. Am J Health Promot. 1997;12(1):38-48. doi:10.4278/0890-1171-12.1.38.

This summary was created with assistance from generative artificial intelligence (Microsoft Copilot, 2025)