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. 2020 Dec 31;10(6):1554-1558.
doi: 10.1093/tbm/ibz098.

Rural/urban disparities in access to the National Diabetes Prevention Program

Aviva H Ariel-Donges  1 , Eliza L Gordon  1 , Brittney N Dixon  1 , Abraham J Eastman  1 , Viviana Bauman  1 , Kathryn M Ross  1 , Michael G Perri  1
Affiliations

Rural/urban disparities in access to the National Diabetes Prevention Program

Aviva H Ariel-Donges et al. Transl Behav Med. .

Abstract

Residents of rural communities generally have limited access to preventive health services such as lifestyle programs for weight management. In 2009, the U.S. Congress authorized the Centers for Disease Control and Prevention (CDC) to partner with local community organizations to disseminate the Diabetes Prevention Program (DPP), an evidence-based lifestyle intervention for weight management. Given that the National DPP (NDPP) was designed to broaden nationwide access to weight-loss treatment for adults at high risk for developing diabetes, the present study examined the implementation of the NDPP in rural and urban counties across the USA. The names and locations of NDPP community partnership sites were collected from the CDC website and cross-referenced with the U.S. Census Bureau's classification of counties as rural versus urban. Results showed that overall 27.9% of the 3,142 counties in the USA contained one or more NDPP partnership sites. However, significantly fewer rural counties had access to a NDPP site compared with urban counties (14.6% vs. 48.4%, respectively, p < .001). This disparity was evident across all types of partnership sites (ps < .001). These findings indicate that implementation of the NDPP has expanded the overall availability of evidence-based weight-management programs across the USA. However, this increase has been disproportionately greater for urban counties versus rural counties, thereby widening the rural/urban disparity in access to preventive health services. Alternative dissemination strategies that address the special barriers to implementation faced by rural communities are needed to increase access to the NDPP.

Keywords: Diabetes Prevention Program; Health disparities; Rural health; Weight management.

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Figures

Figure 1
Figure 1
Percentage of rural and urban countries with National Diabetes Prevention Program access according to partnership type. The percentage of sites with access was higher in urban versus countries across all partnership types, all ps < .0001.
See this image and copyright information in PMC

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