| Question |
Code |
Response |
| Demographic |
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| 1. Grantee/Organization Name |
GRANTEE |
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| 2. Grant Year |
GRANT_YR |
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| 3. Fiscal Year |
FIS_YR |
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| Intervention Description |
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| 4. Is there purposeful targeting of NEW disparate or vulnerable populations at the grantee level? If so, what populations are targeted? Please select ALL that apply. |
OVULPOP |
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| If you answer "Other," please specify. |
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| 5. Did you recruit or select NEW sites in the current grant year? If no, skip to question 9. |
SITE_NEW |
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| 6. Please provide the name and organizational code for all NEW sites recruited or selected in the current grant year. |
NEWSITE_CODE |
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| 7. Among NEW sites that began in the current grant year, how many are currently offering the National DPP lifestyle change classes? |
NUM_SITE |
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| 8. How did you or your sub awardee (if applicable) recruit and/or select sites to offer the lifestyle program (i.e., recruitment methods such as materials or campaigns, working with healthcare groups/practices, etc.) in the current grant year? Please select ALL that apply. |
OREC_METH_SITE |
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| If you answer "Other," or "Select based on other criteria" please specify. |
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| 9. Where or at what level are you targeting participant recruitment efforts? Please select ALL that apply. |
INTLEVL_Y3 |
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| If you answer "Other," please specify. |
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| 10. Did you engage in any activities to recruit participants directly or connect them to a program site? If so, what activities? Please select ALL that apply. |
OREC_ACT_PAR |
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| If you answer "Other," please specify. |
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| 11. What materials, if any, were used to help drive/direct participants to the site lifestyle change programs? Please select ALL that apply. |
OREC_METH_PAR |
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| If you answer "Other," please specify. |
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| 12. If you engage in any activities to recruit participants through marketing materials, including social media postings; please provide total number per each type of marketing materials or postings used/distributed if available. |
NUMMKMAT |
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| 13. What kinds of incentives and/or behavioral techniques, if any, were used to retain program participants? Please select ALL that apply. |
ORG_INCENT |
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| If you answer "Other," please specify. |
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| 14. Was there any change in policy resulting in a new financing/reimbursement mechanism? If so, who was the target of the change in policy resulting in a new financing/reimbursement mechanism? Please select ALL that apply. |
OCOVPOL_Y2 |
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| If you answer "Other," please specify. |
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| 15. What was the policy that was changed? Please select ALL that apply. |
OCOVPOL_Y3 |
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| If you answer "Other," please specify. |
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| 16. If yes to policy changes with insurers, how many new insurers and markets are now providing reimbursement or coverage for the lifestyle change program? Please select which type of insurer, and for each insurer please specify the name of the insurer and specify the market (a geographic level indicating the state or region, or county). |
INS_NEW |
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| If you answer "Other," please specify. |
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| Resources |
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| 17. For the current grant year, how many lifestyle coaches were trained? |
TOTTRND |
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| 18. For the current grant year, how many master trainer lifestyle coaches were trained? |
TOTTRND_MASTER |
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| 19. For the current grant year, what was the average number of days of training received for lifestyle coaches? |
DAYSTRND |
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| 20. For the current grant year, what was the average number of days of training received for master trainers? |
DAYSTRND_MASTER |
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| 21. Please select from the list who trained NEW lifestyle coaches. Please select ALL that apply. |
WHOTRAND |
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| If you answer "Other," please specify. |
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| 22. Did lifestyle coaches receive an additional one day of motivational interview training? |
MOT_INTW |
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| 23. Please provide the average monetary cost per new lifestyle coach trained. |
AVCOSTRN |
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| Reach |
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| 24. For current grant year, at what level is the reimbursement or financing mechanism targeted (e.g., state, county, other government or non-profit organization, etc.)? Please select ALL that apply. |
SEEKFUND |
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| If you answer "Other," please specify. |
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| 25. Have you communicated with any state health departments or other 1422 awardees about collaboration for diabetes prevention program reimbursement? If so, please describe. |
REIMCOMM |
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| 26. For the current grant year, please provide the number of employers who were educated about the benefits and cost-savings of the evidence-based lifestyle change program as a covered health benefit for employees. |
NUMEMPEDEMPLY |
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| 27. For the current grant year, please provide the number of employers who offer the National DPP program on-site. |
NUMEMPLY |
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| 28. For current grant year, please provide the number of employers offering the National DPP lifestyle change program as a covered benefit or as a wellness benefit for employees. |
NUMWELL |
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| 29. For the current grant year, please provide the number of employer council events attended to educate participants about the benefits and cost-savings of the evidence-based lifestyle change program. |
NUMEMCON |
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| 30. For current grant year, please provide the number of health care purchasing coalitions educated about the benefits and cost-savings of the evidence-based lifestyle change program. |
NUMHCPRC |
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| 31. For current grant year, please provide the number of insurance broker events attended to educate participants about the benefits and cost-savings of the evidence-based lifestyle change program. |
NUMINSBK |
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| Implementation Strategies |
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| 32. Please select from the list the barriers to NEW site start-up (if applicable) and implementation in current grant year. Please select ALL that apply. |
ORG_BAR |
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| If you answer "Other," please specify. |
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| 33. Have you calculated the average cost per participant amongst your program sites? If you are able to report, what is the numeric value of the cost? |
AVCOSTPAR |
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| 34. Please select from the list strategies to address barriers listed above at organizational level for Year 3. Please select ALL that apply. |
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| ORGSRAT |
If you answer "Other," please specify. |
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| Grantee |
GRANT_YR |
FIS_YR |
OVULPOP |
SITE_NEW |
OREC_METHSITE |
INTLEVL_Y3 |
OREC_ACT_PAR |
OREC_METH_PAR |
ORG_INCENT |
OCOVPOL_Y2 |
OCOVPOL_Y3 |
INS_NEW |
WHOTRAND |
MOT_INTW |
SEEKFUND |
ORG_BAR |
ORGSRAT |
NUMMKMAT |
| AADE |
Year 1 |
2013 |
No targeting of NEW disparate or vulnerable populations |
Yes |
Recruit via Organization's website |
State Population |
Did not engage in any participant recruitment |
CDC/DTTAC Consumer Brochure |
Cash prizes |
Insurance |
Employee coverage benefit |
Private Insurer (e.g., Cigna, BCBS, United Healthcare): Please Specify insurers and markets |
DTTAC |
Yes, all |
Public Insurance Plan |
Procuring funding |
Improve communication with CDC |
Paper marketing materials (i.e. flyers, pamphlets, brochures, and/or posters) |
| AHIP |
Year 2 |
2014 |
Low SES |
No |
Recruit via Email blast to partners |
County/Local Population |
Direct recruitment by program staff (i.e. approaching participants one-on-one in their physician office or other setting) |
CDC/DTTAC Consumer Poster, 8.5x11 |
Motivational interviewing |
Employer |
Insurance coverage benefit |
Government-sponsored: Medicare |
University of Pittsburg |
Yes, some |
Private Insurers |
Lifestyle change program reimbursement issues |
Offering additional classes |
Social media postings (i.e., FB, Twitter, Instagram) |
| BWHI |
Year 3 |
2015 |
Under or uninsured |
N/A |
Recruit via Leveraging pre-existing relationships |
Health care systems/Practices |
Conducting or participating in health fairs and/or other community outreach activities (including blood glucose screening events at worksites) |
CDC/DTTAC Consumer Poster, 11x17 |
Nonmonetary benefits: gym membership |
National |
Pay for performance |
Government sponsored: Medicaid |
University of Indiana |
No, none |
Grants |
Staff support |
Adjusting class schedule/timelines |
Organization website visits |
| NACDD |
Year 4 |
2016 |
Race/ethnicity: African-American |
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Recruit via Phone outreach |
Insurers |
Recruiting providers to make referrals during patient visit or to send letters/postcards to patients |
CDC/DTTAC HCP Referral Form |
Nonmonetary benefits: athletic gear |
Other |
Participant fee waiver or scholarship paid by grant |
Government sponsored Other (e.g., TriCare) |
YUSA |
N/A |
Other Government Funding |
Lack of clear program guidance from CDC |
Organizational staff volunteer additional hours |
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| OPTUM |
N/A |
N/A |
Race/ethnicity: Native American |
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Recruit via Press release |
Non-profit org |
Recruiting other organizational partners to make direct referrals or recruit via contact lists |
CDC/DTTAC HCP Brochure |
Nonmonetary benefits: grocery store vouchers |
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New in kind support |
State Employee sponsored |
New trainers trained by Master Trainers |
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Employer Funding |
Buy-in/engagement from partners |
Expanding marketing efforts to community to increase participant enrollment |
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| YUSA |
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Race/ethnicity: Hispanic/Latino |
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Recruit via collaborating with state 1422 grantees |
Employers |
Advertising and press release in newsletters, local newspapers, radio, or television stations |
ANY Common Ground resource not listed here |
Nonmonetary benefits: cookbooks or other dietary materials |
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Employer sponsored delivery |
Other |
Other |
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Other Funding |
Space for program delivery |
Restructuring incentive strategies |
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Race/ethnicity: Asian/Pacific Islander |
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Select based on Proximity to target demographic |
Government entity (state employees) |
Presentations/information sessions to community/employees |
Grantee- developed marketing materials/campaigns |
Non-monetary benefits: healthful food snacks or samples |
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Other |
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N/A |
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N/A |
Healthcare providers or physician resistance to refer to program |
Seeking in-kind staff/classroom space |
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Race/ethnicity: Other (describe) |
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Select based on Readiness assessment (org/partners) |
Y-membership |
Volunteer recruiters from previous lifestyle change classes (through word-of-mouth, phone, or email) |
Materials/campaigns developed by partner organizations |
Other |
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Low enrollment |
Continued engagement with partners/key stakeholders |
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Geography: Rural or frontier |
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Select based on other criteria |
Other |
Posting on Organization website, or email blast to members |
N/A |
N/A |
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Participant drop-out |
Organization developed own marketing materials |
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Geography: Urban |
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N/A |
N/A |
Other |
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Length of lifestyle change program |
Implementation/work plan revision |
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Elderly |
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Other |
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Lifestyle coach training delay |
Educating target audience on evidence-based lifestyle change programs |
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Low literacy |
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Organization structural change |
Recruite alternative program providers |
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Disabled |
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Class schedule timing |
Finding provider champions |
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Not targeting a vulnerable population |
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Lack of motivation from participants |
Organization developed own Spanish materials/offered class in Spanish |
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Other (describe) |
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Slow hiring process at organizational level |
Offer additional training on DPRP data collection |
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N/A |
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Public/private insurers' delayed process on membership outreach |
Other |
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Delay in Spanish curriculum/marketing materials |
N/A |
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Planning and implementation barriers |
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Sub-grantee non-compliance |
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Other |
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N/A |
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