Journal of Medical Internet Research - International Scientific Journal for Medical Research, Information and Communication on the Internet #Preprint #PeerReviewMe: Warning: This is a unreviewed preprint. Readers are warned that the document has not been peer-reviewed by expert/patient reviewers or an academic editor, may contain misleading claims, and is likely to undergo changes before final publication, if accepted, or may have been rejected/withdrawn. Readers with interest and expertise are encouraged to sign up as peer-reviewer, if the paper is within an open peer-review period. Please cite this preprint only for review purposes or for grant applications and CVs (if you are the author). Background: With increased access to technology and the Internet there are many opportunities for utilizing e-health, Internet or technology-delivered health services and information, for the prevention and management of chronic diseases. Objective: The purpose of this paper is to explore (1) the differences in technology use, (2) online health information seeking and use behaviors, (3) attitudes towards seeking health information online, and (4) level of e-health literacy between adults aged 18-64 with and without chronic disease(s). Methods: A cross-sectional, Internet survey was conducted in March 2017 with 401 U.S adults. Participant responses were examined to understand associations between chronic disease status and e-health behaviors such as Internet health-seeking behaviors and online behaviors related to health, tracking health indicators with a mobile app, patient portal use, and preferences for health information. Results: About one in three (37.2%) participants reported at least one chronic disease diagnosis. Around 75% of all participants reported having ever searched for health information online. Participants with a chronic disease reported significantly higher instances of visiting and talking to a healthcare provider based on health information found online (40.0% vs. 25.8%, X2(2)=6.65, p=.01; 43.3% vs. 27.9%, X2(2)=7.58, p=.006). The uses of health information found online also significantly differed between participants with and without chronic diseases in affecting a decision about how to treat an illness or condition (49.2% vs. 35.0%, X2(3)=6.66, p=.04), changing the way they cope with a chronic condition or manage pain (40.8% vs. 19.4%, X2(2)=16.33, P<.001), and leading them to ask a doctor new questions or get a second opinion (37.5% vs. 19.6%, X2(2)=11.8, p<.001). Chronic disease participants were significantly more likely to be tracking health indicators (43.9% vs. 28.3%, X2(2) = 10.42, p=.006). Around 24% of all participants reported using a health related mobile app. In addition, participants with a chronic disease diagnosis reported significantly higher rates of patient portal access (55.0% vs 42.1%, X2(2)=6.33, p=.01) and use (40.9% vs 21%, X2(2)=18.24, P<.001). Lastly, both groups reported similar perceived skills in using the Internet for health information on the eHEALS health literacy scale. Higher eHEALS average scores also were significantly associated with e-health behavior engagement in both groups. The majority of participants responded positively when asked about the usefulness of health information and importance of accessing health resources online. Conclusions: The high rates of reported information seeking and use of Internet-based health technology among participants with chronic disease may reflect the uptake in e-health to help manage chronic disease conditions. Healthcare providers and educators should continue to seek ways to interact and support patients in their management of chronic disease through e-health platforms, including capitalizing on online resources, patient portals, and smartphone apps for disease education and monitoring.

Background: Scaling evidence-based interventions are key to impacting population health. The National DPP lifestyle change program is one such intervention that has been scaled across the USA over the past 20 years; however, enrollment is an ongoing challenge. Furthermore, little is known about which organizations are most successful with program delivery, enrollment, and scaling. This study aims to understand more about the internal and external organization factors that impact program implementation and reach.Methods: Between August 2020 and January 2021, data were collected through semi-structured key informant interviews with 30 National DPP delivery organization implementers. This study uses a qualitative cross-case construct rating methodology to assess which Consolidated Framework for Implementation Research (CFIR)innerandouter settingconstructs contributed (both in valence and magnitude) to the organization’s current level of implementation reach (measured by average participant enrollment per year). A construct by case matrix was created with ratings for each CFIR construct by interviewee and grouped by implementation reach level.Results: Across the 16 inner and outer setting constructs and subconstructs, the interviewees with greater enrollment per year provided stronger and more positive examples related to implementation and enrollment of the program, while the lower reach groups reported stronger and more negative examples across rated constructs. Four inner setting constructs/subconstructs (structural characteristics, compatibility, goals and feedback, and leadership engagement) were identified as “distinguishing” between enrollment reach levels based on the difference between groups by average rating, the examination of the number of extreme ratings within levels, and the thematic analysis of the content discussed. Within these constructs, factors such as organization size and administrative processes; program fit with existing organization services and programs; the presence of enrollment goals; and active leadership involvement in implementation were identified as influencing program reach.Conclusions: Our study identified a number of influential CFIR constructs and their impact on National DPP implementation reach. These findings can be leveraged to improve efforts in recruiting and assisting delivery organizations to increase the reach and scale of the National DPP as well as other evidence-based interventions.

Background: The National Diabetes Prevention Program (DPP) has made great strides in increasing accessibility to its year-long, evidence-based lifestyle change program, with around 3000 organizations having delivered the program. This large dissemination effort offers a unique opportunity to identify organization-level factors associated with program implementation and reach (enrollment) across diverse settings. The purpose of this study was to quantitatively examine the relationships among Consolidated Framework for Implementation Research (CFIR) Inner Setting and Outer Setting constructs and the implementation outcome of reach. Methods: This study analyzed data from a 2021 cross-sectional online survey with 586 National DPP Staff (lifestyle coaches, master trainers, program coordinators) with information about their organization, implementation outcomes, and responses to quantitative CFIR Inner Setting and Outer Setting construct items. Structural equation modeling was used to test a hypothesized path model with Inner and Outer Setting variables to explore direct and indirect pathways to enrollment. Results: The CFIR items had good internal consistency and indicated areas of implementation strength and weakness. Eight variables included as part of the CFIR structural characteristics and one organization characteristic variable had significant direct relationships with enrollment. The length of delivery, number of lifestyle coaches, number of full-time staff, large organization size, and organizations delivering in rural, suburban, and/or urban settings all had positive significant direct relationships with enrollment, while academic organizations and organizations with only non-White participants enrolled in their National DPP lifestyle change programs had a negative association with enrollment. Conclusions: Participant reach is an important implementation outcome for the National DPP and vital to making population-level decreases in diabetes incidence in the USA. Our findings suggest that to facilitate enrollment, program implementers should focus on organizational structural characteristics such as staffing. Strengths of this study include the use of adapted and newly developed quantitative CFIR measures and structural equation modeling. Health prevention programs can use the methods and findings from this study to further understand and inform the impact of organization factors on implementation outcomes.

Preventing Chronic Disease (PCD) is a peer-reviewed electronic journal established by the National Center for Chronic Disease Prevention and Health Promotion. PCD provides an open exchange of information and knowledge among researchers, practitioners, policy makers, and others who strive to improve the health of the public through chronic disease prevention.

Background/Objectives: Lifestyle coaches are integral to delivery of the National Diabetes Prevention Program (DPP); however, few studies have explored the role of the lifestyle coach in relation to participant success. This study aimed to develop a conceptual model of the factors that contribute to lifestyle coach performance and success. Methods: A cross-sectional qualitative study including 82 semi-structured interviews with National DPP staff and participants between June 2020 and February 2022. Results: Based on the analysis of the interviews, the developed model illustrates how central to coach success are the intrinsic qualities they bring to the role, the quality of their training and preparation for the lifestyle coach role, and the mechanization of their qualities and training through their program delivery. Around this focal relationship revolve four other factors that together or independently affect lifestyle coach success: organization influences; external influences; program participants; and evaluation and feedback. Conclusions: Health coaching can be an incredibly powerful tool in behavior change. This model provides insight into how coaching can impact participant outcomes and can be used by other health promotion programs who use the coach model.

Background: Scaling evidence-based interventions is key to impacting population health. The National DPP lifestyle change program is one such intervention that has been scaled across the United States over the past 20 years, however enrollment is an ongoing challenge. Furthermore, little is known about which organizations are most successful with program delivery, enrollment, and scaling. This study aims to understand more about the internal and external organization factors that impact program implementation and reach.Methods: Between August 2020 and January 2021, data were collected through semi-structured key informant interviews with 30 National DPP delivery organization implementers. This study uses a qualitative cross-case construct rating methodology to assess which Consolidated Framework for Implementation Research (CFIR) Inner and Outer Setting constructs contributed (both in valence and magnitude) to the organization’s current level of implementation reach (measured by average participant enrollment per year). A construct by case matrix was created with ratings for each CFIR construct by interviewee and grouped by implementation reach level.Results: Across the 16 inner and outer setting constructs and subconstructs, the interviewees in the higher reach group provided stronger (+2) and more positive examples related to implementation and enrollment of the program, while the lower reach groups reported stronger (-2) and more negative examples across rated constructs. Four inner setting constructs/subconstructs (structural characteristics, compatibility, goals & feedback, and leadership engagement) were identified as “distinguishing” based on the difference between groups by average rating (+.5 difference between levels), the examination of the number of extreme (+2 or -2) ratings within levels, and the thematic analysis of the content discussed.No outer setting constructs were distinguishing. Four constructs/subconstructs (incentives & rewards, learning climate, access to knowledge & information, and patient needs & resources) were not discussed in relation to implementation reach sufficiently for the rating analysis. Conclusions: Our study identified a number of influential CFIR constructs and their impact on National DPP implementation reach. These findings can be leveraged to improve efforts in recruiting and assisting delivery organizations to increase the reach and scale of the National DPP as well as other evidence-based interventions.