A mixed-methods assessment of engagement in wellness programs for patients with prediabetes: Factors associated with referral and participation in lifestyle wellness programs.

Objective: We assessed factors associated with engagement in lifestyle wellness programs for patients with prediabetes.

Methods: This mixed-methods study, conducted between March 2018 and April of 2021, combined a retrospective cohort study and semi-structured interviews in a Northern California cohort of patients from a randomized controlled pragmatic clinical trial aged 18-75 with body mass index 25 and at least one HbA1c between 5.7-6.4 % in the previous 3 months. Patients were assigned to a peer support, enhanced usual care, or control arm. We used generalized linear mixed models to analyze the association between clinical, demographic, and study-related factors and referral to and participation in wellness programs within 12 months. We conducted semi-structured interviews with intervention participants and analyzed them using thematic analysis. We integrated qualitative and quantitative findings using the "following a thread" method.

Results: We identified 2,164 eligible patients; 12.8% were referred to a wellness program and 7% attended a wellness program. Patients not exposed to peer support, males, and Asian-American participants had the lowest odds of participation in wellness programs. Qualitative interviews with 30 intervention participants provided contextual information on quantitative findings including the importance of physician referrals and formal recruitment, a need for social support and accountability, and matching patient needs to wellness program descriptions as facilitators of engaging in wellness programs.

Conclusion: Given the low percentage of patients with prediabetes referred to and participating in wellness programs, there is a need to develop health system strategies to improve wellness program engagement for patients at-risk for diabetes.