Skip to main content

Table 3 Qualitative Quotes

From: Implementation of a group-based diabetes prevention program within a healthcare delivery system

 1. Adoption

1.1. “There is a higher need. We have a lot of patients in this area who need this kind of program” (7–1)

1.2. “We needed the program and we thought that it would be beneficial to help prevent diabetes and for weight loss” (34–3)

 2. Penetration

2.1. “when I practice and I see a patient individually for weight management, I also will mention, we have this program that’s available to you” (20–2)

2.2. “I went to all of their staff meetings. I went to a staff meeting for every department in our area. So, I went and introduced myself and the program” (9–1)

2.3. “We had an endocrinologist here that was part of the program that pushed it and went around and talked to all the primary doctors about what a great program and the outcomes that Pittsburgh have had.” (23–2)

2.4. “The process is that we get a referral from the physician then they do a one-on-one consultation” (35–3)

2.5. “The providers are extremely busy. They do a follow up to a certain extent” (21–2)

2.6. “It falls off their radar when they’re managing everything else” (9–1)

 3. Acceptability

3.1. “I love it when patients maybe lose a little bit of weight and change their eating lifestyle and then they come to me so excited that their lipid panels have improved or their A1C has improved” (34–3)

3.2. “It’s really allows patients to think, it gives them flexibility versus handing over a diet, so that’s good”(32–2)

3.3. “I think the strengths of the program were that it offered a proven program that worked” (28–2)

3.4. “I think it’s good information because they really need to have the medical evidence because the medical background made them understand that in the past this has worked for people and these are the statistics” (6–1)

3.5. “I do really like that that’s a big part of that program because it would get them thinking about why they made some of the choices that they made” (18–1)

3.6. “When we work on problem solving and just identifying emotional triggers, and then get into mindful eating; they’ve been like – it blows their mind. That stuff is powerful. I think that’s more important, honestly, than the nutritional info” (14–2)

3.7. “I think they found that when they have support from the other participants really helps keep them going to because they’re going to the same thing. I think it’s just the support they get in the program the kept them going” (35–3)

3.8. “I think having the group that was there cheered him” (2–2)

3.9. “No, it’s not because once we get the referral they can either choose to attend the one class Healthy Basics. If that doesn’t work out for them or they don’t want to do the class setting, then they get the one-on-one (35–3)

3.10. “It’s always a challenge to keep the group coherent and that one member doesn’t do all the talking. You have to control that group setting” (34–3)

3.11. “You don’t know who comes in the beginning, and if that group works, and if the chemistry of that group is working or not” (1–2)

3.12. “It’s presented in a manner that I think most people can understand and not feel overwhelmed by, especially when it’s explained” (22–2)

3.13. “The classes went in a nice order, kind of building on each topic throughout the three months” (12–1)

3.14. “Basically it puts people to sleep, so I make my own slides. I will get my own visual. I will bring in like food models, or real food and have them taste it” (33–2)

3.15. “They like the idea that they talk about a topic and they can set a goal based on that topic. Or, they’ll change a goal” (3–2)

3.16. “Aiming for 7% weight loss is often a lot less than what participants state that they want to lose …I think patients expect greater results” (27–2)

 4. Appropriateness

4.1. “The patient population here is very educated, very smart. They’re technologically extremely advanced and savvy….they used to ask complex questions” (32–2)

4.2. “The highly educated that were in our groups, that was a negative because they felt it was just too simplistic and didn’t give them enough resources in their every-day life.” 25–2

4.3. “I think the learning level is appropriate. Because I think, the way that they break down the concepts is easy to understand for most people” (16–1)

4.4. “It’s written at a pretty good level…..the patients have all understood it pretty well” (34–3)

4.5. “I feel like it just skims the surface for a lot of information” (4–1)

4.6. “I think for my group… they can deal with more complicated examples.” (3–2)

4.7. “Some of the handouts just don’t have enough information about exercising or physical activity… whatever the topic may be” (15–2)

4.8. “It is very diet-oriented, which can backfire if you’re not careful” (24–2)

4.9. “It’s just kind of like … like nutrition, nutrition, nutrition, nutrition” (9–1)

4.10. “So, nutrition is constantly changing. Right? By the time you print something, the recommendation already changed…So, that was the problem with GLB, because that material we were looking at originally was like, 18 years ago maybe.” (15–2)

4.11. “it was just really targeting fat, so for some people, genetically they might do better with a different-- Maybe modifying carbs might work better for their body” (28–2)

 5. Feasibility

5.1. “Right now, I don’t have a class so we are trying to waitlist people” (6–1)

5.2. “It’s not active at all in [302]. It was only offered once and that was it. It was poorly attended at that location, so we did not try it again for a second round. It has not been offered again.” (35–3)

5.3. “We don’t have facilitators. Yeah. I believe I’m the only one that was trained at this site to teach” (28–2)

5.4. “Now the [clinic site 1] closed up. We transferred patients to [clinic site 2]”

 6. Fidelity

6.1. I’ll use, like, a PowerPoint for kind of like a virtual grocery shopping tour. When we talk about eating out, I’ll do a PowerPoint on menu comparisons” (8–1)

6.2. ” I make my own slides. I will get my own visual. I will bring in like food models, or real food and have them taste it. I incorporate a little game or something that people will get excited. So I do different things to get… if I see there’s an issue on certain things, I will look up on different apps because if it’s not covered, I will look it up myself.” 33–2″

6.3. “I was also wanting to know what the participants wanted to learn. And so, I modified it according to their needs” (5–1)

6.4. “These people are pre-diabetic, so I have to tweak it; I cannot use that, having that it’s so many carbs. I’d be stoned. Yeah, so I have to tweak a lot of it” (33–2)

6.5. “I think a lot of people come in with a lot of knowledge. This area, people in general eat pretty healthily, or at least know how to. They already kind of had a fundamental knowledge; I think it was just adding onto it. They hear so much, read things on the internet, or they’ve already tried certain things, certain diets and so they come in with some baseline. So it’s just more of providing information on that level.” 13–2

 7. Program Costs

7.1. “It depends on their insurance, we’ll kind of talk to them about their insurance coverage” (9–1).

7.2. “If they have an HMO and they attend nine out of 12 courses, they get reimbursed half….If they have Sutter Select and their BMI is over 30, then Sutter Select pays for it” (7–1)

7.3. “Most people find the cost pretty reasonable, but I have had some patients that, you know, they have to think about it for cost” (16–1)

7.4. “It’s a more rural area, more spread out. Most people or patients that I’ve spoken to, because insurance does not cover it for most part these types of programs, they can’t afford even that one day’s payment to come to a class” (18–1).

 8. Sustainability

8.1. “I do talk to the physicians. Of course those that I see most frequently, they’re most familiar with the program. I have been to each and every physician’s office and have told them about this program” (17–1)

8.2. “Presenting the program at a standup meeting in the morning for all the providers to remind them that the class is starting in March and to remember who is an ideal candidate to refer” (22–2)

8.3. “We’ve switched to this rolling enrollment where somebody can start every month” (7–1)

8.4. “We do have a prompt pay discount, which we let them know about. If they pay in full within 30 days of receiving the bill, they can get, I think, a 30% reduction” (22–2)

8.5. “So we would touch base. If they were going to be there the next week I’d catch them up. Here’s written materials when they would come back again” (24–2)

8.6. “We did biweekly for the last three months instead of monthly. It seemed better. It’s easier to retain people, and they wanted it, too” (14–2)

8.7. “We’re screening to see if anybody has an underlying eating disorder. Then, also, psych history. We look at…We had some previous groups where there was patients with previous eating disorder behavior and a group—it wasn’t appropriate setting for them.” (25–2)