Adaptation of a diabetes self-management training program for a community setting: evidence of feasibility, acceptability, and program fit

Resumen

Introduction Community-based diabetes self-management education and support can improve access to self-management resources, but less is known about how established programs can be systematically adapted for community settings before broader implementation. This pilot evaluated a community-centered adaptation of an evidence based, clinical program and assessed whether it achieved sufficient feasibility, acceptability, and program fit to support continued implementation. Materials and methods Over the course of 16 months, this bilingual, community-based program consisted of 5 weekly sessions delivered by Community Health Workers/Promotores de Salud to 161 adults with or at risk for type 2 diabetes across nine cohorts and three iterative implementation phases. Adaptations focused on curriculum and materials, content delivery and session logistics, cultural and linguistic relevance, and the evaluation and feedback process. Participant surveys, facilitator feedback, and observer rubrics were reviewed between phases to guide refinements. Feasibility and acceptability were assessed using participation, retention, fidelity, logistical, satisfaction, and qualitative indicators. Knowledge and self-efficacy were examined as supportive indicators of program fit using descriptive analyses and linear mixed-effects models; qualitative feedback was analyzed using rapid qualitative analysis. Results Enrollment approached 90%, attrition remained low, and 1-month follow-up completion increased from 84% in Phase 1 to 98% in Phase 3. Facilitator and observer feedback indicated fewer implementation barriers, improved session flow and fidelity, and greater delivery stability in later phases. Satisfaction remained high across phases (3.83, 3.87, and 3.89 on a four-point scale). Knowledge increased significantly in Phase 1 at post-training and follow-up, while Phases 2 and 3 demonstrated additional post-training gains of 16.9 and 28.7 percentage points, respectively, compared with Phase 1. Self-efficacy increased significantly in Phase 1, and Phase 3 demonstrated an additional 1.705-point gain compared with Phase 1. Participants described the training as understandable, culturally relevant, practical, and supportive. Discussion A structured process of implementation, reflection, and refinement supported the adaptation of this program into a bilingual, CHW/P-led community program. At the end of phase 3, evidence supported sufficient feasibility, acceptability, and program fit for continued implementation and future evaluation of longer-term behavioral and clinical outcomes.