Table 3.

Sample matrices of change objectives for the adoption of the National Diabetes Prevention Program among the participating clinics in Texas, United States.

Adoption outcome: Clinic leadership adopts National DPP to prevent diabetes among patients with prediabetes.
Performance objectives	Knowledge	Perceived severity	Attitudes	Perceived benefits
PO1. Clinic leadership partners with a CDC-recognized National DPP.	K1a. Describe the steps for partnering with a National DPP provider.	PS1a. Understand that adopting the National DPP will decrease patients’ risk of developing diabetes.	A1a. Believe that lifestyle change programs can help patients with prediabetes decrease the risk of developing diabetes.	PB1a. Expresses that referring patients with prediabetes to the National DPP will decrease their risk of developing diabetes.
PO2. Clinic leadership delineates the clinic’s National DPP referral goals.	K2a. List the number of patients with diabetes and prediabetes (at risk). K2b. Describes the expected change/patient outcomes in preventing diabetes.	PS2a. Understand the importance of setting goals for referrals to track referral outcomes. PS2b. Understand that setting achievable referral goals will help the clinic prevent diabetes.	A2a. Express a positive attitude about setting referral goals to promote referrals to the National DPP.	PB2a. Recognize that identifying clinic-wide referral goals will help providers make more informed decisions about making referrals. PB2b. Understand that by identifying referral goals, they will be able to track success.
PO3. Clinic leadership reviews and approves legal agreement (MOU) with National DPP.	K3a. Lists terms of the agreement. AK3b. Describes what the partnership will entail in detail.	PS3a. Perceives that the National DPP partnership will help the clinic prevent diabetes.	A3a. Believes that the MOU will establish guidelines and scope work of the relationship with the National DPP.	PB3. Expresses the need to have an MOU to guide the partnership successfully and provide accountability.
PO4. Clinic leadership designates a clinic program champion to spearhead the implementation of the National DPP referral process.	K4. Acknowledge that the program champion can successfully lead the clinic’s National DPP referral process.	PS4a. Believe that the program champion understands that the National DPP referral process fits the clinic’s diabetes management goals.	A4a. Express that the program champion will acknowledge the benefits of the adoption of National DPP.	PB4. Recognize that the program champion will support the National DPP referral efforts.
PO5. Clinic leadership establishes reporting of participants who meet prediabetes criteria to the National DPP.	K5a. List criteria for diagnoses of prediabetes. K5b. Understand how to pull patients with prediabetes based on lab values. K5c. Describe inclusion and exclusion criteria for National DPP participation.	PS5a. Understand the complications patients may experience if they progress from prediabetes to diabetes. PS5b. Understand that diabetes is a serious disease that can be prevented through early intervention in identified patients.	A5a. Express a positive attitude about pulling information of patients with prediabetes.	PB5a. Recognize that identifying patients with prediabetes will help the patients and providers make more informed decisions about the patient’s health. PB5b. Understand that by identifying patients with prediabetes, they will now be able to connect them with useful educational resources.

This table shows a sample of the performance objectives for the adoption of the National DPP program based on the determinants from the Social Cognitive Theory (SCT) and Health Behavior Model (HBM).

CDC, Centers for Disease Control and Prevention; EHR, electronic health records.

Healthcare providers: physicians making referrals, nurse practitioners, and physician assistants.

Program champion: health care providers or clinic administration.

Clinic leadership: chief executive officer, chief operations officer, chief medical officer, and chief nursing officer.

Clinic administration: technology/data analyst, practice administrator, and practice manager.

National DPP provider: lifestyle change coach and program administrator.