Table 2.

Translational strategies and cultural adaptations of the Diabetes Prevention Program, 2005–2013

Translational strategies (n = 44)
Translational category	Description of strategy	Number reporting, N (%)	Study reference
Visuals	• Visuals reflecting study population, foods, and activities included in print materials	2 (4 %)	[84, 88]
Language and reading level	• Cultural sensitivity in wording • Literacy sensitive • Translation (tribal and Spanish)	11 (25 %)	[69, 79, 84–86, 88–90, 92, 96, 99]
Inclusion criteria	• Variation in age limit (18–25) • Variation in inclusion criteria based on health (type of screening or actual condition—e.g., some included metabolic syndrome vs risk for DM vs those with DM vs varying number of risk factors for DM); medical exclusion criteria (e.g., need clearance by physician)	22 (50 %)	[57, 69, 73–76, 78, 80, 81, 84–87, 89–92, 95, 96, 98, 99]
Incentives	• Small gifts (e.g., t-shirt) or money for data collection • (Refundable) commitment fees • Money/gift cards/raffle • Variation on the “toolkit” (e.g., pedometers, printed materials, money for food during class, gym membership, behavioral tracking materials)	21 (48 %)	[56–58, 61, 62, 64, 67, 72, 80, 81, 84, 85, 87–91, 94, 95, 97, 99]
Added activities	• Churches: prayer/time with God • Native community studies: talking circles, indigenous food Group exercise activities during/before/after class • Taste testing • Education on low-cost healthy eating • Communicating with your provider • Metabolic syndrome/CVD (blood lipids, etc.) • Requiring a support person • Technology (e.g., DVD, online resources)	34 (77 %)	[56–60, 62–71, 76–82, 86–92, 94–98]
Exclusion of DPP core components	• Selected only most relevant top to target population • Deleted toolbox due to funds • Removed sections due to staffing	7 (16 %)	[60, 63, 85, 88, 93, 95, 96]
Frequency and timing of DPP classes	• Changes to meeting frequency (e.g., weekly, bi-weekly, over a certain number of months) • Most commonly condensed to 12, 8, or 6 weeks • Variety in number and length of post-core sessions • Time of sessions varied from 30 min–2.5 h	24 (54 %)	[56, 60, 63, 65, 66, 72–75, 77, 79–81, 84–88, 91, 93, 95–98]
Class format	• Group • Web-based • DVD • Telephone-delivered classes • Self-study • Mix of individual and group classes • Family/support person groups (size 3–35)	42 (95 %)	All except [61, 96]
Implementation staff	• Dieticians • Nurses, other clinical staff • Other health professionals/medical background (e.g., exercise physiologist, psychologist) • Lay/Community health workers • Bilingual • Variations in amount, but nearly all describe training/certification/oversight	42 (95 %)	All except [61, 68]
Cultural adaptations (n = 15)
Category of cultural adaptation	Description of adaptation	Number reporting, N (%)	Study reference
Language	• Spanish • Tribal	4 (40 %)	[69, 79, 84, 89]
Implementation staff	• Bilingual individuals • Community or tribal members	10 (67 %)	[61, 65, 66, 70, 71, 74, 79, 84, 89, 99]
Metaphors	• Linking faith and health, i.e., encourage participants to draw strength from their faith to make positive health changes; included Scripture in lessons	1 (7 %)	[99]
Content	• Described culturally appropriate/traditional recipes and physical activities • Talked about cultural ideas related to diabetes risk • General description that the program was adapted to the cultural needs of the community	13 (73 %)	[59, 60, 63, 65, 66, 69, 74, 84, 86, 88, 89, 97, 99]
Concepts	• Targeting cultural beliefs (e.g., soap opera/novella) • Resiliency skills (recognize the link between stressful events and beliefs, emotional responses based on these beliefs, and subsequent behaviors)	3 (20 %)	[61, 84, 86, 99]
Goals	• Specifically culturally relevant goals	1 (7 %)	[86]
Methods	• Faith Task Force explored methods (e.g., lay health advisor model, group-based format) and incorporated culturally appropriate components for their community to produce The WORD • Talking circles in Native American communities	1 (7 %)	[99]
Framework	• Community-based participatory research	5 (27 %)	[60, 65, 66, 89, 99]