Determining Barriers and Facilitators to Implementing the Resist Diabetes Intervention in Salem Veterans Administration Medical Center Patients

With 47% of the veteran population aged 65 years or older, an age group with the highest prevalence of type 2 diabetes (T2D), prevention of T2D is critical within the Veterans Health Administration (VHA) system (1). Resist Diabetes (RD), a Social Cognitive Theory-based resistance training program, has been shown to reduce the prevalence of prediabetes by 34% in prediabetic older adults (2). The RD program could fill the gap within the VHA system for a structured diabetes prevention program not focused on weight, but instead focused on exercise. This thesis describes a mixed-methods investigation to determine what adaptations to the RD program are needed to implement the program within the Salem Veterans Affairs Medical Center (VAMC) patients. Salem VAMC care providers and veteran patients were recruited to gauge perceptions of the RD program, and identify barriers and facilitators to the referral process and program implementation. Semi-structured open-ended questionnaires and interview guides based upon the Consolidated Framework for Implementation Research (CFIR) (3) were utilized to determine major and minor themes within the provider and veteran responses. Quantitative data was also obtained to assess provider perceptions and participant characteristics. Major findings included: positive perceptions by providers for RD program acceptability, appropriateness and feasibility (4) within the Salem VAMC, positive perceptions of Intervention Characteristics of RD by veterans, major barriers to participation lied within the Outer Setting domain with travel, transportation, and time constraints. Major facilitators to program implementation lied within the Inner Setting domain with promotion by primary care. These findings could be used to inform a future version of the RD program adapted for the VHA system.