Hispanic men face disproportionately high rates of diabetes yet remain underrepresented in prevention programs like the National Diabetes Prevention Program (NDPP).1 A new study revealed that low engagement stems from limited diagnosis awareness, financial barriers, and doubts about the program’s relevance and benefits. These findings highlight the urgent need for culturally tailored outreach and support strategies.
This qualitative study is published in JAMA Network Open.
Knowledge gaps, financial burdens, and skepticism hinder Hispanic men’s participation in the National Diabetes Prevention Program, study finds. | Image credit: Krakenimages.com – stock.adobe.com
“Our findings suggest that facilitating health care navigation, highlighting the consequences of developing diabetes, advertising the group format of the program as a resource for staying accountable to their lifestyle change goals, and offering the program in diverse formats are each strategies that could be leveraged to potentially improve enrollment and initial engagement in the program,” wrote the researchers of the study.
Hispanic or Latino individuals make up the largest minority group in the US, accounting for 13.7% of the population.2 This group experiences disproportionately high rates of type 2 diabetes, obesity, and related metabolic and vascular complications. These health disparities are driven by a combination of genetic predisposition, inadequate nutrition, low physical activity, and socioeconomic and cultural factors.
The researchers recruited Hispanic men aged 18 years and older who were identified as at risk for diabetes through electronic medical records at Montefiore Health System primary care sites.1 Recruitment occurred between June 2023 and February 2024, with participants selected to ensure balanced representation between those with low engagement (fewer than 4 sessions attended) and high engagement (4 or more sessions) in the NDPP. One-time, semi-structured phone interviews were conducted in English or Spanish, depending on participant preference. Interviews were transcribed and analyzed using a deductive approach guided by established behavior change frameworks to identify key themes and subthemes influencing program engagement.
Among the 32 Hispanic men interviewed, 15 demonstrated low engagement in the NDPP. Most low-engagement participants were not born in the US (87%), had limited English proficiency (80%), and over half had not completed high school (53%). The analysis revealed 3 major themes and 11 subthemes influencing low engagement. Key barriers included limited awareness of their prediabetes diagnosis, a belief in personal self-sufficiency for making lifestyle changes, and skepticism about their risk for diabetes and the NDPP’s effectiveness. Additional challenges involved financial constraints, limited program accessibility, and the perception that the potential burdens of participation outweighed its benefits.
However, the researchers noted several limitations. First, it was designed to generate hypotheses rather than quantify or rank beliefs. The sample was also limited to individuals engaged in health care and enrolled through the Power Up study, which may have affected generalizability. Demographic differences between low and high engagers may have also confounded comparisons, and body mass index data were not collected. Furthermore, high engagers may have drawn from NDPP experiences, while low engagers may have spoken from limited exposure.
Despite these limitations, the researchers believe the study highlights the need for culturally and contextually tailored strategies to improve engagement.
“Low engagers lacked awareness of prediabetes and preventive measures, felt confident managing lifestyle change independently, and perceived NDPP risks outweighed its benefits,” wrote the researchers. “Financial constraints and health care skepticism further hindered engagement. Our findings showed that enhancing engagement among Hispanic men may require addressing knowledge gaps, financial barriers, and perceptions of program relevance, while leveraging culturally tailored approaches that resonate with their identities and motivations.”
References
1. Gonzalez CJ, Perez-Mejia CN, Hernandez N, et al. Engagement in the National Diabetes Prevention Program among Hispanic men. JAMA Netw Open. 2025;8(6):e2515046. doi:10.1001/jamanetworkopen.2025.15046
2. Caballero, AE. Diabetes in the Hispanic or Latino population: Genes, environment, culture, and more. Curr Diab Rep. 2005;5(3):217-225. doi:10.1007/s11892-005-0012-5
