ABSTRACT Type 2 diabetes affects over 13 million women in the US. Lifestyle programs to improve weight management, diet, and physical activity can prevent type 2 diabetes, are recommended for high-risk adults, and are increasingly available in healthcare delivery systems. Yet while prior research has focused on the efficacy and effectiveness of lifestyle programs, little research has examined factors associated with patient engagement in lifestyle programs in real-world clinical settings. Low program participation and high attrition may contribute to poorer health outcomes for patients. Research on patient engagement is especially important for women with a history of gestational diabetes, who face markedly higher risk for type 2 diabetes. To advance the field of diabetes prevention and improve healthcare delivery for individuals at high risk, the overall objective of this proposal is to identify patient characteristics associated with engagement in an effective lifestyle program offered on behalf of an integrated healthcare delivery system to diverse women with a recent history of gestational diabetes. The project aims to determine patient characteristics that identify subgroups at risk for poor patient engagement (Aim 1), and to develop meaningful descriptive profiles of these subgroups (Aim 2). This secondary analysis leverages a unique source of electronic health record and patient-reported information. Results may creatively inform the future design of targeted outreach and curriculum materials to maximize program participation, with the ultimate goal of improving health in a young and diverse population at high risk for type 2 diabetes.

PROJECT NARRATIVE Women with a history of gestational diabetes are at high risk for type 2 diabetes, a serious but preventable disease. This research examines patient characteristics associated with engagement in an effective lifestyle program for diabetes prevention offered on behalf of an integrated healthcare delivery system. Deepening our understanding of characteristics associated with patient engagement may shape new strategies to improve participation in preventive programs, with the ultimate goal of improving public health among diverse groups of people at high risk for type 2 diabetes.