The impact of positive social reinforcement on time-to-attrition from the Diabetes Prevention Program in college students at high risk for Type II Diabetes: a study protocol for a phase 3, multicenter, cluster randomized trial

Introduction: The prevalence of type 2 diabetes mellitus (T2DM) in young adults has increased considerably in the pastdecade. Evidence shows that lifestyle modification programs such as the Diabetes Prevention Program (DPP) areeffective in improving health behaviors and lowering the risk of diabetes. DPP follow-up studies have found that a lackof retention can reduce the effectiveness of such programs. Adding a positive social reinforcement platform is a novelstrategy to provide educational resources to facilitate lifestyle changes. However, evidence regarding the effect ofpositive social reinforcement as a theory-based strategy to prolong retention within the DPP is limited. The current studyprotocol aims to evaluate the efficacy of the online Prevent Diabetes® Program, including a Positive Inter@ctiOn forumon time-to-attrition from the DPP among college students at high risk for T2DM.Methods: This study protocol is a phase 3, multicenter, double-blinded, cluster-randomized, superiority, controlled trialconducted in West Virginia, Alabama, and Mississippi. Four hundred eigclthty college students will be centrallyrandomized in a cluster-wise 1:1 ratio to the online Prevent Diabetes® Program integrated with the Positive Inter@ctiOnforum or to the online Prevent Diabetes® Program alone for 12 months. The primary outcome is time-to-attrition fromthe DPP.Discussion: Successful completion of the study will provide valuable information on whether implementing theory-basedhealth behavior strategies can improve the retention of participants in the online DPP and contribute to enhancing DPPeffectiveness.