OMB No. xxxx

Exp. Date xx/xx/xx



Shape1 National Diabetes Prevention Program Lifestyle Change Program Introductory Session Landscape Assessment

Thank you for agreeing to participate in this survey about your National Diabetes Prevention Program (DPP) lifestyle change program and the strategies that you use to recruit participants. The purpose of this survey is to gain insight into how you use your recruitment strategies and introductory sessions (also known as session zeros) to recruit and enroll participants in your National DPP lifestyle change program. Findings from this survey will be used to further examine introductory sessions as an effective recruitment strategy to enroll participants in the National DPP lifestyle change program. Your organization was selected because you offer a Centers for Disease Control and Prevention (CDC) recognized lifestyle change program. Participation in this survey is completely voluntary and will not affect your CDC recognition status.

CDC estimates the average public reporting burden for this collection of information as 15 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to CDC/ATSDR Reports Clearance Officer; 1600 Clifton Road NE, MS D-74, Atlanta, Georgia 30333; ATTN: PRA (0920-xxx). If you have any questions about this survey please contact       [insert contact name, organization affiliation, e-mail address, and telephone number].





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The following questions ask about the characteristics of the community where your class location is located and, if applicable, of lifestyle change program participants at your location.

  1. Which of the following best describes your class location? Please select only one.

  1. In what county is your class location?

County: _______________

  1. In what state is your class location?

State: _______________

  1. For approximately how many months has your location offered National DPP lifestyle change program classes?

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Number of months:



  1. Which racial or ethnic groups are most participants who attend National DPP lifestyle change program classes at your location? Please select only one.

  1. Which gender are most participants who attend National DPP lifestyle change program classes at your class location? Please select only one.

  1. Which age range are most participants who attend National DPP lifestyle change program classes at your class location? Please select only one.

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The following questions ask about how your lifestyle change program is delivered.

  1. Which of the following best describes when you start a new National DPP lifestyle change program year-long class?

  1. During the past 12 months, did your class location begin National DPP lifestyle change program year-long class(es) based on the season of the year (for example, no classes in the summer, begin most classes after the New Year)?

  1. During the past 12 months, did the session times of the National DPP lifestyle change program vary throughout the course of a year-long class?

  1. During the past 12 months, how many National DPP lifestyle change program year-long classes did your class location deliver?

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Number of classes:

  1. During the past 12 months, what was the average number of participants enrolled (i.e., attended at least one session) in a National DPP lifestyle change program year-long class?

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Average number of participants:

  1. During the past 12 months, approximately how many staff, in terms of full-time equivalents (FTEs), were dedicated to conducting a National DPP lifestyle change program year-long class (i.e., including recruiting, registering, and delivering the lifestyle change program to participants)? An FTE is the hours worked by one employee on a full-time basis.

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Number of FTE: .

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The following questions ask about how you recruit participants to enroll in your lifestyle change program at your class location.

  1. Does your class location implement any recruitment strategies to promote enrollment into your National DPP lifestyle change program?



  1. Select the recruitment strategies that you use to promote enrollment into your National DPP lifestyle change program. Please select all strategies that apply.

  1. Does your class location offer program support tools (for example, gym memberships, digital fitness trackers, cookbooks, digital weight scales) to encourage participant enrollment?

  1. Some programs assess the readiness of potential participants by looking at factors like previous chronic disease prevention program participation, motivation to change, time to participate (lifestyle) and general attitude. Do you assess the readiness of potential participants before they enroll in a National DPP lifestyle change program?

  1. What do you assess? Please select all that apply.



  1. What do you do to support an individual’s readiness to enroll in a National DPP lifestyle change program? Please select all that apply.

  1. In what ways do your National DPP lifestyle change program coaches engage participants before the program begins? Please select all that apply.

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The following questions ask about your introductory session (also known as “session zero”).

  1. Does your class location offer an introductory session (also known as “session zero”) to potential participants?



  1. Which of the following best describes why you offer an introductory session? Please select all items that apply.

  1. Which of the following elements are included in your program’s introductory session? Please select all items that apply.

  1. Does your location adhere to a consistent agenda or format for all introductory sessions offered?



  1. During the past 12 months, how many individuals, on average, attended each introductory session?

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Number of individuals:

  1. During the past 12 months, approximately how long, on average, was your introductory session?

  1. Do you offer an introductory session before each upcoming year-long class?

  1. During the past 12 months, approximately how many introductory sessions did you offer?

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Number of introductory sessions:

  1. During the past 12 months, approximately how many staff, in terms of full-time equivalents (FTEs), are dedicated to organizing and delivering an introductory session (i.e., including recruiting and delivering the introductory session to participants and registering participants for the National DPP lifestyle change program)? An FTE is the hours worked by one employee on a full-time basis.

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Number of FTE: .

  1. On average, how many people deliver the introductory session each time to potential lifestyle change program participants?

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Number of people:

  1. Who usually delivers the introductory session to potential National DPP lifestyle change program participants? Please select all that apply.

  1. Does the location where your introductory sessions are offered vary?

  1. Does the meeting day and/or time of your introductory session(s) vary?



Shape30 The final two questions ask about your organization’s interest in participating in future CDC activities to identify successful strategies to increase enrollment in the National DPP lifestyle change program.

  1. Would you be interested in collaborating on future projects that CDC’s Division of Diabetes Translation is working on to increase enrollment in the National DPP lifestyle change program?

  1. Can RTI International, on behalf of CDC’s Division of Diabetes Translation, to contact you with more information about an upcoming CDC project? The purpose is to assess an intervention to increase enrollment in the National DPP lifestyle change program.

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