Characteristics of participants in the first fully online National Diabetes Prevention Programme: A quantitative survey

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McHugh" } ], "publisher": { "@type": "Organization", "name": "HRB Open Research", "logo": { "@type": "ImageObject", "url": "https://hrbopenresearch.org/img/AMP/HRB_image.png", "height": 566, "width": 60 } }, "image": { "@type": "ImageObject", "url": "https://hrbopenresearch.org/img/AMP/HRB_image.png", "height": 1200, "width": 127 }, "description": " Background Diabetes prevention programmes (DPPs) are being implemented around the world to tackle the rise in type 2 diabetes. In 2021/22, the Health Service Executive(HSE) in Ireland piloted a fully online national diabetes prevention programme(NDPP). Characteristics and factors affecting participation may be different among people attending online DPPs compared to face-to-face programmes. The aim of this study was to describe the demographic, psychosocial and health characteristics of participants in the pilot of the online NDPP in Ireland. Methods A survey from the evaluation of the English NDPP was adapted for the Irish context with Patient and Public Involvement (PPI) input. The survey was sent (between April and June 2022) to all individuals who attended the initial assessment of the pilot NDPP (n=73). It contained questions on health status, co-morbidities, motivation to improve health, quality of life, self-efficacy, beliefs about the risk of diabetes, participation(e.g. recollection and understanding of invite, number of sessions attended), as well as demographic information. Results Response rate was 30.5% (n=22). Mean age of responders was 62 years (range 36–82 years) and over half were men (57.1%, n=12). The majority (81%, n=17) had attended 6 or more of the 14 sessions. Most (90.5% n=19) reported having family members or acquaintances with diabetes, had positive views of their current health status and high quality of life scores (71.4%, n= 15). Mental health scores were slightly higher than the national average. Over half (57.2%, n=12) were confident or very confident about participating in an online DPP. Almost all (95.2%, n=20) believed it was important to manage their risk of type 2 diabetes. Conclusions Participants in the online pilot NDPP had positive views of their general health and positive psychosocial characteristics affecting their decision to participate. These beliefs may be modifiable intervention targets to encourage participation among non-attenders in future programmes. 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HRB Open Res 2025, 6 :61 ( https://doi.org/10.12688/hrbopenres.13807.4 ) NOTE: If applicable, it is important to ensure the information in square brackets after the title is included in all citations of this article. Close Copy Citation Details Export Export Citation Sciwheel EndNote Ref. Manager Bibtex ProCite Sente EXPORT Select a format first Track Share ▬ ✚ Research Note Revised Characteristics of participants in the first fully online National Diabetes Prevention Programme: A quantitative survey [version 4; peer review: 2 approved, 1 not approved] Clair Haseldine https://orcid.org/0000-0002-1038-6352 1 , Gráinne O'Donoghue 2 , Patricia M Kearney https://orcid.org/0000-0001-9599-3540 1 , [...] Fiona Riordan https://orcid.org/0000-0003-2572-4729 1 , Margaret Humphreys 3 , Liz Kirby 3 , Sheena M. McHugh https://orcid.org/0000-0002-6595-0491 1 Clair Haseldine https://orcid.org/0000-0002-1038-6352 1 , Gráinne O'Donoghue 2 , [...] Patricia M Kearney https://orcid.org/0000-0001-9599-3540 1 , Fiona Riordan https://orcid.org/0000-0003-2572-4729 1 , Margaret Humphreys 3 , Liz Kirby 3 , Sheena M. McHugh https://orcid.org/0000-0002-6595-0491 1 PUBLISHED 06 Mar 2025 Author details Author details 1 Department of Public Health, University College Cork, Cork, County Cork, Ireland 2 School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Leinster, Ireland 3 Health Service Executive, Cork, Ireland Clair Haseldine Roles: Conceptualization, Data Curation, Formal Analysis, Investigation, Methodology, Project Administration, Validation, Visualization, Writing – Original Draft Preparation Gráinne O'Donoghue Roles: Conceptualization, Methodology, Supervision, Writing – Review & Editing Patricia M Kearney Roles: Conceptualization, Funding Acquisition, Methodology, Supervision, Writing – Review & Editing Fiona Riordan Roles: Conceptualization, Methodology, Supervision, Writing – Review & Editing Margaret Humphreys Roles: Conceptualization, Writing – Review & Editing Liz Kirby Roles: Conceptualization, Writing – Review & Editing Sheena M. McHugh Roles: Conceptualization, Methodology, Supervision, Writing – Review & Editing OPEN PEER REVIEW DETAILS REVIEWER STATUS Abstract Background Diabetes prevention programmes (DPPs) are being implemented around the world to tackle the rise in type 2 diabetes. In 2021/22, the Health Service Executive(HSE) in Ireland piloted a fully online national diabetes prevention programme(NDPP). Characteristics and factors affecting participation may be different among people attending online DPPs compared to face-to-face programmes. The aim of this study was to describe the demographic, psychosocial and health characteristics of participants in the pilot of the online NDPP in Ireland. Methods A survey from the evaluation of the English NDPP was adapted for the Irish context with Patient and Public Involvement (PPI) input. The survey was sent (between April and June 2022) to all individuals who attended the initial assessment of the pilot NDPP (n=73). It contained questions on health status, co-morbidities, motivation to improve health, quality of life, self-efficacy, beliefs about the risk of diabetes, participation(e.g. recollection and understanding of invite, number of sessions attended), as well as demographic information. Results Response rate was 30.5% (n=22). Mean age of responders was 62 years (range 36–82 years) and over half were men (57.1%, n=12). The majority (81%, n=17) had attended 6 or more of the 14 sessions. Most (90.5% n=19) reported having family members or acquaintances with diabetes, had positive views of their current health status and high quality of life scores (71.4%, n= 15). Mental health scores were slightly higher than the national average. Over half (57.2%, n=12) were confident or very confident about participating in an online DPP. Almost all (95.2%, n=20) believed it was important to manage their risk of type 2 diabetes. Conclusions Participants in the online pilot NDPP had positive views of their general health and positive psychosocial characteristics affecting their decision to participate. These beliefs may be modifiable intervention targets to encourage participation among non-attenders in future programmes. READ ALL READ LESS Keywords Diabetes prevention programme, Prediabetes, Psychosocial, Participation, Online, Quantitative survey, Participant characteristics Corresponding Author(s) Clair Haseldine ( [email protected] ) Close Corresponding author: Clair Haseldine Competing interests: No competing interests were disclosed. Grant information: This study was funded by a Health Research Board (HRB) Collaborative Doctoral Award, 2019 (CDA-2019-001). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Copyright: © 2025 Haseldine C et al . This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. How to cite: Haseldine C, O'Donoghue G, Kearney PM et al. Characteristics of participants in the first fully online National Diabetes Prevention Programme: A quantitative survey [version 4; peer review: 2 approved, 1 not approved] . HRB Open Res 2025, 6 :61 ( https://doi.org/10.12688/hrbopenres.13807.4 ) First published: 18 Oct 2023, 6 :61 ( https://doi.org/10.12688/hrbopenres.13807.1 ) Latest published: 06 Mar 2025, 6 :61 ( https://doi.org/10.12688/hrbopenres.13807.4 ) Revised Amendments from Version 3 The sample size and response rate are discussed further in the strengths and limitations section. The sample size and response rate are discussed further in the strengths and limitations section. See the authors' detailed response to the review by Rhiannon Hawkes See the authors' detailed response to the review by Lillian Madrigal See the authors' detailed response to the review by Michael J Cannon READ REVIEWER RESPONSES Introduction Type 2 diabetes is a growing global health problem which can result in serious chronic health complications for individuals and places a financial burden on health systems 1 . Diabetes prevention programmes (DPPs) are being implemented worldwide to tackle the growing problem of type 2 diabetes 2 – 4 . High levels of participation in these programmes are essential to reduce the rates of people developing diabetes, however, a systematic review of DPPs in real world settings found low participation rates in 71% of programmes studied 5 . A 2022 systematic review and meta synthesis of factors affecting lifestyle change in people with prediabetes found the individual’s evaluation of the importance of making lifestyle changes and the presence of supportive family and programmes facilitated change 6 . Psychosocial factors (belief in the seriousness of type 2 diabetes, their elevated risk, and confidence the DPP could reduce their risk) were shown to be strongly associated with participation in a recent study examining uptake in the English NHS DPP 7 . Practical barriers such as lack of time were also found to impact participation in a 2017 systematic review of diabetes prevention in primary care 8 . DPPs which are delivered synchronously online have been shown to address some of the barriers of face-to-face delivery while retaining effectiveness 9 . Synchronous online programmes are delivered through videoconferencing with a group of participants and educators in real time. The NHS refer to this mode of delivery as remote 10 and in the US the Centre for Disease Control refers to it as distance learning 11 . People attending such online DPPs may have different characteristics and different factors affecting their decision to participate compared to face-to-face programmes. For example, a greater proportion of men and more people of working age have been found to take part in synchronous online DPPs 9 . However, very little is known about the psychosocial factors affecting participation. A recent paper exploring participation in the NHS digital DPP had 4 interviewees who declined the digital app in favour of the synchronous online programme as they preferred the peer support provided by the group format 10 . In Ireland, the Health Service Executive (HSE -national publicly funded healthcare system) piloted the National Diabetes Prevention Programme (NDPP) from June 2021 to September 2022. Prior to this there was very limited availability to short prediabetes courses that were not standardised. The Irish DPP was developed and delivered to a group synchronously online due to Covid 19 restrictions. This programme is novel and unique as the first NDPP to be developed specifically for the online format and offered exclusively online. No face-to-face version of the NDPP was available at the time. In other countries programmes were initially offered face-to-face and subsequently developed into programmes for digital or online delivery 12 , 13 . This study aims to describe the demographic, psychosocial and health characteristics of participants in the pilot of the online NDPP in Ireland. Understanding the reasons people participate in DPPs is important to help design strategies to improve the uptake, and therefore the effectiveness, of these programmes. Methods This quantitative study used a postal survey for data collection. STROBE reporting guidelines were followed (Extended Data-Appendix 1). Ethical approval for the study was given by the Clinical Research Ethics Committee of the Cork Teaching Hospitals (ref: ECM 4 (n) 10/8/21). Materials The survey was adapted from the survey used in the evaluation of the (NHS) DPP in England 7 . The NHS survey was developed to identify factors associated with the uptake of the face-to-face DPP. The NHS survey was theory-based and included questions with established validity used in other studies where available. Adaptations to the survey for our study included using the Irish national census categories for ethnicity, using the Irish levels of education, using the full quality of life measure 14 and a full health confidence measure 15 . As the Irish DPP is delivered entirely online, a question regarding confidence in participating in an online programme was added. Our survey was piloted prior to use with the research team, health professionals, a Patient and Public Involvement group (PPI) based at University College Cork and a university statistician was consulted. The PPI group consisted of 10 people with an interest in diabetes prevention. They advised on recruitment and the wording of questions. Based on their feedback on recruitment, the cover letters used the participant’s name rather than a generic address. Data collected included factors that could influence participation in the programme including health status, motivation to improve health, quality of life, self-efficacy, beliefs about the risk of diabetes, presence of co-morbidities as well as demographic and programme participation information (Extended Data-Appendix 2). Survey domains Participation Recruitment for the NDPP pilot was from existing dietetic waiting lists and by referrals from GPs who had been informed of the pilot. Educators (dietitians in the HSE) invited people eligible to participate in the NDPP by phone. NDPP participants attended an initial assessment (in person, online or on the phone to have baseline measurements recorded, to receive a personal plan for lifestyle change and onboarding for the online session), and this was followed by 14 sessions of the NDPP (Extended Data-Appendix 3). Questions on participation in the NDPP included: recollection and understanding of invite, whether survey respondents were currently attending, and how many sessions they attended. Demographics Questions on age, self-reported gender, and ethnicity as well as living status (living with how many others), employment status and highest level of education attained were included. Health factors Health literacy was assessed using the Single Item Literacy Screener 16 and general health using the single general health item from the RAND SF-36 17 . Mental health was assessed using the Mental Health Inventory short 5 item scale (MHI 5) 18 . This scale has 5 questions with 6 possible responses which are transformed into a score from 0 – 100 using a standard linear calculation where 100 represents optimal health. Quality of life was assessed using the EUROHIS-QOL 8-item index, which is a shortened version of the World Health Organisation Quality of Life Instrument- Abbreviated Version 14 . It includes 2 questions each in psychological, physical, social and environmental domains with 5 possible responses and the overall score is calculated by summing up the responses. The maximum score is 40 with higher scores indicating higher quality of life. Other factors which could affect participation were investigated using questions on language and culture, disability, confidence in participating in an online programme and whether people had joined another lifestyle programme to improve their health in the past. Psychosocial factors Health confidence was assessed using a 4 question Health Confidence Score 15 . Responses were allocated a score from 0 = disagree to 3 = strongly agree. The summary score which ranges from 0 – 12 was transformed to a linear scale from 0 – 100 with higher scores indicating higher health confidence. Self-efficacy was measured using a 4 item self-efficacy scale with 4 possible responses 19 . The responses were summed up to give a score of 4 – 16, then converted to a 0 – 100 scale with higher scores indicating a higher self-efficacy. The remaining psychosocial questions examined the perceived need for the programme, the respondent’s vulnerability to developing diabetes, their ability to reduce the risk, how seriously they viewed the disease and how important it was to reduce the risk. The 5 category Likert scale variables are combined to 3 and 4 categories in Table 1 and Table 2 for ease of presentation. Table 1. Health characteristics of the survey sample. All N=21 Women N=9 Men N=12 N (%) N(%) N(%) Health literacy Help understanding written material Never 8 (38.1) 5 (55.6) 3 (25) Rarely 8 (38.1) 2 (22.2) 6 (50) Sometimes 4 (19) 1 (11.1) 3 (25) Often 1 (4.8) 1 (11.1) 0 (0) General health Excellent/ very good 2 (9.6) 0 (0) 2 (16.6) Good 15 (71.4) 7 (77.8) 8 (66.7) Fair 3 (14.3) 2 (22.2) 1 (8.3) Poor 1 (4.8) 0 (0) 1 (8.3) MHI 5 (0 – 100) * Mean (SD) 77.71 (12.1) 74.67 (10.2) 80 (13.32) Range 52 – 96 60 – 80 52 – 96 EUROHIS-QOL 8-item (8 – 40 scale) † Mean (SD) 31.38 (3.8) 30 (3.66) 32.33 (3.77) Range 22 – 36 22 – 35 23 – 36 Know someone with diabetes Yes 19 (90.5) 9 (100) 10 (83.3) No 1 (4.8) 0 (0) 1 (8.3) Unsure 1 (4.8) 0 (0) 1 (8.3) Family member with diabetes Yes 11 (52.4) 4 (4.44) 7 (53.8) No 10 (47.6) 5 (55.6) 5 (41.7) Joined another group for improving health in the past Yes 6 (28.6) 5 (55.6) 1 (8.3) No 15 (71.4) 4 (44.4) 11 (91.7) Confidence joining online programme Very unconfident/ unconfident 5 (23.9) 1 (11.1) 4 (33.4) Neither confident nor unconfident 4 (19) 3 (33.3) 1 (8.3) Confident / very confident 12 (57.2) 5 (55.6) 7 (58.3) Difficulties with health services due to language or culture Agree/ agree strongly 0 (0) 0 (0) 0 (0) Disagree/ disagree strongly 20 (95.2) 8 (88.9) 12 (100) Missing 1 (4.8) 1 (11.1) 0 (0) Other health problems or disability more of a priority Agree/ agree strongly 6 (28.6) 3 (33.3) 3 (25) Disagree/ disagree strongly 13 (61.9) 4 (44.4) 9 (75) Missing 2 (9.6) 2 (22.2) 0 (0) Abbreviations: MHI-5 = Mental Health Inventory-5, QOL = Quality of Life *MHI-5 scored from 0 – 100 where 100 represents optimal health. † EUROHIS-QOL 8-item index maximum score is 40 with higher scores indicating higher quality of life. Table 2. Psychosocial characteristics of the survey sample. All N=21 Women N=9 Men N=12 N (%) N(%) N(%) Health Confidence (0–100) ‡ Mean (SD) 66.6 (17.93) 62.96 (23.61) 68.89 (12.76) Range 17 –100 17 – 100 50 – 100 Self- efficacy (0–100) § Mean (SD) 67.08 (16.33) 61.08 (19.58) 71.5 (12.58) Range 25 – 100 25 – 83 58 – 100 Beliefs about the programme The programme can help me reduce my risk of diabetes Agree/ agree strongly 21 (100) 9 (100) 12 (100) Disagree/ disagree strongly 0 (0) 0 (0) 0 (0) I can look after my risk without the programme Agree/ agree strongly 3 (14.3) 0 (0) 3 (25) Disagree/ disagree strongly 18 (85.7) 9 (100) 9 (75) The DPP couldn’t tell me anything new Agree/ agree strongly 0 (0) 0 (0) 0 (0) Disagree/ disagree strongly 21 (100) 9 (100) 12 (100) Attitudes about the risk of diabetes My risk of developing diabetes is too low to worry about Agree/ agree strongly 0 (0) 0 (0) 0 (0) Disagree/ disagree strongly 21 (100) 9 (100) 12 (100) If I carry on as normal, there is a good chance that I will develop diabetes Agree/ agree strongly 18 (85.7) 8 (88.9) 10 (83.3) Disagree/ disagree strongly 2 (9.5) 0 (0) 2 (16.7) Missing 1 (4.8) 1 (11.1) 0 Diabetes is not a very serious illness Agree/ agree strongly 0 (0) 0 (0) 0 (0) Disagree/ disagree strongly 20 (95.2) 9 (100) 11 (91.7) Missing 1 (4.8) 0 (0) 1 (8.3) It is too difficult for me to change my lifestyle to reduce my diabetes risk Agree/ agree strongly 1 (4.8) 1 (11.1) 0 (0) Disagree/ disagree strongly 20 (95.2) 8 (88.9) 12 (100) Nothing I do can reduce my risk of getting diabetes Agree/agree strongly 0 (0) 0 (0) 0 (0) Disagree/disagree strongly 21 (100) 9 (100) 12 (100) I can do whatever is needed to reduce my risk of getting diabetes Agree/agree strongly 18 (85.7) 7 (77.8) 11 (91.7) Disagree/disagree strongly 3 (14.3) 2 (22.2) 1 (8.3) Motivation to reduce risk I am happy with my lifestyle as it is Agree / agree strongly 15 (70.4) 4 (44.4) 11 (91.7) Disagree/ disagree strongly 5 (23.8) 4 (44.4) 1 (8.3) Missing 1 (4.8) 1 (11.1) 0 (0) It is important that I manage my risk of getting diabetes Agree/ agree strongly 20 (95.2) 9 (100) 11 (91.7) Disagree/ disagree strongly 1 (4.8) 0 (0) 1 (8.3) Going to this programme requires a lot of effort Agree/ agree strongly 1 (4.8) 0 (0) 1 (8.3) Disagree/ disagree strongly 20 (95.2) 9 (100) 11 (91.7) ‡ Health confidence scored from 0 – 100 with higher scores indicating higher health confidence. § Self-efficacy scored from 0 – 100 with higher scores indicating higher self-efficacy. Participants and procedure Of the 158 people invited to attend the NDPP, 73 attended the initial assessment and 67 went on to attend at least one further session. All those who attended the pilot of the NDPP for initial assessment (n=73) were sent an invitation to take part in the study, a survey, a participant information leaflet and a consent form by programme educators (Extended Data-Appendix 2, 4 – 6). For eligibility criteria for the NDPP see appendix 3. Invitations were sent by post between April and June 2022. Respondents had the opportunity to attend the programme for at least 7 months when they received the survey. A €10 voucher was offered to compensate people for the time spent completing the survey. Respondents returned the survey with the consent form directly to the researcher (CH) either via email or by post. Data analysis To ensure data accuracy, 2 researchers (CH, ROM) entered the data from the surveys separately using SPSS software and then compared the 2 datasets to check for errors. Descriptive statistics were then used to summarise the data. Men's and women’s responses are also presented separately. Results A total of 22 surveys were returned (30.5% response rate). One person did not sign the consent form and did not provide contact details, therefore, was excluded from the analysis. For a description of the NDPP and characteristics of those who attended the NDPP initial assessment see extended data Appendix 3 and 7. Participation in the NDPP pilot All those that responded remembered being invited to the NDPP and almost all (90.5%, n=19) understood why they were invited. At the time of survey completion, 15 people (71.4%) were still attending the programme, 2 (9.5%) had completed the programme, and 3 (14.3%) left before the end of the programme. Those who left before programme completion reported work commitments (9.6% n=2) and family circumstances (4.8% n=1) as completion barriers. Of the 14 online group sessions (Extended Data-Appendix 3), the majority (81%, n=17) of respondents attended 6 or more sessions, 2 (9.5%) attended between 2–5 sessions, and 2 (9.5%) attended a single session. Demographics The mean age of those who responded to the survey was 62 years (SD=11.6; range 36 to 82 years) and over half were men (57.1%, n=12). All self-identified their ethnicity as White. Fifty-two percent had advanced certificate or third level qualifications (n=11). More than half were retired (52.4%, n=11), one third were in paid employment (33.3%, n=7) with the remainder not working due to disability or looking after family or home (9.5%, n=2). No one described themselves as unemployed. Health factors The majority of respondents reported that they rarely/never needed help understanding written material such as instructions or leaflets from the doctor or pharmacy (76.2%, n=16). Most described their general health as good (71.4%, n=15). The mean score on the MHI-5 (mental health) was 77.7 (SD=12.1). The mean on the EUROHIS-QOL 8-item (quality of life) was 31.38 (SD=3.8). All but 2 (90.5%, n=19) knew someone with diabetes while over half (52.4%, n=11) had a close family member with diabetes. Most had never previously participated in a programme to promote health (71.4%, n=15). Over half (57.2%, n=12) rated themselves as confident or very confident when it came to participating in an online DPP ( Table 1 ). Psychosocial factors All respondents recognised they were at risk of diabetes and believed the programme could help them reduce their risk of diabetes. Most agreed it was important to manage this risk (95.2%, n=20) and 85.7% (n=18) agreed they could reduce the risk. The majority disagreed that diabetes was not serious (95.2% n=20), and all disagreed that the risk was too low to worry about. All but one respondent (95.2%, n=20) scored more than 50 in the Health Confidence Score and the mean self-efficacy score was 66.6%. The majority were happy with their current lifestyle (71.4%, n=15) and disagreed that going to the online programme required a lot of effort ( Table 2 ). Subgroup analysis Men who took part in the survey were slightly older than the women (64 years vs 61 years). The men reported less confidence using online format with 33.3% (n=4) rating themselves as unconfident or very unconfident compared to 11.1% of the women (n=1) ( Table 2 ). A higher proportion of women (55.6%, n=5) than men (8.3%, n=1) had previously joined a group to improve health. Discussion The aim of this study was to describe the demographic, psychosocial and health characteristics of participants in the pilot of the online NDPP in Ireland. The survey provided a unique opportunity to describe the profile of those who participated in an online DPP, and their perceptions of health and psychosocial factors that may affect participation. Findings provide a number of key insights in terms of participant characteristics. Firstly, men were well represented, secondly respondents had high levels of self-reported general health and finally they understood the seriousness of type 2 diabetes. Those who responded to the survey were representative of the cohort (n=73) that participated in the pilot online NDPP 20 (Extended Data-Appendix 7). Over half the respondents in this study were men (57.1%). Men have historically been harder to reach with face-to-face DPPs 21 . In a 2018 systematic review and meta-analysis of the impact of global diabetes prevention interventions, men represented only 28.8% of the 17,272 participants 22 . Recent evidence indicates that a higher proportion of men attend digital DPPs (which include online programmes) than face-to-face programmes 12 , 23 however, little is known about the reasons why. Further research should examine why this format is more attractive to men and what facilitated participation for those who rated their confidence with an online format as low. NDPP participants who returned the survey considered themselves to be generally in good physical and mental health. Mental health scores were slightly above the national average for Ireland (77.7/100 vs 76/100) 24 . Reported self-efficacy was higher than those who responded to an NHS DPP survey (67.08/100 Vs 64.6/100) 7 . This is a positive finding as self-efficacy has been shown to favourably influence health behaviours such as the decision to attend digital DPPs 10 . While it is possible that lifestyle changes made as part of the programme could have affected these scores it is also possible that the people with poorer health who were most at risk of diabetes did not attend the programme. Efforts need to be made to ensure people most at risk are recruited to DPPs to prevent a widening of health inequities 25 . Successful strategies to improve attendance for people from diverse backgrounds such as using an extra session before the DPP involving motivational interviewing to increase risk awareness and problem solving around barriers should be considered 26 . Respondents in our study understood that type 2 diabetes was a serious disease, that they were at risk of developing it and that taking part in the DPP could help them to reduce that risk. These factors have been found to be important in uptake of the NHS DPP 7 and were found to affect motivation in a meta-synthesis of facilitators and barriers to lifestyle change in 2022 6 . It is possible that attending the programme influenced these beliefs. Further study is warranted to understand why the respondents in our study held these beliefs and if these beliefs could be encouraged in others at risk to improve participation. Strengths and limitations This study has several strengths. We used an existing theoretically informed validated survey and modified it through discussion with the research team, health professionals, PPI and a university statistician. This ensured that the survey was appropriate for the Irish context. The study aligns with a positive deviance approach by investigating the characteristics of people who attended the online NDPP 27 . This allows for greater understanding of the factors affecting the implementation of a successful healthcare practice, in this case attending the NDPP. Finally, and most importantly, it provides preliminary information on the first fully online NDPP, which can be used to improve participation in further roll out of the Irish NDPP and other online DPPs in the future and researchers will find this study helpful to understand participation when no other format such as face-to-face was available. The uptake of this survey was lower than the response to the NHS survey (31% vs 54%) however, the people who responded to the survey had a broad age range, a wide range of educational attainment, and there was good representation from both men and women. While the small sample size and response rate may limit the generalisability of this research note, the findings provide an update to researchers and DPP providers about the online pilot of an NDPP and the emerging evidence on the characteristics of those invited to attend. They may however have chosen to take part due to their positive views on the NDPP and additional insights may have been identified with a larger sample. The people attending the programme may have been the easiest to recruit, or they may have differed in important ways from those who chose to respond, therefore further research (such as survey or other data sources) should focus on understanding the views of those who declined to attend to improve participation in the future. Further research is also recommended with those who attended the initial assessment but did not attend further sessions to understand the factors affecting their decisions not to participate in the programme. Conclusion This survey provides a snapshot into the demographic, health and psychosocial factors of participants in the online NDPP in Ireland. Participant’s perceptions may indicate potentially modifiable targets to increase participation in DPPs. Further qualitative research is planned to explore these factors in greater depth. Consent Ethical approval for the study was given by the Clinical Research Ethics Committee of the Cork Teaching Hospitals (ref: ECM 4 (n) 10/8/21) Written informed consent to participate in the study and for findings to be published was obtained. Data availability Underlying data The underlying data are not available for this study. The study participants did not give consent for their data to be shared in a public repository. The information leaflet they received stated that their data would be anonymised and reported in aggregate. This was deemed necessary as the study is reporting on a pilot programme with a small number of participants. The data contains information such as gender, age, ethnicity, educational level, number of classes attended and number of people in the household which could compromise confidentiality. Removing this data would compromise the usefulness of the dataset. Extended data Figshare: Characteristics of participants in the first fully online National Diabetes Prevention Programme: A quantitative survey http://doi.org/10.6084/m9.figshare.2412620426 28 . This project contains the following extended data: – STROBE reporting guidelines (Appendix 1) – Survey (Appendix 2) – TIDieR description of the NDPP (Appendix 3) – Invitation (Appendix 4) – Participant Information Leaflet (Appendix 5) – Consent form (Appendix 6) – NDPP participant demographic information (Appendix 7) Reporting guidelines STROBE checklist for cross sectional studies was used (Appendix 1) Figshare: Characteristics of participants in the first fully online National Diabetes Prevention Programme: A quantitative survey http://doi.org/10.6084/m9.figshare.24126204 28 . Data are available under the terms of the Creative Commons Attribution 4.0 International license (CC-BY 4.0). Acknowledgements Firstly we would like to thank the people who responded to the survey. We would also like to sincerely thank the Health Service Executive NDPP educators who facilitated recruitment. We would like to thank the patient and public involvement group in University College Cork for their advice during survey development. Thank you also to Ruth O’ Mahony BSc student in University College Cork for her assistance with data entry. Faculty Opinions recommended References 1. International Diabetes Federation: IDF diabetes atlas. 10th edn. Brussels, Belgium, 2021. Reference Source 2. Stokes J, Gellatly J, Bower P, et al. : Implementing a National Diabetes Prevention Programme in England: lessons learned. BMC Health Serv Res. 2019; 19 (1): 991. PubMed Abstract | Publisher Full Text | Free Full Text 3. Ackermann RT, O’Brien MJ: Evidence and challenges for translation and population impact of the Diabetes Prevention Program. Curr Diab Rep. 2020; 20 (3): 9. PubMed Abstract | Publisher Full Text | Free Full Text 4. 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Ely EK, Gruss SM, Luman ET, et al. : A national effort to prevent type 2 diabetes: participant-level evaluation of CDC’s National Diabetes Prevention Program. Diabetes Care. 2017; 40 (10): 1331–1341. PubMed Abstract | Publisher Full Text | Free Full Text 22. Galaviz KI, Weber MB, Straus A, et al. : Global diabetes prevention interventions: a systematic review and network meta-analysis of the real-world impact on incidence, weight, and glucose. Diabetes Care. 2018; 41 (7): 1526–1534. PubMed Abstract | Publisher Full Text | Free Full Text 23. Ross JAD, Barron E, McGough B, et al. : Uptake and impact of the English National Health Service digital Diabetes Prevention Programme: observational study. BMJ Open Diabetes Res Care. 2022; 10 (3): e002736. PubMed Abstract | Publisher Full Text | Free Full Text 24. Department of Health: Healthy Ireland survey 2021. 2021; Accessed July 7, 2023. Reference Source 25. McHugh S, Riordan F, Shelton RC: Breaking the quality-equity cycle when implementing prevention programmes. BMJ Qual Saf. 2023; 32 (5): 247–250. PubMed Abstract | Publisher Full Text 26. Ritchie ND, Kaufmann PG, Gritz RM, et al. : Presessions to the National Diabetes Prevention Program may be a promising strategy to improve attendance and weight loss outcomes. Am J Health Promot. 2019; 33 (2): 289–292. PubMed Abstract | Publisher Full Text 27. Bradley EH, Curry LA, Ramanadhan S, et al. : Research in action: using positive deviance to improve quality of health care. Implement Sci. 2009; 4 (1): 25. PubMed Abstract | Publisher Full Text | Free Full Text 28. Haseldine C: Characteristics of participants in the first fully online National Diabetes Prevention Programme: a quantitative survey. figshare. Online resource. 2023. http://www.doi.org/10.6084/m9.figshare.24126204.v1 Comments on this article Comments (0) Version 4 VERSION 4 PUBLISHED 18 Oct 2023 ADD YOUR COMMENT Comment Author details Author details 1 Department of Public Health, University College Cork, Cork, County Cork, Ireland 2 School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Leinster, Ireland 3 Health Service Executive, Cork, Ireland Clair Haseldine Roles: Conceptualization, Data Curation, Formal Analysis, Investigation, Methodology, Project Administration, Validation, Visualization, Writing – Original Draft Preparation Gráinne O'Donoghue Roles: Conceptualization, Methodology, Supervision, Writing – Review & Editing Patricia M Kearney Roles: Conceptualization, Funding Acquisition, Methodology, Supervision, Writing – Review & Editing Fiona Riordan Roles: Conceptualization, Methodology, Supervision, Writing – Review & Editing Margaret Humphreys Roles: Conceptualization, Writing – Review & Editing Liz Kirby Roles: Conceptualization, Writing – Review & Editing Sheena M. McHugh Roles: Conceptualization, Methodology, Supervision, Writing – Review & Editing Competing interests No competing interests were disclosed. Grant information This study was funded by a Health Research Board (HRB) Collaborative Doctoral Award, 2019 (CDA-2019-001). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Article Versions (4) version 4 Revised Published: 06 Mar 2025, 6:61 https://doi.org/10.12688/hrbopenres.13807.4 version 3 Revised Published: 17 Dec 2024, 6:61 https://doi.org/10.12688/hrbopenres.13807.3 version 2 Revised Published: 21 Nov 2024, 6:61 https://doi.org/10.12688/hrbopenres.13807.2 version 1 Published: 18 Oct 2023, 6:61 https://doi.org/10.12688/hrbopenres.13807.1 Copyright © 2025 Haseldine C et al . This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Download Export To Sciwheel Bibtex EndNote ProCite Ref. Manager (RIS) Sente metrics VIEWS $counts.viewCount downloads Citations open_in_new 0 open_in_new 0 open_in_new SEE MORE DETAILS CITE how to cite this article Haseldine C, O'Donoghue G, Kearney PM et al. Characteristics of participants in the first fully online National Diabetes Prevention Programme: A quantitative survey [version 4; peer review: 2 approved, 1 not approved] . HRB Open Res 2025, 6 :61 ( https://doi.org/10.12688/hrbopenres.13807.4 ) NOTE: If applicable, it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS track receive updates on this article Track an article to receive email alerts on any updates to this article. TRACK THIS ARTICLE Share Open Peer Review Current Reviewer Status: ? Key to Reviewer Statuses VIEW HIDE Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions Version 3 VERSION 3 PUBLISHED 17 Dec 2024 Revised Views 0 Cite How to cite this report: Madrigal L. Reviewer Report For: Characteristics of participants in the first fully online National Diabetes Prevention Programme: A quantitative survey [version 4; peer review: 2 approved, 1 not approved] . HRB Open Res 2025, 6 :61 ( https://doi.org/10.21956/hrbopenres.15429.r44229 ) The direct URL for this report is: https://hrbopenresearch.org/articles/6-61/v3#referee-response-44229 NOTE: it is important to ensure the information in square brackets after the title is included in this citation. Close Copy Citation Details Reviewer Report 19 Dec 2024 Lillian Madrigal , Emory University, Atlanta, USA Approved VIEWS 0 https://doi.org/10.21956/hrbopenres.15429.r44229 Authors have ... Continue reading READ ALL Authors have addressed my comments. Competing Interests: No competing interests were disclosed. Reviewer Expertise: Implementation science, public health promotion programs, diabetes prevention and management, behavioral health, program evaluation I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard. Close READ LESS CITE CITE HOW TO CITE THIS REPORT Madrigal L. Reviewer Report For: Characteristics of participants in the first fully online National Diabetes Prevention Programme: A quantitative survey [version 4; peer review: 2 approved, 1 not approved] . HRB Open Res 2025, 6 :61 ( https://doi.org/10.21956/hrbopenres.15429.r44229 ) The direct URL for this report is: https://hrbopenresearch.org/articles/6-61/v3#referee-response-44229 NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS Report a concern Respond or Comment COMMENT ON THIS REPORT Version 2 VERSION 2 PUBLISHED 21 Nov 2024 Revised Views 0 Cite How to cite this report: Cannon MJ. Reviewer Report For: Characteristics of participants in the first fully online National Diabetes Prevention Programme: A quantitative survey [version 4; peer review: 2 approved, 1 not approved] . HRB Open Res 2025, 6 :61 ( https://doi.org/10.21956/hrbopenres.15404.r43337 ) The direct URL for this report is: https://hrbopenresearch.org/articles/6-61/v2#referee-response-43337 NOTE: it is important to ensure the information in square brackets after the title is included in this citation. Close Copy Citation Details Reviewer Report 17 Dec 2024 Michael J Cannon , Centers for Disease Control and Prevention, Atlanta, USA Not Approved VIEWS 0 https://doi.org/10.21956/hrbopenres.15404.r43337 This article describes demographic, psychosocial, and health characteristics of individuals who participated in a pilot online national diabetes prevention programme delivered via videoconferencing. This kind of information is important for understanding who is being reached by such programs, what factors ... Continue reading READ ALL This article describes demographic, psychosocial, and health characteristics of individuals who participated in a pilot online national diabetes prevention programme delivered via videoconferencing. This kind of information is important for understanding who is being reached by such programs, what factors might lead people to participate, and what sort of attitudes and motivation participants might have. The information was collected using validated survey instruments where applicable. Several findings indicate characteristics that might be targeted for participant recruitment, as well as health messages that may be needed to increase interest in the online program. They include that participants often had a family member with diabetes, were confident about joining an online program, believed that diabetes is important and that participating in the program could reduce their risk of developing diabetes. For understanding this study better, I would recommend adding a few sentences about recruitment in the section under Survey domains/Participation. How did recruitment work? How were people identified as eligible to participate? What percentage of people called agreed to participate and then actually participated? I realize this information may be in one of the cited reports, but a concise description here would really help the reader. The main limitation of the study is that the sample size was very small (N=22). As a result, it is hard to know how generalizable the results are. This, to me, is a serious limitation. Furthermore, the respondents only represented 30.5% of participants who were invited to participate (N=73), and they may differ in important ways from those who did not respond. As a result of these limitations, I do not have confidence that the findings can be applied more widely. For future research, in addition to having a larger sample of respondents, it would be great to have a better sense of how some of the measures differed for eligible individuals who declined participation in the NDPP (perhaps through surveys) and for all eligible participants in the country (perhaps using other data sources). This would give a stronger sense of what is different for those who decide to participate compared to those who do not. Is the work clearly and accurately presented and does it cite the current literature? Yes Is the study design appropriate and is the work technically sound? Yes Are sufficient details of methods and analysis provided to allow replication by others? Yes If applicable, is the statistical analysis and its interpretation appropriate? Yes Are all the source data underlying the results available to ensure full reproducibility? No Are the conclusions drawn adequately supported by the results? Yes Competing Interests: No competing interests were disclosed. Reviewer Expertise: I do research on the implementation of diabetes prevention and management programs. I confirm that I have read this submission and believe that I have an appropriate level of expertise to state that I do not consider it to be of an acceptable scientific standard, for reasons outlined above. Close READ LESS CITE CITE HOW TO CITE THIS REPORT Cannon MJ. Reviewer Report For: Characteristics of participants in the first fully online National Diabetes Prevention Programme: A quantitative survey [version 4; peer review: 2 approved, 1 not approved] . HRB Open Res 2025, 6 :61 ( https://doi.org/10.21956/hrbopenres.15404.r43337 ) The direct URL for this report is: https://hrbopenresearch.org/articles/6-61/v2#referee-response-43337 NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS Report a concern Author Response 05 Mar 2025 clair haseldine , Department of Public Health, University College Cork, Cork, Ireland 05 Mar 2025 Author Response Dear Dr Cannon, Thank you for you helpful review. I respond to all of the points you raised below. 1. For understanding this study better, I would recommend adding ... Continue reading Dear Dr Cannon, Thank you for you helpful review. I respond to all of the points you raised below. 1. For understanding this study better, I would recommend adding a few sentences about recruitment in the section under Survey domains/Participation 1. This information has been added in Version 3 in response to Reviewer 2 comments as detailed below. The page numbers and line numbers have been updated for the latest version (Version 4). How did recruitment work? How were people identified as eligible to participate? Further details have been added to “Survey Domains: Participation” Recruitment for the NDPP pilot was from existing dietetic waiting lists and by referrals from GPs who had been informed of the pilot. Page 5 lines 12, 13 What percentage of people called agreed to participate and then actually participated? Further clarification has been added to the section “Participants and procedure” Of the 158 people invited to attend the NDPP, 73 attended the initial assessment and 67 went on to attend at least one further session. Page 10 lines 5,6 2. The main limitation of the study is that the sample size was very small (N=22). As a result, it is hard to know how generalizable the results are. This, to me, is a serious limitation. Furthermore, the respondents only represented 30.5% of participants who were invited to participate (N=73), and they may differ in important ways from those who did not respond. As a result of these limitations, I do not have confidence that the findings can be applied more widely. 2. We acknowledge the reviewer’s concerns about the sample size (N=22) and the response rate (30.5%). The number invited to take part in the pilot programme was small (N=73) which limited the overall number of survey respondents. Pilot programmes are often intentionally small to test the feasibility of implementing the programme before scale up and as a trial run of the intervention itself (Skivington et al, 2021). To maximise the response rate, we personalised the invite to the survey, included a €10 voucher to compensate the respondents for their time and included a stamped addressed envelope for the survey return, strategies shown to be effective in a Cochrane systematic review (Edwards, et al, 2007). References Skivington K, Matthews L, Simpson SA, Craig P, Baird J, Blazeby JM, Boyd KA, Craig N, French DP, McIntosh E, Petticrew M. A new framework for developing and evaluating complex interventions: update of Medical Research Council guidance. bmj. 2021 Sep 30;374. Edwards PJ, Roberts IG, Clarke MJ, DiGuiseppi C, Wentz R, Kwan I, Cooper R, Felix L, Pratap S. Methods to increase response rates to postal questionnaires. Cochrane Database of systematic reviews 2007, issue 2. Art No : MR000008 The generalisability of small sample size and response rate are discussed further in the strengths and limitations section: The uptake of this survey was lower than the response to the NHS survey (31% vs 54%) however, the people who responded to the survey had a broad age range, a wide range of educational attainment, and there was good representation from both men and women. While the small sample size and response rate may limit the generalisability of this research note, the findings provide an update to researchers and DPP providers about the online pilot of an NDPP and the emerging evidence on the characteristics of those invited to attend. Page 13 lines 25 - 30 3. For future research, in addition to having a larger sample of respondents, it would be great to have a better sense of how some of the measures differed for eligible individuals who declined participation in the NDPP (perhaps through surveys) and for all eligible participants in the country (perhaps using other data sources). This would give a stronger sense of what is different for those who decide to participate compared to those who do not. 3. Originally, we had hoped to survey the people who declined to attend but this access to this data was not possible. The recommendations for further research have been added to the strengths and limitations section as suggested: The people attending the programme may have been the easiest to recruit, or they may have differed in important ways from those who chose to respond, therefore further research (such as survey or other data sources) should focus on understanding the views of those who declined to attend to improve participation in the future. Page 13 lines 33 and 34 Dear Dr Cannon, Thank you for you helpful review. I respond to all of the points you raised below. 1. For understanding this study better, I would recommend adding a few sentences about recruitment in the section under Survey domains/Participation 1. This information has been added in Version 3 in response to Reviewer 2 comments as detailed below. The page numbers and line numbers have been updated for the latest version (Version 4). How did recruitment work? How were people identified as eligible to participate? Further details have been added to “Survey Domains: Participation” Recruitment for the NDPP pilot was from existing dietetic waiting lists and by referrals from GPs who had been informed of the pilot. Page 5 lines 12, 13 What percentage of people called agreed to participate and then actually participated? Further clarification has been added to the section “Participants and procedure” Of the 158 people invited to attend the NDPP, 73 attended the initial assessment and 67 went on to attend at least one further session. Page 10 lines 5,6 2. The main limitation of the study is that the sample size was very small (N=22). As a result, it is hard to know how generalizable the results are. This, to me, is a serious limitation. Furthermore, the respondents only represented 30.5% of participants who were invited to participate (N=73), and they may differ in important ways from those who did not respond. As a result of these limitations, I do not have confidence that the findings can be applied more widely. 2. We acknowledge the reviewer’s concerns about the sample size (N=22) and the response rate (30.5%). The number invited to take part in the pilot programme was small (N=73) which limited the overall number of survey respondents. Pilot programmes are often intentionally small to test the feasibility of implementing the programme before scale up and as a trial run of the intervention itself (Skivington et al, 2021). To maximise the response rate, we personalised the invite to the survey, included a €10 voucher to compensate the respondents for their time and included a stamped addressed envelope for the survey return, strategies shown to be effective in a Cochrane systematic review (Edwards, et al, 2007). References Skivington K, Matthews L, Simpson SA, Craig P, Baird J, Blazeby JM, Boyd KA, Craig N, French DP, McIntosh E, Petticrew M. A new framework for developing and evaluating complex interventions: update of Medical Research Council guidance. bmj. 2021 Sep 30;374. Edwards PJ, Roberts IG, Clarke MJ, DiGuiseppi C, Wentz R, Kwan I, Cooper R, Felix L, Pratap S. Methods to increase response rates to postal questionnaires. Cochrane Database of systematic reviews 2007, issue 2. Art No : MR000008 The generalisability of small sample size and response rate are discussed further in the strengths and limitations section: The uptake of this survey was lower than the response to the NHS survey (31% vs 54%) however, the people who responded to the survey had a broad age range, a wide range of educational attainment, and there was good representation from both men and women. While the small sample size and response rate may limit the generalisability of this research note, the findings provide an update to researchers and DPP providers about the online pilot of an NDPP and the emerging evidence on the characteristics of those invited to attend. Page 13 lines 25 - 30 3. For future research, in addition to having a larger sample of respondents, it would be great to have a better sense of how some of the measures differed for eligible individuals who declined participation in the NDPP (perhaps through surveys) and for all eligible participants in the country (perhaps using other data sources). This would give a stronger sense of what is different for those who decide to participate compared to those who do not. 3. Originally, we had hoped to survey the people who declined to attend but this access to this data was not possible. The recommendations for further research have been added to the strengths and limitations section as suggested: The people attending the programme may have been the easiest to recruit, or they may have differed in important ways from those who chose to respond, therefore further research (such as survey or other data sources) should focus on understanding the views of those who declined to attend to improve participation in the future. Page 13 lines 33 and 34 Competing Interests: No competing interests were disclosed. Close Report a concern Respond or Comment COMMENTS ON THIS REPORT Author Response 05 Mar 2025 clair haseldine , Department of Public Health, University College Cork, Cork, Ireland 05 Mar 2025 Author Response Dear Dr Cannon, Thank you for you helpful review. I respond to all of the points you raised below. 1. For understanding this study better, I would recommend adding ... Continue reading Dear Dr Cannon, Thank you for you helpful review. I respond to all of the points you raised below. 1. For understanding this study better, I would recommend adding a few sentences about recruitment in the section under Survey domains/Participation 1. This information has been added in Version 3 in response to Reviewer 2 comments as detailed below. The page numbers and line numbers have been updated for the latest version (Version 4). How did recruitment work? How were people identified as eligible to participate? Further details have been added to “Survey Domains: Participation” Recruitment for the NDPP pilot was from existing dietetic waiting lists and by referrals from GPs who had been informed of the pilot. Page 5 lines 12, 13 What percentage of people called agreed to participate and then actually participated? Further clarification has been added to the section “Participants and procedure” Of the 158 people invited to attend the NDPP, 73 attended the initial assessment and 67 went on to attend at least one further session. Page 10 lines 5,6 2. The main limitation of the study is that the sample size was very small (N=22). As a result, it is hard to know how generalizable the results are. This, to me, is a serious limitation. Furthermore, the respondents only represented 30.5% of participants who were invited to participate (N=73), and they may differ in important ways from those who did not respond. As a result of these limitations, I do not have confidence that the findings can be applied more widely. 2. We acknowledge the reviewer’s concerns about the sample size (N=22) and the response rate (30.5%). The number invited to take part in the pilot programme was small (N=73) which limited the overall number of survey respondents. Pilot programmes are often intentionally small to test the feasibility of implementing the programme before scale up and as a trial run of the intervention itself (Skivington et al, 2021). To maximise the response rate, we personalised the invite to the survey, included a €10 voucher to compensate the respondents for their time and included a stamped addressed envelope for the survey return, strategies shown to be effective in a Cochrane systematic review (Edwards, et al, 2007). References Skivington K, Matthews L, Simpson SA, Craig P, Baird J, Blazeby JM, Boyd KA, Craig N, French DP, McIntosh E, Petticrew M. A new framework for developing and evaluating complex interventions: update of Medical Research Council guidance. bmj. 2021 Sep 30;374. Edwards PJ, Roberts IG, Clarke MJ, DiGuiseppi C, Wentz R, Kwan I, Cooper R, Felix L, Pratap S. Methods to increase response rates to postal questionnaires. Cochrane Database of systematic reviews 2007, issue 2. Art No : MR000008 The generalisability of small sample size and response rate are discussed further in the strengths and limitations section: The uptake of this survey was lower than the response to the NHS survey (31% vs 54%) however, the people who responded to the survey had a broad age range, a wide range of educational attainment, and there was good representation from both men and women. While the small sample size and response rate may limit the generalisability of this research note, the findings provide an update to researchers and DPP providers about the online pilot of an NDPP and the emerging evidence on the characteristics of those invited to attend. Page 13 lines 25 - 30 3. For future research, in addition to having a larger sample of respondents, it would be great to have a better sense of how some of the measures differed for eligible individuals who declined participation in the NDPP (perhaps through surveys) and for all eligible participants in the country (perhaps using other data sources). This would give a stronger sense of what is different for those who decide to participate compared to those who do not. 3. Originally, we had hoped to survey the people who declined to attend but this access to this data was not possible. The recommendations for further research have been added to the strengths and limitations section as suggested: The people attending the programme may have been the easiest to recruit, or they may have differed in important ways from those who chose to respond, therefore further research (such as survey or other data sources) should focus on understanding the views of those who declined to attend to improve participation in the future. Page 13 lines 33 and 34 Dear Dr Cannon, Thank you for you helpful review. I respond to all of the points you raised below. 1. For understanding this study better, I would recommend adding a few sentences about recruitment in the section under Survey domains/Participation 1. This information has been added in Version 3 in response to Reviewer 2 comments as detailed below. The page numbers and line numbers have been updated for the latest version (Version 4). How did recruitment work? How were people identified as eligible to participate? Further details have been added to “Survey Domains: Participation” Recruitment for the NDPP pilot was from existing dietetic waiting lists and by referrals from GPs who had been informed of the pilot. Page 5 lines 12, 13 What percentage of people called agreed to participate and then actually participated? Further clarification has been added to the section “Participants and procedure” Of the 158 people invited to attend the NDPP, 73 attended the initial assessment and 67 went on to attend at least one further session. Page 10 lines 5,6 2. The main limitation of the study is that the sample size was very small (N=22). As a result, it is hard to know how generalizable the results are. This, to me, is a serious limitation. Furthermore, the respondents only represented 30.5% of participants who were invited to participate (N=73), and they may differ in important ways from those who did not respond. As a result of these limitations, I do not have confidence that the findings can be applied more widely. 2. We acknowledge the reviewer’s concerns about the sample size (N=22) and the response rate (30.5%). The number invited to take part in the pilot programme was small (N=73) which limited the overall number of survey respondents. Pilot programmes are often intentionally small to test the feasibility of implementing the programme before scale up and as a trial run of the intervention itself (Skivington et al, 2021). To maximise the response rate, we personalised the invite to the survey, included a €10 voucher to compensate the respondents for their time and included a stamped addressed envelope for the survey return, strategies shown to be effective in a Cochrane systematic review (Edwards, et al, 2007). References Skivington K, Matthews L, Simpson SA, Craig P, Baird J, Blazeby JM, Boyd KA, Craig N, French DP, McIntosh E, Petticrew M. A new framework for developing and evaluating complex interventions: update of Medical Research Council guidance. bmj. 2021 Sep 30;374. Edwards PJ, Roberts IG, Clarke MJ, DiGuiseppi C, Wentz R, Kwan I, Cooper R, Felix L, Pratap S. Methods to increase response rates to postal questionnaires. Cochrane Database of systematic reviews 2007, issue 2. Art No : MR000008 The generalisability of small sample size and response rate are discussed further in the strengths and limitations section: The uptake of this survey was lower than the response to the NHS survey (31% vs 54%) however, the people who responded to the survey had a broad age range, a wide range of educational attainment, and there was good representation from both men and women. While the small sample size and response rate may limit the generalisability of this research note, the findings provide an update to researchers and DPP providers about the online pilot of an NDPP and the emerging evidence on the characteristics of those invited to attend. Page 13 lines 25 - 30 3. For future research, in addition to having a larger sample of respondents, it would be great to have a better sense of how some of the measures differed for eligible individuals who declined participation in the NDPP (perhaps through surveys) and for all eligible participants in the country (perhaps using other data sources). This would give a stronger sense of what is different for those who decide to participate compared to those who do not. 3. Originally, we had hoped to survey the people who declined to attend but this access to this data was not possible. The recommendations for further research have been added to the strengths and limitations section as suggested: The people attending the programme may have been the easiest to recruit, or they may have differed in important ways from those who chose to respond, therefore further research (such as survey or other data sources) should focus on understanding the views of those who declined to attend to improve participation in the future. Page 13 lines 33 and 34 Competing Interests: No competing interests were disclosed. Close Report a concern COMMENT ON THIS REPORT Views 0 Cite How to cite this report: Madrigal L. Reviewer Report For: Characteristics of participants in the first fully online National Diabetes Prevention Programme: A quantitative survey [version 4; peer review: 2 approved, 1 not approved] . HRB Open Res 2025, 6 :61 ( https://doi.org/10.21956/hrbopenres.15404.r43334 ) The direct URL for this report is: https://hrbopenresearch.org/articles/6-61/v2#referee-response-43334 NOTE: it is important to ensure the information in square brackets after the title is included in this citation. Close Copy Citation Details Reviewer Report 02 Dec 2024 Lillian Madrigal , Emory University, Atlanta, USA Approved with Reservations VIEWS 0 https://doi.org/10.21956/hrbopenres.15404.r43334 This paper presents the results of a survey of participants in Ireland who had attended an initial assessment to participate in a pilot online synchronous version of the Irish National Diabetes Prevention Program. The study aims are to describe the demographic, ... Continue reading READ ALL This paper presents the results of a survey of participants in Ireland who had attended an initial assessment to participate in a pilot online synchronous version of the Irish National Diabetes Prevention Program. The study aims are to describe the demographic, psychosocial and health characteristics of participants in this online pilot. The evaluation methods appear to be sound for the aims of the study and results are clearly written. The findings of this work are useful for others implementing DPPs as well as other health promotion programs as they can replicate the surveys to assess demographic, psychosocial and health characteristics of participants in their populations. As someone who implements DPPs myself, I find the psychosocial factors in particular useful for understanding awareness and motivation to participate in the program. As the authors also point out it is nice to see an evaluation with a good representation of men in the cohort as men typically have lower participation rates in these programs. I have one revision request for the methods. I am unclear who the initial pool of eligible participants was. Under "Survey Domains: Participation" it says "educators invited people eligible" - who are these educators? where are the people from? Was a list of eligible candidates pulled from the HSE? What was the denominator to get to the 73 participants for the initial assessment? I believe more details are needed here to understand any bias in the recruitment and participants selected. Furthermore, a big challenge with DPPs is the "conversion rate" meaning the percent of individuals who are identified as eligible for these programs who actually enroll. I think that would be helpful to understand as many in the field as trying to assess if recruitment into programs is more successful for online vs distance vs in-person programs. Some comment on this might also be useful in the discussion. Is the work clearly and accurately presented and does it cite the current literature? Yes Is the study design appropriate and is the work technically sound? Yes Are sufficient details of methods and analysis provided to allow replication by others? Partly If applicable, is the statistical analysis and its interpretation appropriate? Yes Are all the source data underlying the results available to ensure full reproducibility? No source data required Are the conclusions drawn adequately supported by the results? Yes Competing Interests: No competing interests were disclosed. Reviewer Expertise: Implementation science, public health promotion programs, diabetes prevention and management, behavioral health, program evaluation I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above. Close READ LESS CITE CITE HOW TO CITE THIS REPORT Madrigal L. Reviewer Report For: Characteristics of participants in the first fully online National Diabetes Prevention Programme: A quantitative survey [version 4; peer review: 2 approved, 1 not approved] . HRB Open Res 2025, 6 :61 ( https://doi.org/10.21956/hrbopenres.15404.r43334 ) The direct URL for this report is: https://hrbopenresearch.org/articles/6-61/v2#referee-response-43334 NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS Report a concern Author Response 18 Dec 2024 clair haseldine , Department of Public Health, University College Cork, Cork, Ireland 18 Dec 2024 Author Response Dear Dr Madrigal, Thank you for your helpful comments. Please see the responses below to each point raised. I have one revision request for the methods. I am unclear ... Continue reading Dear Dr Madrigal, Thank you for your helpful comments. Please see the responses below to each point raised. I have one revision request for the methods. I am unclear who the initial pool of eligible participants was. Under "Survey Domains: Participation" it says "educators invited people eligible" Further details have been added to “Survey Domains: Participation”. Full details of the NDPP are available in Extended data – Appendix 3 Who are these educators? Educators (dieticians in the HSE) invited people eligible to participate in the NDPP by phone. Page 5 line 9 Where are the people from? Was a list of eligible candidates pulled from the HSE? Recruitment for the NDPP pilot was from existing dietetic waiting lists and by referrals from GPs who had been informed of the pilot. Page 5 lines 8, 9 What was the denominator to get to the 73 participants for the initial assessment? Further clarification has been added to the section “Participants and procedure” Of the 158 people invited to attend the NDPP, 73 attended the initial assessment and 67 went on to attend at least one further session. Page 10 lines 5,6 Furthermore, a big challenge with DPPs is the "conversion rate" meaning the percent of individuals who are identified as eligible for these programs who actually enroll. I think that would be helpful to understand as many in the field as trying to assess if recruitment into programs is more successful for online vs distance vs in-person programs. Some comment on this might also be useful in the discussion. These are important points however the pilot was testing the feasibility of implementing the programme and it was not designed to provide definite data on recruitment. Further research is needed to understand if recruitment is more successful for online Vs distance Vs in-person programmes. To acknowledge that this study may be useful to researchers investigating the conversion rates with different modes of delivery I have added the following comments to the strengths and limitations: “…and researchers will find this study helpful to understand participation when no other format such as face-to-face was available.” Page 13, lines 10 and 11 Dear Dr Madrigal, Thank you for your helpful comments. Please see the responses below to each point raised. I have one revision request for the methods. I am unclear who the initial pool of eligible participants was. Under "Survey Domains: Participation" it says "educators invited people eligible" Further details have been added to “Survey Domains: Participation”. Full details of the NDPP are available in Extended data – Appendix 3 Who are these educators? Educators (dieticians in the HSE) invited people eligible to participate in the NDPP by phone. Page 5 line 9 Where are the people from? Was a list of eligible candidates pulled from the HSE? Recruitment for the NDPP pilot was from existing dietetic waiting lists and by referrals from GPs who had been informed of the pilot. Page 5 lines 8, 9 What was the denominator to get to the 73 participants for the initial assessment? Further clarification has been added to the section “Participants and procedure” Of the 158 people invited to attend the NDPP, 73 attended the initial assessment and 67 went on to attend at least one further session. Page 10 lines 5,6 Furthermore, a big challenge with DPPs is the "conversion rate" meaning the percent of individuals who are identified as eligible for these programs who actually enroll. I think that would be helpful to understand as many in the field as trying to assess if recruitment into programs is more successful for online vs distance vs in-person programs. Some comment on this might also be useful in the discussion. These are important points however the pilot was testing the feasibility of implementing the programme and it was not designed to provide definite data on recruitment. Further research is needed to understand if recruitment is more successful for online Vs distance Vs in-person programmes. To acknowledge that this study may be useful to researchers investigating the conversion rates with different modes of delivery I have added the following comments to the strengths and limitations: “…and researchers will find this study helpful to understand participation when no other format such as face-to-face was available.” Page 13, lines 10 and 11 Competing Interests: No competing interests were disclosed. Close Report a concern Respond or Comment COMMENTS ON THIS REPORT Author Response 18 Dec 2024 clair haseldine , Department of Public Health, University College Cork, Cork, Ireland 18 Dec 2024 Author Response Dear Dr Madrigal, Thank you for your helpful comments. Please see the responses below to each point raised. I have one revision request for the methods. I am unclear ... Continue reading Dear Dr Madrigal, Thank you for your helpful comments. Please see the responses below to each point raised. I have one revision request for the methods. I am unclear who the initial pool of eligible participants was. Under "Survey Domains: Participation" it says "educators invited people eligible" Further details have been added to “Survey Domains: Participation”. Full details of the NDPP are available in Extended data – Appendix 3 Who are these educators? Educators (dieticians in the HSE) invited people eligible to participate in the NDPP by phone. Page 5 line 9 Where are the people from? Was a list of eligible candidates pulled from the HSE? Recruitment for the NDPP pilot was from existing dietetic waiting lists and by referrals from GPs who had been informed of the pilot. Page 5 lines 8, 9 What was the denominator to get to the 73 participants for the initial assessment? Further clarification has been added to the section “Participants and procedure” Of the 158 people invited to attend the NDPP, 73 attended the initial assessment and 67 went on to attend at least one further session. Page 10 lines 5,6 Furthermore, a big challenge with DPPs is the "conversion rate" meaning the percent of individuals who are identified as eligible for these programs who actually enroll. I think that would be helpful to understand as many in the field as trying to assess if recruitment into programs is more successful for online vs distance vs in-person programs. Some comment on this might also be useful in the discussion. These are important points however the pilot was testing the feasibility of implementing the programme and it was not designed to provide definite data on recruitment. Further research is needed to understand if recruitment is more successful for online Vs distance Vs in-person programmes. To acknowledge that this study may be useful to researchers investigating the conversion rates with different modes of delivery I have added the following comments to the strengths and limitations: “…and researchers will find this study helpful to understand participation when no other format such as face-to-face was available.” Page 13, lines 10 and 11 Dear Dr Madrigal, Thank you for your helpful comments. Please see the responses below to each point raised. I have one revision request for the methods. I am unclear who the initial pool of eligible participants was. Under "Survey Domains: Participation" it says "educators invited people eligible" Further details have been added to “Survey Domains: Participation”. Full details of the NDPP are available in Extended data – Appendix 3 Who are these educators? Educators (dieticians in the HSE) invited people eligible to participate in the NDPP by phone. Page 5 line 9 Where are the people from? Was a list of eligible candidates pulled from the HSE? Recruitment for the NDPP pilot was from existing dietetic waiting lists and by referrals from GPs who had been informed of the pilot. Page 5 lines 8, 9 What was the denominator to get to the 73 participants for the initial assessment? Further clarification has been added to the section “Participants and procedure” Of the 158 people invited to attend the NDPP, 73 attended the initial assessment and 67 went on to attend at least one further session. Page 10 lines 5,6 Furthermore, a big challenge with DPPs is the "conversion rate" meaning the percent of individuals who are identified as eligible for these programs who actually enroll. I think that would be helpful to understand as many in the field as trying to assess if recruitment into programs is more successful for online vs distance vs in-person programs. Some comment on this might also be useful in the discussion. These are important points however the pilot was testing the feasibility of implementing the programme and it was not designed to provide definite data on recruitment. Further research is needed to understand if recruitment is more successful for online Vs distance Vs in-person programmes. To acknowledge that this study may be useful to researchers investigating the conversion rates with different modes of delivery I have added the following comments to the strengths and limitations: “…and researchers will find this study helpful to understand participation when no other format such as face-to-face was available.” Page 13, lines 10 and 11 Competing Interests: No competing interests were disclosed. Close Report a concern COMMENT ON THIS REPORT Views 0 Cite How to cite this report: Hawkes R. Reviewer Report For: Characteristics of participants in the first fully online National Diabetes Prevention Programme: A quantitative survey [version 4; peer review: 2 approved, 1 not approved] . HRB Open Res 2025, 6 :61 ( https://doi.org/10.21956/hrbopenres.15404.r43309 ) The direct URL for this report is: https://hrbopenresearch.org/articles/6-61/v2#referee-response-43309 NOTE: it is important to ensure the information in square brackets after the title is included in this citation. Close Copy Citation Details Reviewer Report 25 Nov 2024 Rhiannon Hawkes , University of Manchester, Manchester, UK Approved VIEWS 0 https://doi.org/10.21956/hrbopenres.15404.r43309 Thank you for addressing my comments, I have no further comments to make. I'm ... Continue reading READ ALL Thank you for addressing my comments, I have no further comments to make. I'm looking forward to hearing about future work from the research team on the Irish NDPP. Competing Interests: No competing interests were disclosed. Reviewer Expertise: Diabetes prevention programmes, behaviour change, health psychology I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard. Close READ LESS CITE CITE HOW TO CITE THIS REPORT Hawkes R. Reviewer Report For: Characteristics of participants in the first fully online National Diabetes Prevention Programme: A quantitative survey [version 4; peer review: 2 approved, 1 not approved] . HRB Open Res 2025, 6 :61 ( https://doi.org/10.21956/hrbopenres.15404.r43309 ) The direct URL for this report is: https://hrbopenresearch.org/articles/6-61/v2#referee-response-43309 NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS Report a concern Respond or Comment COMMENT ON THIS REPORT Version 1 VERSION 1 PUBLISHED 18 Oct 2023 Views 0 Cite How to cite this report: Hawkes R. Reviewer Report For: Characteristics of participants in the first fully online National Diabetes Prevention Programme: A quantitative survey [version 4; peer review: 2 approved, 1 not approved] . HRB Open Res 2025, 6 :61 ( https://doi.org/10.21956/hrbopenres.15110.r40518 ) The direct URL for this report is: https://hrbopenresearch.org/articles/6-61/v1#referee-response-40518 NOTE: it is important to ensure the information in square brackets after the title is included in this citation. Close Copy Citation Details Reviewer Report 20 Jun 2024 Rhiannon Hawkes , University of Manchester, Manchester, UK Approved with Reservations VIEWS 0 https://doi.org/10.21956/hrbopenres.15110.r40518 This is a well-written paper describing findings from a survey distributed to participants of pilot online diabetes prevention programme in Ireland. This is particularly novel as Ireland is the first to pilot a national DPP that is online only and ... Continue reading READ ALL This is a well-written paper describing findings from a survey distributed to participants of pilot online diabetes prevention programme in Ireland. This is particularly novel as Ireland is the first to pilot a national DPP that is online only and delivered to a group synchronously. Findings from this programme of work will therefore be of interest to other countries developing their own versions of diabetes prevention initiatives. Thank you for the opportunity to review this paper, and I look forwards to seeing further work from the research team to see how the Irish NDPP progresses. The following comments are some minor suggestions for consideration: 1. There are some instances throughout the abstract and manuscript where there needs to be a space between a word and opening bracket, for example: “the Health Service Executive(HSE)”, “HSE(national publicly funded healthcare system)”. 2. The abbreviations NDPP and HSE are defined in the abstract, but these should be defined again at first mention in the main manuscript. 3. At the start of the introduction the authors could consider adding in a brief sentence explaining why type 2 diabetes is a growing problem (e.g., complications and costs to the health service) to further set the scene for readers. 4. Prior to the NDPP being piloted, was Ireland offering any other diabetes prevention initiatives? An extra sentence in the introduction with some context might be useful for readers. 5. It is mentioned that participants attend an initial assessment that was followed by 14 sessions of the NDPP. Appendix 3 is particularly useful here, but perhaps it could be briefly explained in the paper what the initial assessment might entail for readers who are less familiar with DPPs? For example, was the initial assessment solely to determine the eligibility of participants for the programme, or were baseline measures also taken? How long did the initial assessment last? Was it online or in-person? Does this include onboarding or is that a separate session? 6. In Appendix 3 of the TIDieR checklist, could the abbreviation CNS be clarified? 7. It is mentioned that the survey was piloted with a patient and public involvement group, which is commendable and an example of best practice. Could there be some more information about how PPI shaped this research? E.g., what were the characteristics of the group? (Males/females, ages, were these people at risk of or living with type 2 diabetes?) What feedback did they provide on the survey and what feedback was incorporated into the final version of the survey? 8. The survey response rate was 31%, and although this was lower than similar studies conducted (e.g., response to the NHS DPP survey), it is noted that respondents were representative of the 73 people in the cohort who participated in the NDPP. Out of curiosity I was wondering whether the research team had considered also offering the survey as an online format (e.g., via Qualtrics or another platform), which might have increased the response rate, given that respondents were taking part in an online programme? Were any reminder letters sent out? Perhaps these could be future considerations if a similar evaluation is conducted on the NDPP (if the programme is continuing?) 9. Limitations – is there the potential that the 73 people who participated in the pilot NDPP were the ‘low hanging fruit’, i.e. the people who were most likely to participate in the programme in the first place? So this study is useful for understanding how to improve participation in the ‘engaged’ participants, but less useful for understanding why people don’t participate. There is mention of understanding the views of those who declined to participate in the NDPP, but there could also be further mention of understanding reasons for non-participation of those who attended the initial assessment but did not attend any online sessions of the NDPP. 10. What are the plans for the NDPP in Ireland now that the pilot programme has finished? If the programme is continuing, what will the programme look like and is there any further evaluation work planned? Is the work clearly and accurately presented and does it cite the current literature? Yes Is the study design appropriate and is the work technically sound? Yes Are sufficient details of methods and analysis provided to allow replication by others? Yes If applicable, is the statistical analysis and its interpretation appropriate? Yes Are all the source data underlying the results available to ensure full reproducibility? Yes Are the conclusions drawn adequately supported by the results? Yes Competing Interests: No competing interests were disclosed. Reviewer Expertise: Diabetes prevention programmes, behaviour change, health psychology I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above. Close READ LESS CITE CITE HOW TO CITE THIS REPORT Hawkes R. Reviewer Report For: Characteristics of participants in the first fully online National Diabetes Prevention Programme: A quantitative survey [version 4; peer review: 2 approved, 1 not approved] . HRB Open Res 2025, 6 :61 ( https://doi.org/10.21956/hrbopenres.15110.r40518 ) The direct URL for this report is: https://hrbopenresearch.org/articles/6-61/v1#referee-response-40518 NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS Report a concern Author Response 22 Nov 2024 clair haseldine , Department of Public Health, University College Cork, Cork, Ireland 22 Nov 2024 Author Response Dear Reviewer, Thank you for your helpful review. We made every effort to address all the points raised. The changes are highlighted in red in the revised text. 1.There ... Continue reading Dear Reviewer, Thank you for your helpful review. We made every effort to address all the points raised. The changes are highlighted in red in the revised text. 1.There are some instances throughout the abstract and manuscript where there needs to be a space between a word and opening bracket, for example: “the Health Service Executive(HSE)”, “HSE(national publicly funded healthcare system)”. Thank you for highlighting this. I have corrected the issue with spacing throughout the manuscript. 2. The abbreviations NDPP and HSE are defined in the abstract, but these should be defined again at first mention in the main manuscript. I have now defined the abbreviations at first mention in the main manuscript: Page 4, line 19 Page 4, line 20 3. At the start of the introduction the authors could consider adding in a brief sentence explaining why type 2 diabetes is a growing problem (e.g., complications and costs to the health service) to further set the scene for readers. I have now included the following line on the growing problem of type 2 diabetes to set the scene at the start of the introduction. Page 3, lines 2, 3 “Type 2 diabetes is a growing global health problem which can result in serious chronic health complications for individuals and places a financial burden on health systems.” Reference: International Diabetes Federation. IDF Diabetes Atlas, 10th edn. Brussels, Belgium: 2021. Available at https://www.diabetesatlas.org 4. Prior to the NDPP being piloted, was Ireland offering any other diabetes prevention initiatives? An extra sentence in the introduction with some context might be useful for readers. I have added the following information on diabetes prevention initiatives that were available before the introduction of the NDPP. Page 4, lines 21, 22 “Prior to this there was very limited availability to short prediabetes courses that were not standardised.” 5. It is mentioned that participants attend an initial assessment that was followed by 14 sessions of the NDPP. Appendix 3 is particularly useful here, but perhaps it could be briefly explained in the paper what the initial assessment might entail for readers who are less familiar with DPPs? For example, was the initial assessment solely to determine the eligibility of participants for the programme, or were baseline measures also taken? How long did the initial assessment last? Was it online or in-person? Does this include onboarding or is that a separate session? I have added details about the initial assessment. Page 5 lines 13 - 15 “NDPP participants attended an initial assessment (in person, online or on the phone to have baseline measurements recorded, to receive a personal plan for lifestyle change and onboarding for the online session), and this was followed by 14 sessions of the NDPP (Extended Data-Appendix 3).” Note: Under extended data in the paper the appendices were labelled incorrectly – this has now been corrected. Page 14, lines 20 - 22 6. In Appendix 3 of the TIDieR checklist, could the abbreviation CNS be clarified? The abbreviation CNS has been clarified to Clinical Nurse Specialist in the TIDieR checklist in Appendix 3. 7. It is mentioned that the survey was piloted with a patient and public involvement group, which is commendable and an example of best practice. Could there be some more information about how PPI shaped this research? E.g., what were the characteristics of the group? (Males/females, ages, were these people at risk of or living with type 2 diabetes?) What feedback did they provide on the survey and what feedback was incorporated into the final version of the survey? Thank you for these suggestions. I have included further information on the contribution of the PPI panel however I have not included their demographic or medical history as I do not have their permission to do so. Page 5, lines 3 - 6: “The PPI group consisted of 10 people with an interest in diabetes prevention. They advised on recruitment and the wording of questions. Based on their feedback on recruitment, the cover letters used the participant’s name rather than a generic address.” 8. The survey response rate was 31%, and although this was lower than similar studies conducted (e.g., response to the NHS DPP survey), it is noted that respondents were representative of the 73 people in the cohort who participated in the NDPP. Out of curiosity I was wondering whether the research team had considered also offering the survey as an online format (e.g., via Qualtrics or another platform), which might have increased the response rate, given that respondents were taking part in an online programme? Were any reminder letters sent out? Perhaps these could be future considerations if a similar evaluation is conducted on the NDPP (if the programme is continuing?) Thank you for those suggestions. We had initially hoped to also survey people who declined to attend, therefore we developed the postal survey so as not to exclude those who may not have been comfortable with the online format. As the research team did not have access to the participant’s details the educators sent out the surveys on our behalf. Due to time constraints a reminder letter was not sent. I agree that your suggestions could be very helpful in the future if another evaluation is conducted. 9. Limitations – is there the potential that the 73 people who participated in the pilot NDPP were the ‘low hanging fruit’, i.e. the people who were most likely to participate in the programme in the first place? So this study is useful for understanding how to improve participation in the ‘engaged’ participants, but less useful for understanding why people don’t participate. There is mention of understanding the views of those who declined to participate in the NDPP, but there could also be further mention of understanding reasons for non-participation of those who attended the initial assessment but did not attend any online sessions of the NDPP. I have acknowledged these limitations and the need for further research with those who declined to participate. Page 13, lines 31 - 36 “The people attending the programme may have been the easiest to recruit, therefore further research should focus on understanding the views of those who declined to attend to improve participation in the future. Further research is also recommended with those who attended the initial assessment but did not attend further sessions to understand the factors affecting their decisions not to participate in the programme.” 10. What are the plans for the NDPP in Ireland now that the pilot programme has finished? If the programme is continuing, what will the programme look like and is there any further evaluation work planned? At the time of this survey the pilot was ongoing. On completion of the pilot in 2022 the NDPP began a phased nationwide roll out and since mid-2024 has offered a face-to-face programme in addition to the online format. I am not aware of any further evaluation of the programme at this time. Dear Reviewer, Thank you for your helpful review. We made every effort to address all the points raised. The changes are highlighted in red in the revised text. 1.There are some instances throughout the abstract and manuscript where there needs to be a space between a word and opening bracket, for example: “the Health Service Executive(HSE)”, “HSE(national publicly funded healthcare system)”. Thank you for highlighting this. I have corrected the issue with spacing throughout the manuscript. 2. The abbreviations NDPP and HSE are defined in the abstract, but these should be defined again at first mention in the main manuscript. I have now defined the abbreviations at first mention in the main manuscript: Page 4, line 19 Page 4, line 20 3. At the start of the introduction the authors could consider adding in a brief sentence explaining why type 2 diabetes is a growing problem (e.g., complications and costs to the health service) to further set the scene for readers. I have now included the following line on the growing problem of type 2 diabetes to set the scene at the start of the introduction. Page 3, lines 2, 3 “Type 2 diabetes is a growing global health problem which can result in serious chronic health complications for individuals and places a financial burden on health systems.” Reference: International Diabetes Federation. IDF Diabetes Atlas, 10th edn. Brussels, Belgium: 2021. Available at https://www.diabetesatlas.org 4. Prior to the NDPP being piloted, was Ireland offering any other diabetes prevention initiatives? An extra sentence in the introduction with some context might be useful for readers. I have added the following information on diabetes prevention initiatives that were available before the introduction of the NDPP. Page 4, lines 21, 22 “Prior to this there was very limited availability to short prediabetes courses that were not standardised.” 5. It is mentioned that participants attend an initial assessment that was followed by 14 sessions of the NDPP. Appendix 3 is particularly useful here, but perhaps it could be briefly explained in the paper what the initial assessment might entail for readers who are less familiar with DPPs? For example, was the initial assessment solely to determine the eligibility of participants for the programme, or were baseline measures also taken? How long did the initial assessment last? Was it online or in-person? Does this include onboarding or is that a separate session? I have added details about the initial assessment. Page 5 lines 13 - 15 “NDPP participants attended an initial assessment (in person, online or on the phone to have baseline measurements recorded, to receive a personal plan for lifestyle change and onboarding for the online session), and this was followed by 14 sessions of the NDPP (Extended Data-Appendix 3).” Note: Under extended data in the paper the appendices were labelled incorrectly – this has now been corrected. Page 14, lines 20 - 22 6. In Appendix 3 of the TIDieR checklist, could the abbreviation CNS be clarified? The abbreviation CNS has been clarified to Clinical Nurse Specialist in the TIDieR checklist in Appendix 3. 7. It is mentioned that the survey was piloted with a patient and public involvement group, which is commendable and an example of best practice. Could there be some more information about how PPI shaped this research? E.g., what were the characteristics of the group? (Males/females, ages, were these people at risk of or living with type 2 diabetes?) What feedback did they provide on the survey and what feedback was incorporated into the final version of the survey? Thank you for these suggestions. I have included further information on the contribution of the PPI panel however I have not included their demographic or medical history as I do not have their permission to do so. Page 5, lines 3 - 6: “The PPI group consisted of 10 people with an interest in diabetes prevention. They advised on recruitment and the wording of questions. Based on their feedback on recruitment, the cover letters used the participant’s name rather than a generic address.” 8. The survey response rate was 31%, and although this was lower than similar studies conducted (e.g., response to the NHS DPP survey), it is noted that respondents were representative of the 73 people in the cohort who participated in the NDPP. Out of curiosity I was wondering whether the research team had considered also offering the survey as an online format (e.g., via Qualtrics or another platform), which might have increased the response rate, given that respondents were taking part in an online programme? Were any reminder letters sent out? Perhaps these could be future considerations if a similar evaluation is conducted on the NDPP (if the programme is continuing?) Thank you for those suggestions. We had initially hoped to also survey people who declined to attend, therefore we developed the postal survey so as not to exclude those who may not have been comfortable with the online format. As the research team did not have access to the participant’s details the educators sent out the surveys on our behalf. Due to time constraints a reminder letter was not sent. I agree that your suggestions could be very helpful in the future if another evaluation is conducted. 9. Limitations – is there the potential that the 73 people who participated in the pilot NDPP were the ‘low hanging fruit’, i.e. the people who were most likely to participate in the programme in the first place? So this study is useful for understanding how to improve participation in the ‘engaged’ participants, but less useful for understanding why people don’t participate. There is mention of understanding the views of those who declined to participate in the NDPP, but there could also be further mention of understanding reasons for non-participation of those who attended the initial assessment but did not attend any online sessions of the NDPP. I have acknowledged these limitations and the need for further research with those who declined to participate. Page 13, lines 31 - 36 “The people attending the programme may have been the easiest to recruit, therefore further research should focus on understanding the views of those who declined to attend to improve participation in the future. Further research is also recommended with those who attended the initial assessment but did not attend further sessions to understand the factors affecting their decisions not to participate in the programme.” 10. What are the plans for the NDPP in Ireland now that the pilot programme has finished? If the programme is continuing, what will the programme look like and is there any further evaluation work planned? At the time of this survey the pilot was ongoing. On completion of the pilot in 2022 the NDPP began a phased nationwide roll out and since mid-2024 has offered a face-to-face programme in addition to the online format. I am not aware of any further evaluation of the programme at this time. Competing Interests: No competing interests were disclosed. Close Report a concern Respond or Comment COMMENTS ON THIS REPORT Author Response 22 Nov 2024 clair haseldine , Department of Public Health, University College Cork, Cork, Ireland 22 Nov 2024 Author Response Dear Reviewer, Thank you for your helpful review. We made every effort to address all the points raised. The changes are highlighted in red in the revised text. 1.There ... Continue reading Dear Reviewer, Thank you for your helpful review. We made every effort to address all the points raised. The changes are highlighted in red in the revised text. 1.There are some instances throughout the abstract and manuscript where there needs to be a space between a word and opening bracket, for example: “the Health Service Executive(HSE)”, “HSE(national publicly funded healthcare system)”. Thank you for highlighting this. I have corrected the issue with spacing throughout the manuscript. 2. The abbreviations NDPP and HSE are defined in the abstract, but these should be defined again at first mention in the main manuscript. I have now defined the abbreviations at first mention in the main manuscript: Page 4, line 19 Page 4, line 20 3. At the start of the introduction the authors could consider adding in a brief sentence explaining why type 2 diabetes is a growing problem (e.g., complications and costs to the health service) to further set the scene for readers. I have now included the following line on the growing problem of type 2 diabetes to set the scene at the start of the introduction. Page 3, lines 2, 3 “Type 2 diabetes is a growing global health problem which can result in serious chronic health complications for individuals and places a financial burden on health systems.” Reference: International Diabetes Federation. IDF Diabetes Atlas, 10th edn. Brussels, Belgium: 2021. Available at https://www.diabetesatlas.org 4. Prior to the NDPP being piloted, was Ireland offering any other diabetes prevention initiatives? An extra sentence in the introduction with some context might be useful for readers. I have added the following information on diabetes prevention initiatives that were available before the introduction of the NDPP. Page 4, lines 21, 22 “Prior to this there was very limited availability to short prediabetes courses that were not standardised.” 5. It is mentioned that participants attend an initial assessment that was followed by 14 sessions of the NDPP. Appendix 3 is particularly useful here, but perhaps it could be briefly explained in the paper what the initial assessment might entail for readers who are less familiar with DPPs? For example, was the initial assessment solely to determine the eligibility of participants for the programme, or were baseline measures also taken? How long did the initial assessment last? Was it online or in-person? Does this include onboarding or is that a separate session? I have added details about the initial assessment. Page 5 lines 13 - 15 “NDPP participants attended an initial assessment (in person, online or on the phone to have baseline measurements recorded, to receive a personal plan for lifestyle change and onboarding for the online session), and this was followed by 14 sessions of the NDPP (Extended Data-Appendix 3).” Note: Under extended data in the paper the appendices were labelled incorrectly – this has now been corrected. Page 14, lines 20 - 22 6. In Appendix 3 of the TIDieR checklist, could the abbreviation CNS be clarified? The abbreviation CNS has been clarified to Clinical Nurse Specialist in the TIDieR checklist in Appendix 3. 7. It is mentioned that the survey was piloted with a patient and public involvement group, which is commendable and an example of best practice. Could there be some more information about how PPI shaped this research? E.g., what were the characteristics of the group? (Males/females, ages, were these people at risk of or living with type 2 diabetes?) What feedback did they provide on the survey and what feedback was incorporated into the final version of the survey? Thank you for these suggestions. I have included further information on the contribution of the PPI panel however I have not included their demographic or medical history as I do not have their permission to do so. Page 5, lines 3 - 6: “The PPI group consisted of 10 people with an interest in diabetes prevention. They advised on recruitment and the wording of questions. Based on their feedback on recruitment, the cover letters used the participant’s name rather than a generic address.” 8. The survey response rate was 31%, and although this was lower than similar studies conducted (e.g., response to the NHS DPP survey), it is noted that respondents were representative of the 73 people in the cohort who participated in the NDPP. Out of curiosity I was wondering whether the research team had considered also offering the survey as an online format (e.g., via Qualtrics or another platform), which might have increased the response rate, given that respondents were taking part in an online programme? Were any reminder letters sent out? Perhaps these could be future considerations if a similar evaluation is conducted on the NDPP (if the programme is continuing?) Thank you for those suggestions. We had initially hoped to also survey people who declined to attend, therefore we developed the postal survey so as not to exclude those who may not have been comfortable with the online format. As the research team did not have access to the participant’s details the educators sent out the surveys on our behalf. Due to time constraints a reminder letter was not sent. I agree that your suggestions could be very helpful in the future if another evaluation is conducted. 9. Limitations – is there the potential that the 73 people who participated in the pilot NDPP were the ‘low hanging fruit’, i.e. the people who were most likely to participate in the programme in the first place? So this study is useful for understanding how to improve participation in the ‘engaged’ participants, but less useful for understanding why people don’t participate. There is mention of understanding the views of those who declined to participate in the NDPP, but there could also be further mention of understanding reasons for non-participation of those who attended the initial assessment but did not attend any online sessions of the NDPP. I have acknowledged these limitations and the need for further research with those who declined to participate. Page 13, lines 31 - 36 “The people attending the programme may have been the easiest to recruit, therefore further research should focus on understanding the views of those who declined to attend to improve participation in the future. Further research is also recommended with those who attended the initial assessment but did not attend further sessions to understand the factors affecting their decisions not to participate in the programme.” 10. What are the plans for the NDPP in Ireland now that the pilot programme has finished? If the programme is continuing, what will the programme look like and is there any further evaluation work planned? At the time of this survey the pilot was ongoing. On completion of the pilot in 2022 the NDPP began a phased nationwide roll out and since mid-2024 has offered a face-to-face programme in addition to the online format. I am not aware of any further evaluation of the programme at this time. Dear Reviewer, Thank you for your helpful review. We made every effort to address all the points raised. The changes are highlighted in red in the revised text. 1.There are some instances throughout the abstract and manuscript where there needs to be a space between a word and opening bracket, for example: “the Health Service Executive(HSE)”, “HSE(national publicly funded healthcare system)”. Thank you for highlighting this. I have corrected the issue with spacing throughout the manuscript. 2. The abbreviations NDPP and HSE are defined in the abstract, but these should be defined again at first mention in the main manuscript. I have now defined the abbreviations at first mention in the main manuscript: Page 4, line 19 Page 4, line 20 3. At the start of the introduction the authors could consider adding in a brief sentence explaining why type 2 diabetes is a growing problem (e.g., complications and costs to the health service) to further set the scene for readers. I have now included the following line on the growing problem of type 2 diabetes to set the scene at the start of the introduction. Page 3, lines 2, 3 “Type 2 diabetes is a growing global health problem which can result in serious chronic health complications for individuals and places a financial burden on health systems.” Reference: International Diabetes Federation. IDF Diabetes Atlas, 10th edn. Brussels, Belgium: 2021. Available at https://www.diabetesatlas.org 4. Prior to the NDPP being piloted, was Ireland offering any other diabetes prevention initiatives? An extra sentence in the introduction with some context might be useful for readers. I have added the following information on diabetes prevention initiatives that were available before the introduction of the NDPP. Page 4, lines 21, 22 “Prior to this there was very limited availability to short prediabetes courses that were not standardised.” 5. It is mentioned that participants attend an initial assessment that was followed by 14 sessions of the NDPP. Appendix 3 is particularly useful here, but perhaps it could be briefly explained in the paper what the initial assessment might entail for readers who are less familiar with DPPs? For example, was the initial assessment solely to determine the eligibility of participants for the programme, or were baseline measures also taken? How long did the initial assessment last? Was it online or in-person? Does this include onboarding or is that a separate session? I have added details about the initial assessment. Page 5 lines 13 - 15 “NDPP participants attended an initial assessment (in person, online or on the phone to have baseline measurements recorded, to receive a personal plan for lifestyle change and onboarding for the online session), and this was followed by 14 sessions of the NDPP (Extended Data-Appendix 3).” Note: Under extended data in the paper the appendices were labelled incorrectly – this has now been corrected. Page 14, lines 20 - 22 6. In Appendix 3 of the TIDieR checklist, could the abbreviation CNS be clarified? The abbreviation CNS has been clarified to Clinical Nurse Specialist in the TIDieR checklist in Appendix 3. 7. It is mentioned that the survey was piloted with a patient and public involvement group, which is commendable and an example of best practice. Could there be some more information about how PPI shaped this research? E.g., what were the characteristics of the group? (Males/females, ages, were these people at risk of or living with type 2 diabetes?) What feedback did they provide on the survey and what feedback was incorporated into the final version of the survey? Thank you for these suggestions. I have included further information on the contribution of the PPI panel however I have not included their demographic or medical history as I do not have their permission to do so. Page 5, lines 3 - 6: “The PPI group consisted of 10 people with an interest in diabetes prevention. They advised on recruitment and the wording of questions. Based on their feedback on recruitment, the cover letters used the participant’s name rather than a generic address.” 8. The survey response rate was 31%, and although this was lower than similar studies conducted (e.g., response to the NHS DPP survey), it is noted that respondents were representative of the 73 people in the cohort who participated in the NDPP. Out of curiosity I was wondering whether the research team had considered also offering the survey as an online format (e.g., via Qualtrics or another platform), which might have increased the response rate, given that respondents were taking part in an online programme? Were any reminder letters sent out? Perhaps these could be future considerations if a similar evaluation is conducted on the NDPP (if the programme is continuing?) Thank you for those suggestions. We had initially hoped to also survey people who declined to attend, therefore we developed the postal survey so as not to exclude those who may not have been comfortable with the online format. As the research team did not have access to the participant’s details the educators sent out the surveys on our behalf. Due to time constraints a reminder letter was not sent. I agree that your suggestions could be very helpful in the future if another evaluation is conducted. 9. Limitations – is there the potential that the 73 people who participated in the pilot NDPP were the ‘low hanging fruit’, i.e. the people who were most likely to participate in the programme in the first place? So this study is useful for understanding how to improve participation in the ‘engaged’ participants, but less useful for understanding why people don’t participate. There is mention of understanding the views of those who declined to participate in the NDPP, but there could also be further mention of understanding reasons for non-participation of those who attended the initial assessment but did not attend any online sessions of the NDPP. I have acknowledged these limitations and the need for further research with those who declined to participate. Page 13, lines 31 - 36 “The people attending the programme may have been the easiest to recruit, therefore further research should focus on understanding the views of those who declined to attend to improve participation in the future. Further research is also recommended with those who attended the initial assessment but did not attend further sessions to understand the factors affecting their decisions not to participate in the programme.” 10. What are the plans for the NDPP in Ireland now that the pilot programme has finished? If the programme is continuing, what will the programme look like and is there any further evaluation work planned? At the time of this survey the pilot was ongoing. On completion of the pilot in 2022 the NDPP began a phased nationwide roll out and since mid-2024 has offered a face-to-face programme in addition to the online format. I am not aware of any further evaluation of the programme at this time. Competing Interests: No competing interests were disclosed. Close Report a concern COMMENT ON THIS REPORT Comments on this article Comments (0) Version 4 VERSION 4 PUBLISHED 18 Oct 2023 ADD YOUR COMMENT Comment keyboard_arrow_left keyboard_arrow_right Open Peer Review Reviewer Status info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions Reviewer Reports Invited Reviewers 1 2 3 Version 4 (revision) 06 Mar 25 Version 3 (revision) 17 Dec 24 read Version 2 (revision) 21 Nov 24 read read read Version 1 18 Oct 23 read Rhiannon Hawkes , University of Manchester, Manchester, UK Lillian Madrigal , Emory University, Atlanta, USA Michael J Cannon , Centers for Disease Control and Prevention, Atlanta, USA Comments on this article All Comments (0) Add a comment Sign up for content alerts Sign Up You are now signed up to receive this alert keyboard_arrow_left Back to all reports Reviewer Report 0 Views copyright © 2024 Madrigal L. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 19 Dec 2024 | for Version 3 Lillian Madrigal , Emory University, Atlanta, USA 0 Views copyright © 2024 Madrigal L. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. format_quote Cite this report speaker_notes Responses (0) Approved info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions Authors have addressed my comments. Competing Interests No competing interests were disclosed. Reviewer Expertise Implementation science, public health promotion programs, diabetes prevention and management, behavioral health, program evaluation I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard. reply Respond to this report Responses (0) Madrigal L. Peer Review Report For: Characteristics of participants in the first fully online National Diabetes Prevention Programme: A quantitative survey [version 4; peer review: 2 approved, 1 not approved] . HRB Open Res 2025, 6 :61 ( https://doi.org/10.21956/hrbopenres.15429.r44229) NOTE: it is important to ensure the information in square brackets after the title is included in this citation. The direct URL for this report is: https://hrbopenresearch.org/articles/6-61/v3#referee-response-44229 keyboard_arrow_left Back to all reports Reviewer Report 0 Views copyright © 2024 Cannon M. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 17 Dec 2024 | for Version 2 Michael J Cannon , Centers for Disease Control and Prevention, Atlanta, USA 0 Views copyright © 2024 Cannon M. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. format_quote Cite this report speaker_notes Responses (1) Not Approved info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions This article describes demographic, psychosocial, and health characteristics of individuals who participated in a pilot online national diabetes prevention programme delivered via videoconferencing. This kind of information is important for understanding who is being reached by such programs, what factors might lead people to participate, and what sort of attitudes and motivation participants might have. The information was collected using validated survey instruments where applicable. Several findings indicate characteristics that might be targeted for participant recruitment, as well as health messages that may be needed to increase interest in the online program. They include that participants often had a family member with diabetes, were confident about joining an online program, believed that diabetes is important and that participating in the program could reduce their risk of developing diabetes. For understanding this study better, I would recommend adding a few sentences about recruitment in the section under Survey domains/Participation. How did recruitment work? How were people identified as eligible to participate? What percentage of people called agreed to participate and then actually participated? I realize this information may be in one of the cited reports, but a concise description here would really help the reader. The main limitation of the study is that the sample size was very small (N=22). As a result, it is hard to know how generalizable the results are. This, to me, is a serious limitation. Furthermore, the respondents only represented 30.5% of participants who were invited to participate (N=73), and they may differ in important ways from those who did not respond. As a result of these limitations, I do not have confidence that the findings can be applied more widely. For future research, in addition to having a larger sample of respondents, it would be great to have a better sense of how some of the measures differed for eligible individuals who declined participation in the NDPP (perhaps through surveys) and for all eligible participants in the country (perhaps using other data sources). This would give a stronger sense of what is different for those who decide to participate compared to those who do not. Is the work clearly and accurately presented and does it cite the current literature? Yes Is the study design appropriate and is the work technically sound? Yes Are sufficient details of methods and analysis provided to allow replication by others? Yes If applicable, is the statistical analysis and its interpretation appropriate? Yes Are all the source data underlying the results available to ensure full reproducibility? No Are the conclusions drawn adequately supported by the results? Yes Competing Interests No competing interests were disclosed. Reviewer Expertise I do research on the implementation of diabetes prevention and management programs. I confirm that I have read this submission and believe that I have an appropriate level of expertise to state that I do not consider it to be of an acceptable scientific standard, for reasons outlined above. reply Respond to this report Responses (1) Author Response 05 Mar 2025 clair haseldine, Department of Public Health, University College Cork, Cork, Ireland Dear Dr Cannon, Thank you for you helpful review. I respond to all of the points you raised below. 1. For understanding this study better, I would recommend adding a few sentences about recruitment in the section under Survey domains/Participation 1. This information has been added in Version 3 in response to Reviewer 2 comments as detailed below. The page numbers and line numbers have been updated for the latest version (Version 4). How did recruitment work? How were people identified as eligible to participate? Further details have been added to “Survey Domains: Participation” Recruitment for the NDPP pilot was from existing dietetic waiting lists and by referrals from GPs who had been informed of the pilot. Page 5 lines 12, 13 What percentage of people called agreed to participate and then actually participated? Further clarification has been added to the section “Participants and procedure” Of the 158 people invited to attend the NDPP, 73 attended the initial assessment and 67 went on to attend at least one further session. Page 10 lines 5,6 2. The main limitation of the study is that the sample size was very small (N=22). As a result, it is hard to know how generalizable the results are. This, to me, is a serious limitation. Furthermore, the respondents only represented 30.5% of participants who were invited to participate (N=73), and they may differ in important ways from those who did not respond. As a result of these limitations, I do not have confidence that the findings can be applied more widely. 2. We acknowledge the reviewer’s concerns about the sample size (N=22) and the response rate (30.5%). The number invited to take part in the pilot programme was small (N=73) which limited the overall number of survey respondents. Pilot programmes are often intentionally small to test the feasibility of implementing the programme before scale up and as a trial run of the intervention itself (Skivington et al, 2021). To maximise the response rate, we personalised the invite to the survey, included a €10 voucher to compensate the respondents for their time and included a stamped addressed envelope for the survey return, strategies shown to be effective in a Cochrane systematic review (Edwards, et al, 2007). References Skivington K, Matthews L, Simpson SA, Craig P, Baird J, Blazeby JM, Boyd KA, Craig N, French DP, McIntosh E, Petticrew M. A new framework for developing and evaluating complex interventions: update of Medical Research Council guidance. bmj. 2021 Sep 30;374. Edwards PJ, Roberts IG, Clarke MJ, DiGuiseppi C, Wentz R, Kwan I, Cooper R, Felix L, Pratap S. Methods to increase response rates to postal questionnaires. Cochrane Database of systematic reviews 2007, issue 2. Art No : MR000008 The generalisability of small sample size and response rate are discussed further in the strengths and limitations section: The uptake of this survey was lower than the response to the NHS survey (31% vs 54%) however, the people who responded to the survey had a broad age range, a wide range of educational attainment, and there was good representation from both men and women. While the small sample size and response rate may limit the generalisability of this research note, the findings provide an update to researchers and DPP providers about the online pilot of an NDPP and the emerging evidence on the characteristics of those invited to attend. Page 13 lines 25 - 30 3. For future research, in addition to having a larger sample of respondents, it would be great to have a better sense of how some of the measures differed for eligible individuals who declined participation in the NDPP (perhaps through surveys) and for all eligible participants in the country (perhaps using other data sources). This would give a stronger sense of what is different for those who decide to participate compared to those who do not. 3. Originally, we had hoped to survey the people who declined to attend but this access to this data was not possible. The recommendations for further research have been added to the strengths and limitations section as suggested: The people attending the programme may have been the easiest to recruit, or they may have differed in important ways from those who chose to respond, therefore further research (such as survey or other data sources) should focus on understanding the views of those who declined to attend to improve participation in the future. Page 13 lines 33 and 34 View more View less Competing Interests No competing interests were disclosed. reply Respond Report a concern Cannon MJ. Peer Review Report For: Characteristics of participants in the first fully online National Diabetes Prevention Programme: A quantitative survey [version 4; peer review: 2 approved, 1 not approved] . HRB Open Res 2025, 6 :61 ( https://doi.org/10.21956/hrbopenres.15404.r43337) NOTE: it is important to ensure the information in square brackets after the title is included in this citation. The direct URL for this report is: https://hrbopenresearch.org/articles/6-61/v2#referee-response-43337 keyboard_arrow_left Back to all reports Reviewer Report 0 Views copyright © 2024 Madrigal L. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 02 Dec 2024 | for Version 2 Lillian Madrigal , Emory University, Atlanta, USA 0 Views copyright © 2024 Madrigal L. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. format_quote Cite this report speaker_notes Responses (1) Approved With Reservations info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions This paper presents the results of a survey of participants in Ireland who had attended an initial assessment to participate in a pilot online synchronous version of the Irish National Diabetes Prevention Program. The study aims are to describe the demographic, psychosocial and health characteristics of participants in this online pilot. The evaluation methods appear to be sound for the aims of the study and results are clearly written. The findings of this work are useful for others implementing DPPs as well as other health promotion programs as they can replicate the surveys to assess demographic, psychosocial and health characteristics of participants in their populations. As someone who implements DPPs myself, I find the psychosocial factors in particular useful for understanding awareness and motivation to participate in the program. As the authors also point out it is nice to see an evaluation with a good representation of men in the cohort as men typically have lower participation rates in these programs. I have one revision request for the methods. I am unclear who the initial pool of eligible participants was. Under "Survey Domains: Participation" it says "educators invited people eligible" - who are these educators? where are the people from? Was a list of eligible candidates pulled from the HSE? What was the denominator to get to the 73 participants for the initial assessment? I believe more details are needed here to understand any bias in the recruitment and participants selected. Furthermore, a big challenge with DPPs is the "conversion rate" meaning the percent of individuals who are identified as eligible for these programs who actually enroll. I think that would be helpful to understand as many in the field as trying to assess if recruitment into programs is more successful for online vs distance vs in-person programs. Some comment on this might also be useful in the discussion. Is the work clearly and accurately presented and does it cite the current literature? Yes Is the study design appropriate and is the work technically sound? Yes Are sufficient details of methods and analysis provided to allow replication by others? Partly If applicable, is the statistical analysis and its interpretation appropriate? Yes Are all the source data underlying the results available to ensure full reproducibility? No source data required Are the conclusions drawn adequately supported by the results? Yes Competing Interests No competing interests were disclosed. Reviewer Expertise Implementation science, public health promotion programs, diabetes prevention and management, behavioral health, program evaluation I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above. reply Respond to this report Responses (1) Author Response 18 Dec 2024 clair haseldine, Department of Public Health, University College Cork, Cork, Ireland Dear Dr Madrigal, Thank you for your helpful comments. Please see the responses below to each point raised. I have one revision request for the methods. I am unclear who the initial pool of eligible participants was. Under "Survey Domains: Participation" it says "educators invited people eligible" Further details have been added to “Survey Domains: Participation”. Full details of the NDPP are available in Extended data – Appendix 3 Who are these educators? Educators (dieticians in the HSE) invited people eligible to participate in the NDPP by phone. Page 5 line 9 Where are the people from? Was a list of eligible candidates pulled from the HSE? Recruitment for the NDPP pilot was from existing dietetic waiting lists and by referrals from GPs who had been informed of the pilot. Page 5 lines 8, 9 What was the denominator to get to the 73 participants for the initial assessment? Further clarification has been added to the section “Participants and procedure” Of the 158 people invited to attend the NDPP, 73 attended the initial assessment and 67 went on to attend at least one further session. Page 10 lines 5,6 Furthermore, a big challenge with DPPs is the "conversion rate" meaning the percent of individuals who are identified as eligible for these programs who actually enroll. I think that would be helpful to understand as many in the field as trying to assess if recruitment into programs is more successful for online vs distance vs in-person programs. Some comment on this might also be useful in the discussion. These are important points however the pilot was testing the feasibility of implementing the programme and it was not designed to provide definite data on recruitment. Further research is needed to understand if recruitment is more successful for online Vs distance Vs in-person programmes. To acknowledge that this study may be useful to researchers investigating the conversion rates with different modes of delivery I have added the following comments to the strengths and limitations: “…and researchers will find this study helpful to understand participation when no other format such as face-to-face was available.” Page 13, lines 10 and 11 View more View less Competing Interests No competing interests were disclosed. reply Respond Report a concern Madrigal L. Peer Review Report For: Characteristics of participants in the first fully online National Diabetes Prevention Programme: A quantitative survey [version 4; peer review: 2 approved, 1 not approved] . HRB Open Res 2025, 6 :61 ( https://doi.org/10.21956/hrbopenres.15404.r43334) NOTE: it is important to ensure the information in square brackets after the title is included in this citation. The direct URL for this report is: https://hrbopenresearch.org/articles/6-61/v2#referee-response-43334 keyboard_arrow_left Back to all reports Reviewer Report 0 Views copyright © 2024 Hawkes R. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 25 Nov 2024 | for Version 2 Rhiannon Hawkes , University of Manchester, Manchester, UK 0 Views copyright © 2024 Hawkes R. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. format_quote Cite this report speaker_notes Responses (0) Approved info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions Thank you for addressing my comments, I have no further comments to make. I'm looking forward to hearing about future work from the research team on the Irish NDPP. Competing Interests No competing interests were disclosed. Reviewer Expertise Diabetes prevention programmes, behaviour change, health psychology I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard. reply Respond to this report Responses (0) Hawkes R. Peer Review Report For: Characteristics of participants in the first fully online National Diabetes Prevention Programme: A quantitative survey [version 4; peer review: 2 approved, 1 not approved] . HRB Open Res 2025, 6 :61 ( https://doi.org/10.21956/hrbopenres.15404.r43309) NOTE: it is important to ensure the information in square brackets after the title is included in this citation. The direct URL for this report is: https://hrbopenresearch.org/articles/6-61/v2#referee-response-43309 keyboard_arrow_left Back to all reports Reviewer Report 0 Views copyright © 2024 Hawkes R. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 20 Jun 2024 | for Version 1 Rhiannon Hawkes , University of Manchester, Manchester, UK 0 Views copyright © 2024 Hawkes R. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. format_quote Cite this report speaker_notes Responses (1) Approved With Reservations info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions This is a well-written paper describing findings from a survey distributed to participants of pilot online diabetes prevention programme in Ireland. This is particularly novel as Ireland is the first to pilot a national DPP that is online only and delivered to a group synchronously. Findings from this programme of work will therefore be of interest to other countries developing their own versions of diabetes prevention initiatives. Thank you for the opportunity to review this paper, and I look forwards to seeing further work from the research team to see how the Irish NDPP progresses. The following comments are some minor suggestions for consideration: 1. There are some instances throughout the abstract and manuscript where there needs to be a space between a word and opening bracket, for example: “the Health Service Executive(HSE)”, “HSE(national publicly funded healthcare system)”. 2. The abbreviations NDPP and HSE are defined in the abstract, but these should be defined again at first mention in the main manuscript. 3. At the start of the introduction the authors could consider adding in a brief sentence explaining why type 2 diabetes is a growing problem (e.g., complications and costs to the health service) to further set the scene for readers. 4. Prior to the NDPP being piloted, was Ireland offering any other diabetes prevention initiatives? An extra sentence in the introduction with some context might be useful for readers. 5. It is mentioned that participants attend an initial assessment that was followed by 14 sessions of the NDPP. Appendix 3 is particularly useful here, but perhaps it could be briefly explained in the paper what the initial assessment might entail for readers who are less familiar with DPPs? For example, was the initial assessment solely to determine the eligibility of participants for the programme, or were baseline measures also taken? How long did the initial assessment last? Was it online or in-person? Does this include onboarding or is that a separate session? 6. In Appendix 3 of the TIDieR checklist, could the abbreviation CNS be clarified? 7. It is mentioned that the survey was piloted with a patient and public involvement group, which is commendable and an example of best practice. Could there be some more information about how PPI shaped this research? E.g., what were the characteristics of the group? (Males/females, ages, were these people at risk of or living with type 2 diabetes?) What feedback did they provide on the survey and what feedback was incorporated into the final version of the survey? 8. The survey response rate was 31%, and although this was lower than similar studies conducted (e.g., response to the NHS DPP survey), it is noted that respondents were representative of the 73 people in the cohort who participated in the NDPP. Out of curiosity I was wondering whether the research team had considered also offering the survey as an online format (e.g., via Qualtrics or another platform), which might have increased the response rate, given that respondents were taking part in an online programme? Were any reminder letters sent out? Perhaps these could be future considerations if a similar evaluation is conducted on the NDPP (if the programme is continuing?) 9. Limitations – is there the potential that the 73 people who participated in the pilot NDPP were the ‘low hanging fruit’, i.e. the people who were most likely to participate in the programme in the first place? So this study is useful for understanding how to improve participation in the ‘engaged’ participants, but less useful for understanding why people don’t participate. There is mention of understanding the views of those who declined to participate in the NDPP, but there could also be further mention of understanding reasons for non-participation of those who attended the initial assessment but did not attend any online sessions of the NDPP. 10. What are the plans for the NDPP in Ireland now that the pilot programme has finished? If the programme is continuing, what will the programme look like and is there any further evaluation work planned? Is the work clearly and accurately presented and does it cite the current literature? Yes Is the study design appropriate and is the work technically sound? Yes Are sufficient details of methods and analysis provided to allow replication by others? Yes If applicable, is the statistical analysis and its interpretation appropriate? Yes Are all the source data underlying the results available to ensure full reproducibility? Yes Are the conclusions drawn adequately supported by the results? Yes Competing Interests No competing interests were disclosed. Reviewer Expertise Diabetes prevention programmes, behaviour change, health psychology I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above. reply Respond to this report Responses (1) Author Response 22 Nov 2024 clair haseldine, Department of Public Health, University College Cork, Cork, Ireland Dear Reviewer, Thank you for your helpful review. We made every effort to address all the points raised. The changes are highlighted in red in the revised text. 1.There are some instances throughout the abstract and manuscript where there needs to be a space between a word and opening bracket, for example: “the Health Service Executive(HSE)”, “HSE(national publicly funded healthcare system)”. Thank you for highlighting this. I have corrected the issue with spacing throughout the manuscript. 2. The abbreviations NDPP and HSE are defined in the abstract, but these should be defined again at first mention in the main manuscript. I have now defined the abbreviations at first mention in the main manuscript: Page 4, line 19 Page 4, line 20 3. At the start of the introduction the authors could consider adding in a brief sentence explaining why type 2 diabetes is a growing problem (e.g., complications and costs to the health service) to further set the scene for readers. I have now included the following line on the growing problem of type 2 diabetes to set the scene at the start of the introduction. Page 3, lines 2, 3 “Type 2 diabetes is a growing global health problem which can result in serious chronic health complications for individuals and places a financial burden on health systems.” Reference: International Diabetes Federation. IDF Diabetes Atlas, 10th edn. Brussels, Belgium: 2021. Available at https://www.diabetesatlas.org 4. Prior to the NDPP being piloted, was Ireland offering any other diabetes prevention initiatives? An extra sentence in the introduction with some context might be useful for readers. I have added the following information on diabetes prevention initiatives that were available before the introduction of the NDPP. Page 4, lines 21, 22 “Prior to this there was very limited availability to short prediabetes courses that were not standardised.” 5. It is mentioned that participants attend an initial assessment that was followed by 14 sessions of the NDPP. Appendix 3 is particularly useful here, but perhaps it could be briefly explained in the paper what the initial assessment might entail for readers who are less familiar with DPPs? For example, was the initial assessment solely to determine the eligibility of participants for the programme, or were baseline measures also taken? How long did the initial assessment last? Was it online or in-person? Does this include onboarding or is that a separate session? I have added details about the initial assessment. Page 5 lines 13 - 15 “NDPP participants attended an initial assessment (in person, online or on the phone to have baseline measurements recorded, to receive a personal plan for lifestyle change and onboarding for the online session), and this was followed by 14 sessions of the NDPP (Extended Data-Appendix 3).” Note: Under extended data in the paper the appendices were labelled incorrectly – this has now been corrected. Page 14, lines 20 - 22 6. In Appendix 3 of the TIDieR checklist, could the abbreviation CNS be clarified? The abbreviation CNS has been clarified to Clinical Nurse Specialist in the TIDieR checklist in Appendix 3. 7. It is mentioned that the survey was piloted with a patient and public involvement group, which is commendable and an example of best practice. Could there be some more information about how PPI shaped this research? E.g., what were the characteristics of the group? (Males/females, ages, were these people at risk of or living with type 2 diabetes?) What feedback did they provide on the survey and what feedback was incorporated into the final version of the survey? Thank you for these suggestions. I have included further information on the contribution of the PPI panel however I have not included their demographic or medical history as I do not have their permission to do so. Page 5, lines 3 - 6: “The PPI group consisted of 10 people with an interest in diabetes prevention. They advised on recruitment and the wording of questions. Based on their feedback on recruitment, the cover letters used the participant’s name rather than a generic address.” 8. The survey response rate was 31%, and although this was lower than similar studies conducted (e.g., response to the NHS DPP survey), it is noted that respondents were representative of the 73 people in the cohort who participated in the NDPP. Out of curiosity I was wondering whether the research team had considered also offering the survey as an online format (e.g., via Qualtrics or another platform), which might have increased the response rate, given that respondents were taking part in an online programme? Were any reminder letters sent out? Perhaps these could be future considerations if a similar evaluation is conducted on the NDPP (if the programme is continuing?) Thank you for those suggestions. We had initially hoped to also survey people who declined to attend, therefore we developed the postal survey so as not to exclude those who may not have been comfortable with the online format. As the research team did not have access to the participant’s details the educators sent out the surveys on our behalf. Due to time constraints a reminder letter was not sent. I agree that your suggestions could be very helpful in the future if another evaluation is conducted. 9. Limitations – is there the potential that the 73 people who participated in the pilot NDPP were the ‘low hanging fruit’, i.e. the people who were most likely to participate in the programme in the first place? So this study is useful for understanding how to improve participation in the ‘engaged’ participants, but less useful for understanding why people don’t participate. There is mention of understanding the views of those who declined to participate in the NDPP, but there could also be further mention of understanding reasons for non-participation of those who attended the initial assessment but did not attend any online sessions of the NDPP. I have acknowledged these limitations and the need for further research with those who declined to participate. Page 13, lines 31 - 36 “The people attending the programme may have been the easiest to recruit, therefore further research should focus on understanding the views of those who declined to attend to improve participation in the future. Further research is also recommended with those who attended the initial assessment but did not attend further sessions to understand the factors affecting their decisions not to participate in the programme.” 10. What are the plans for the NDPP in Ireland now that the pilot programme has finished? If the programme is continuing, what will the programme look like and is there any further evaluation work planned? At the time of this survey the pilot was ongoing. On completion of the pilot in 2022 the NDPP began a phased nationwide roll out and since mid-2024 has offered a face-to-face programme in addition to the online format. I am not aware of any further evaluation of the programme at this time. View more View less Competing Interests No competing interests were disclosed. reply Respond Report a concern Hawkes R. Peer Review Report For: Characteristics of participants in the first fully online National Diabetes Prevention Programme: A quantitative survey [version 4; peer review: 2 approved, 1 not approved] . HRB Open Res 2025, 6 :61 ( https://doi.org/10.21956/hrbopenres.15110.r40518) NOTE: it is important to ensure the information in square brackets after the title is included in this citation. The direct URL for this report is: https://hrbopenresearch.org/articles/6-61/v1#referee-response-40518 Alongside their report, reviewers assign a status to the article: Approved - the paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations - A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. 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