title: Mixed methods study of engagement in behaviors to prevent type 2 diabetes among employees with pre-diabetes.
abstract: BACKGROUND
  Many employers use screenings to identify and recommend modification of employees' risk factors for type 2 diabetes, yet little is known about how often employees then engage in recommended behaviors and what factors influence engagement. We examined the frequency of, facilitators of, and barriers to engagement in recommended behaviors among employees found to have pre-diabetes during a workplace screening.
  
  
  METHODS
  We surveyed 82 University of Michigan employees who were found to have pre-diabetes during a 2014 workplace screening and compared the characteristics of employees who 3 months later were and were not engaged in recommended behaviors. We interviewed 40 of these employees to identify the facilitators of and barriers to engagement in recommended behaviors.
  
  
  RESULTS
  3 months after screening, 54% of employees with pre-diabetes reported attempting to lose weight and getting recommended levels of physical activity, had asked their primary care provider about metformin for diabetes prevention, or had attended a Diabetes Prevention Program. These employees had higher median levels of motivation to prevent type 2 diabetes (9/10 vs 7/10, p<0.001) and lower median estimations of their risk for type 2 diabetes (40% vs 60%, p=0.02). Key facilitators of engagement were high motivation and social and external supports. Key barriers were lack of motivation and resources, and competing demands.
  
  
  CONCLUSIONS
  Most employees found to have pre-diabetes through a workplace screening were engaged in a recommended preventive behavior 3 months after the screening. This engagement could be enhanced by optimizing motivation and risk perception as well as leveraging social networks and external supports.
authors.affiliation: VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan, USA; Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA; University of Michigan Institute for Healthcare Policy and Innovation, Ann Arbor, Michigan, USA.
authors.forename: Jeffrey T
authors.initials: JT
authors.lastname: Kullgren
authors.affiliation: Department of Internal Medicine , University of Michigan Medical School , Ann Arbor, Michigan , USA.
authors.forename: Megan
authors.initials: M
authors.lastname: Knaus
authors.affiliation: MHealthy Administration , University of Michigan Health and Well-being Services , Ann Arbor, Michigan , USA.
authors.forename: Kristi Rahrig
authors.initials: KR
authors.lastname: Jenkins
authors.affiliation: VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan, USA; Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA; University of Michigan Institute for Healthcare Policy and Innovation, Ann Arbor, Michigan, USA; Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, Michigan, USA.
authors.forename: Michele
authors.initials: M
authors.lastname: Heisler
keywords: Disease Prevention; Health Behavior; Health Promotion; Occupational Health