Factors Contributing to Iowa State-Certified Diabetes Self-Management Education and Support Program Sustainability

Background & Purpose: Diabetes Self-Management Education and Support (DSMES) programs are evidence-based programs aimed at teaching individuals to manage their diabetes effectively. For over 20 years, the Iowa Department of Health and Human Services (Iowa HHS) has worked to increase the number of DSMES programs operating in the state; however, even as new programs are established, multiple DSMES programs cease operations every year. This study identifies 1) DSMES program sustainability facilitators, 2) perceived patient-related barriers to DSMES program enrollment and completion, and 3) recommendations for addressing barriers.

Methods: Eight sustainability questions were included in an annual evaluation survey of state-certified DSMES programs in Iowa to examine DSMES sustainability. Questions on barriers to DSMES enrollment and completion were also included. The survey was conducted in Spring 2023 through a partnership between Iowa HHS and the University of Iowa’s School of Social Work.

Results: Seventy-eight of 97 (80.4%) state-certified DSMES programs responded to the survey, with 98.6% billing for DSMES services, suggesting that insurance payments at least somewhat financially supported most programs. However, 26.9% of programs were underutilized, 52.6% were well-utilized, and only 20.5% were at full capacity. To obtain DSMES referrals, 23.0% of programs engaged local employers, 40.0% partnered with health care facilities, and 9.3% utilized community health workers (CHWs).

Sustainability responses were dichotomized into high and low confidence in their program’s ability to deliver DSMES for the next three years. Respondents highly confident in their ability to provide DSMES over three years (n=48) were cross-referenced with the following sustainability facilitators: billing for DSMES (97.9%), engaging local employers (16.7%), utilizing CHWs (8.3%), partnering with health care facilities (37.5%), and having supportive administration (83.0%). Most often reported patient barriers to DSMES program enrollment AND completion were competing priorities (84.0%, 84.0%), high out-of-pocket costs (78.7, 74.7%), and time commitment involved (72.0%, 68.0%).

Conclusion: Understanding barriers provides a catalyst for addressing them and helping DSMES programs become more sustainable. Social workers are positioned to help abate various barriers to DSMES enrollment and completion, offsetting costs and managing competing priorities.