CE-Zoom® and FB® groups provided weekly, self-monitoring data for 83% and 84% of the 24 potential weeks, respectively. Participant retention was similar in the CE Zoom® (88%) and FB groups (87%). Attendance did not differ significantly between groups (CE Zoom® = 69%, FB = 83%, p = 0.15). Adults (n = 31, age ~55 years) were enrolled (CE-Zoom® n = 16, FB n = 15). We compared the feasibility/effectiveness of the NDPP (0–6 mos.) delivered by CE personnel to rural residents with prediabetes using Zoom® (CE-Zoom®) or by our research staff using Facebook® (FB). However, the CE remains underutilized for the delivery of NDPP. Cooperative Extension Service (CE) has potential to deliver the National Diabetes Prevention Program (NDPP) to rural residents with prediabetes. Lastly, the article offers thoughts on how to integrate costs analyses into hybrid studies. Further, the article offers recommendations on research designs that align with each hybrid study type. The article also provides a critique on the hybrid 1-2-3 typology and offers reflections on when and how to use the typology moving forward. A series of questions are presented that have been designed to help investigators select the most appropriate hybrid type for their study situation. Supporting this recommendation, the article then offers guidance on selecting a hybrid study type based on evidentiary and contextual information and stakeholder concerns/preferences. The essence of hybrid studies is combining research questions concerning intervention effectiveness and implementation within the same study, and this can and should be achieved by applying a full range of research designs. It begins with the recommendation to replace the term “design” in favor of “study.” The use of the term “design” and the explicit focus on trial methodology in the original paper created confusion. The article offers reflections across five conceptual and methodological areas. Given the widespread and continued use of hybrid studies, critical appraisals are necessary. This article provides new reflections and recommendations from authors of the initial effectiveness-implementation hybrid study manuscript and additional experts in their conceptualization and application. Researchers should explore DPP implementation in real-world settings to determine overall and setting-specific best practices, promote intervention uptake, and reduce diabetes. Extension and other DPP implementers should plan strategies that promote communication, the program's evidence-base, recruitment time, and resource access. Positive RE-AIM outcomes, facilitated by contextual factors, indicate Extension is an effective and sustainable DPP delivery system. Limited time to recruit participants was the primary barrier. Several facilitators were identified, including Extension leadership structure, organizational compatibility, and technical assistance calls. At post-intervention, eight professionals (67%) had begun or planned to maintain the intervention within the next 6 months. The program was effective in achieving weight loss (5.0 ± 5.2%) and physical activity (179 ± 122 min/week) goals. The program reached 119 participants, was adopted by 92% (n = 12/13) of trained Extension professionals and was implemented according to CDC standards: all programs exceeded the minimum 22-session requirement (26 ± 2 sessions). Constructs were rated for magnitude and valence and evaluated as facilitators or barriers of RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) outcomes. The Consolidated Framework for Implementation Research (CFIR) guided interview coding and analysis. Semi-structured interviews with Extension professionals were conducted at three time points. Extension professionals delivered the DPP in a single-arm hybrid type II effectiveness-implementation study. However, research evaluating DPP implementation in Extension remains scant. Due to its nationwide reach and mission to improve health, Cooperative Extension (Extension) is poised to be a sustainable DPP delivery system. Increased dissemination of the CDC's Diabetes Prevention Program (DPP) is imperative to reduce type 2 diabetes.
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