JMIR Publications

ABSTRACT

It is estimated that type 2 diabetes (T2D) impacts an estimated 5.3 million Canadians, despite the condition being largely preventable. Laboratory-based diabetes prevention programs (DPPs) have limited effectiveness when translated into community settings due to their low-quality delivery and inability to reach people in the community most in need. To date, no community-based DPPs have been implemented nationwide across Canada. Small Steps for Big Changes (SSBC) is a diet and physical activity counselling intervention that significantly reduces the risk of developing T2D and has been designed for feasible delivery by community-dwelling peers. To ensure maximum public health impact, SSBC must be optimally implemented, demonstrate effectiveness for diverse groups, and sustainable over time. This project aims to adapt SSBC, and evaluate the implementation, effectiveness, and sustainability of SSBC in diverse urban communities across Canada. A hybrid type 2 implementation-effectiveness study design using multiple and mixed methods will be used to evaluate the implementation and effectiveness of SSBC over six years in partnership with 11 regional YMCAs across eight provinces in Canada. During this time, we will 1) adapt and implement SSBC in diverse urban cities across Canada, 2) examine the implementation (including implementation strategies), effectiveness, and cost-effectiveness of SSBC, and 3) determine the sustainability of SSBC at each delivery location. Data will be collected from SSBC clients, coaches, site leads, and senior leadership municipality partners. The project will be overseen by an advisory group and three committees focused on sex, gender and inclusivity; program evaluation; and diabetes prevention engagement. This study has received ethical approval from the University of British Columbia Clinical Research Ethics Board (H23-01930). Potential for Impact and Dissemination: This research will determine best practice implementation determinants, outcomes, and strategies critical for sustaining DPP implementation across Canada and beyond. Projects findings will be shared through a project website. Project reports will be shared with municipality partners and will be co-presented with partners and SSBC clients to community organizations, local interested parties and academics. Peer-reviewed articles will be generated. ClinicalTrials.gov, NCT06440395. Registered 13 May 2024, https://clinicaltrials.gov/study/NCT06440395