Identification of Intervention Characteristics Within Diabetes Prevention Programs Using the Template for Intervention Description and Replication: A Scoping Review.

OBJECTIVES: Diabetes prevention programs (DPPs) targeting dietary and physical activity behaviour change have been shown to decrease the incidence of type 2 diabetes; however, a more thorough reporting of intervention characteristics is needed to expedite the translation of such programs into different communities. In this scoping review we aim to synthesize how DPPs are being reported and implemented. METHODS: A scoping review using Arkey and O'Malley methods was conducted in accordance with the guidelines of Preferred Reporting Items for Systematic Reviews and Meta-Analysis. MEDLINE, CINAHL, PsycINFO, EMBASE, and SPORTDiscus were searched for studies relating to diabetes prevention, and diet/exercise interventions. Only studies delivering a diet/exercise intervention for adults identified as "at risk" for developing type 2 diabetes were included. The Template for Intervention Description and Replication (TIDieR) was used to guide data extraction, and each DPP was scored on a scale from 0 to 2 for how thoroughly it reported each of the items (0 = did not report, 2 = reported in full; total score out of 26). RESULTS: Of the 25,110 publications screened, 351 (based on 220 programs) met the inclusion criteria and were included for data extraction. No studies comprehensively reported on all TIDieR domains (mean TIDieR score: 15.7 of 26; range 7 to 25). Reporting was particularly poor among domains related to "modifications," "tailoring," and "how well (planned/actual)." "How well (planned)" assesses the intended delivery of an intervention, detailing the initial strategies and components as per the original design, whereas "how well (actual)" evaluates the extent to which the intervention was executed as planned during the study, including any deviations or modifications made in practice. CONCLUSIONS: Although there is evidence to suggest that DPPs are efficacious, a more thorough reporting of program content and delivery is needed to improve the ability for effective programs to be implemented or translated into different communities.

Designing and Developing Online Training for Diabetes Prevention Program Coaches Using an Integrated Knowledge Translation Approach: Development and Usability Study.

BACKGROUND: e-Learning has rapidly become a popular alternative to in-person learning due to its flexibility, convenience, and wide reach. Using a systematic and partnered process to transfer in-person training to an e-learning platform helps to ensure the training will be effective and acceptable to learners. OBJECTIVE: This study aimed to develop an e-learning platform for Small Steps for Big Changes (SSBC) type 2 diabetes prevention program coaches to improve the viability of coach training. METHODS: An integrated knowledge translation approach was used in the first 3 stages of the technology-enhanced learning (TEL) evaluation framework to address the study objective. This included three steps: (1) conducting a needs analysis based on focus groups with previously trained SSBC coaches, meetings with the SSBC research team, and a review of research results on the effectiveness of the previous in-person version of the training; (2) documenting processes and decisions in the design and development of the e-learning training platform; and (3) performing usability testing. Previously trained SSBC coaches and the SSBC research team were included in all stages of this study. RESULTS: Step 1 identified components from the in-person training that should be maintained in the e-learning training (ie, a focus on motivational interviewing), additional components to be added to the e-learning training (ie, how to deliver culturally safe and inclusive care), and mode of delivery (videos and opportunities to synchronously practice skills). Step 2 documented the processes and decisions made in the design and development of the e-learning training, including the resources (ie, time and finances) used, the content of the training modules, and how coaches would flow through the training process. The design and development process consisted of creating a blueprint of the training. The training included 7 e-learning modules, the learning modalities of which included narrated demonstration videos and user-engaging activities, a mock session with feedback from the research team, and a final knowledge test. Step 3, usability testing, demonstrated high levels of learnability, efficiency, memorability, and satisfaction, with minor bugs documented and resolved. CONCLUSIONS: Using an integrated knowledge translation approach to the technology-enhanced learning evaluation framework was successful in developing an e-learning training platform for SSBC coaches. Incorporating end users in this process can increase the chances that the e-learning training platform is usable, engaging, and acceptable. Future research will include examining the satisfaction of coaches using the SSBC coach e-learning training platform, assessing coach learning outcomes (ie, knowledge and behavior), and estimating the cost and viability of implementing this training.

Small Steps Towards an Inclusive Diabetes Prevention Program: How Small Steps for Big Changes is Improving Program Equity and Inclusion.

Social determinants of health, the effects of colonialism, and systemic injustices result in some groups being at disproportionately higher risk for developing type 2 diabetes (T2D). Many T2D prevention programs have not been designed to provide equitable and inclusive care to everyone. This paper presents an example of the steps taken in an evidence-based community T2D prevention program, Small Steps for Big Changes (SSBC), to improve equitable access and inclusivity based on input from a stakeholder advisory group and the ConNECT Framework. To improve reach to those most at risk for T2D, SSBC has changed both eligibility criteria and program delivery. To ensure that all testing is done in an inclusive manner, changes have been made to measurements, and to training for those delivering the program. This paper also provides actionable recommendations for other researchers to incorporate into their own health programs to promote inclusivity and ensure that they reach those most at risk of T2D.

Examining the Effectiveness of an E-Learning Training Course for Coaches of a Type 2 Diabetes Prevention Program.

Small Steps for Big Changes (SSBC) is a community-based diabetes prevention program (DPP). SSBC utilizes a motivational interviewing (MI) informed counseling style to deliver a structured diet and exercise curriculum to empower healthy behavioral modifications and prevent type 2 diabetes (T2D). An electronic learning (e-learning) platform to train SSBC coaches was developed to improve flexibility, reach, and accessibility. While e-learning has shown to be an effective mode of teaching content to health professionals, less is known in the context of DPP coaches. This study aimed to assess the effectiveness of the SSBC e-learning course. Twenty coaches (eleven fitness staff personnel and nine university students) were recruited through existing fitness facilities to participate in the online SSBC coach training which included completing pre- and post-training questionnaires, seven online modules of content and a mock client session. Knowledge regarding MI (Mpre = 3.30 ± 1.95, Mpost = 5.90 ± 1.29; p < 0.01), SSBC content (Mpre = 5.15 ± 2.23, Mpost = 8.60 ± 0.94; p < 0.01), and T2D (Mpre = 6.95 ± 1.57, Mpost = 8.25 ± 0.72; p < 0.01), and self-efficacy to deliver the program (Mpre = 7.93 ± 1.51, Mpost = 9.01 ± 1.00; p < 0.01) all significantly increased from pre- to post e-learning training. Participants reported positively on the user satisfaction and feedback questionnaire with a mean score of 4.58/5 (SD = 0.36). These findings suggest e-learning platforms are a promising mode to improve DPP coaches' knowledge, counseling skills, and to bolster confidence in program delivery with high levels of satisfaction. E-learning to train DPP coaches allows for effective and feasible expansion of DPP's, ultimately permitting more reach to adults living with prediabetes. Supplementary Information: The online version contains supplementary material available at 10.1007/s41347-023-00316-3.

Fitness Facility Staff Can Be Trained to Deliver a Motivational Interviewing-Informed Diabetes Prevention Program.

Background: Training programs must be evaluated to understand whether the training was successful at enabling staff to implement a program with fidelity. This is especially important when the training has been translated to a new context. The aim of this community case study was to evaluate the effectiveness of the in-person Small Steps for Big Changes training for fitness facility staff using the 4-level Kirkpatrick training evaluation model. Methods: Eight staff were trained to deliver the motivational interviewing-informed Small Steps for Big Changes program for individuals at risk of developing type 2 diabetes. Between August 2019 and March 2020, 32 clients enrolled in the program and were allocated to one of the eight staff. The Kirkpatrick 4-level training evaluation model was used to guide this research. Level one assessed staff satisfaction to the training on a 5-point scale. Level two assessed staff program knowledge and motivational interviewing knowledge/skills. Level three assessed staff behaviors by examining their use of motivational interviewing with each client. Level four assessed training outcomes using clients' perceived satisfaction with their staff and basic psychological needs support both on 7-point scales. Results: Staff were satisfied with the training (M = 4.43; SD = 0.45; range = 3.86-4.71). All learning measures demonstrated high post-training scores that were retained at implementation follow-up. Staff used motivational interviewing skills in practice and delivered the program at a client-centered level (≥6; M = 6.34; SD = 0.83; range = 3.75-7.80). Overall, clients perceived staff supported their basic psychological needs (M = 6.55; SD = 0.64; range = 6.17-6.72) and reported high staff satisfaction scores (M = 6.88; SD = 0.33; range = 6-7). Conclusion: The Small Steps for Big Changes training was successful and fitness facility staff delivered a motivational interviewing-informed program. While not all staff operated at a client-centered level, clients perceived their basic psychological needs to be supported. Findings support the training for future scale-up sites. Community fitness staff represent a feasible resource through which to run evidence-based counseling programs.

Using the behavior change wheel to develop text messages to promote diet and physical activity adherence following a diabetes prevention program.

Improving diet and physical activity (PA) can reduce the risk of developing type 2 diabetes (T2D); however, long-term diet and PA adherence is poor. To impact population-level T2D risk, scalable interventions facilitating behavior change adherence are needed. Text messaging interventions supplementing behavior change interventions can positively influence health behaviors including diet and PA. The Behavior Change Wheel (BCW) provides structure to intervention design and has been used extensively in health behavior change interventions. Describe the development process of a bank of text messages targeting dietary and PA adherence following a diabetes prevention program using the BCW. The BCW was used to select the target behavior, barriers and facilitators to engaging in the behavior, and associated behavior change techniques (BCTs). Messages were written to map onto BCTs and were subsequently coded for BCT fidelity. The target behaviors were adherence to diet and PA recommendations. A total of 16 barriers/facilitators and 28 BCTs were selected for inclusion in the messages. One hundred and twenty-four messages were written based on selected BCTs. Following the fidelity check a total of 43 unique BCTs were present in the final bank of messages. This study demonstrates the application of the BCW to guide the development of a bank of text messages for individuals with prediabetes. Results underscore the potential utility of having independent coders for an unbiased expert evaluation of what active components are in use. Future research is needed to demonstrate the feasibility and effectiveness of resulting bank of messages.

Making changes to one's physical activity and diet can reduce future risk of developing type 2 diabetes. That being said, making life-long changes to complex behaviors such as diet or physical activity is easier said than done. Text messages can be used to improve long-term diet and physical activity changes; however, it can be difficult to identify what should be said in a text message to nudge those behaviors. To improve utility and reduce cost of sending unnecessary messages, theory should be used in developing text messaging content. The current study used the Behavior Change Wheel to develop a library of text messages that can be used to improve diet and physical activity in individuals who have taken part in an effective community-based diabetes prevention program. The Behavior Change Wheel guides researchers to develop real-world interventions based on evidence and theory. Overall, we created a library of 124 theory-based messages which can be further tested following a diabetes prevention program.

Identifying Behaviour Change Techniques and Motivational Interviewing Techniques in Small Steps for Big Changes: A Community-Based Program for Adults at Risk for Type 2 Diabetes.

BACKGROUND: The risk of developing type 2 diabetes (T2D) can be reduced through diet and exercise changes. Given the rapidly increasing prevalence of T2D and the associated burden on the health-care system, there is a need for affordable and scalable diet and exercise programs to be delivered in communities. Small Steps for Big Changes (SSBC) is an evidence-based diabetes prevention program for improving diet and exercise adherence in individuals at risk for developing T2D. Detailed reporting of intervention components as SSBC transitions from laboratory to communities is an essential step to understand its effectiveness and subsequent uptake. METHODS: The aim of this study was to identify comprehensively the behaviour change techniques (BCTs) and motivational interviewing techniques used within the community-based SSBC. Intervention components were extracted from the SSBC session protocols using the Behaviour Change Technique Taxonomy v1 and the Table of Motivational Interviewing Techniques. RESULTS: Forty-three BCTs (interrater reliability [kappa]=0.77; prevalence and bias-adjusted kappa=0.78) and 20 MI techniques (kappa=0.63; prevalence and bias-adjusted kappa=0.64) were identified within SSBC session protocols (mean BCTs per session=30, mean MI techniques per session=16). CONCLUSIONS: Consistent and thorough reporting of intervention components as seen in the current analysis is crucial for future meta-analyses to accurately test which intervention components are eliciting change in desired outcomes and can inform which components should be adapted to different settings. SSBC sessions had an emphasis on BCT categories, including "Goals and Planning," "Feedback and Monitoring" and "Repetition and Substitution," and MI technique processes, including "Engaging" and "Evoking." Use of these categories and processes can inform development of future effective diabetes prevention programs.