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Dineen, Tineke Ellen

University of British Columbia

Type two diabetes (T2D) is one of the fastest growing chronic conditions worldwide and has negative health consequences and high costs for healthcare systems. Prediabetes, which precedes T2D, offers an opportunity for early intervention to delay and/or prevent progression to T2D. Diet and exercise are the cornerstones of diabetes prevention and have a large research base demonstrating their efficacy at reducing T2D risk. To combat the rising prevalence of T2D worldwide, diabetes prevention programs need to be implemented in practice within real-world settings. Moving research to practice (real-world) is notoriously slow’. Successful real-world examples exist, but reporting on implementation variables is limited. Implementation science focuses on understanding how and why programs work in real-world settings. Understanding how and why programs work is important because real-world settings have substantially more variables influencing interventions compared to controlled trials. Thus, this dissertation used an implementation science lens to examine the translation of diabetes prevention programs to the real world. Chapters 2-4 examined implementation of the Small Steps for Big Changes (SSBC) diabetes prevention program. Specifically, Chapter 2-3 examined the implementation outcome, fidelity. Chapter 2 evaluated the effectiveness of the in-person Small Steps for Big Changes training for fitness facility staff using the 4-level Kirkpatrick training evaluation model. Chapter 3 examined the delivery of, and engagement with, an evidence-based diet and exercise diabetes prevention program when delivered by fitness facility staff within a community organization. Chapter 4 reported the implementation strategies used and identified implementation determinants through a qualitative examination of implementation process as SSBC was implemented into two local community sites. Finally, through an in-depth systematic search and review, Chapter 5 identified implementation strategies, outcomes, and determinants when diabetes prevention programs were implemented in real-world settings. Together, results from this dissertation establish the foundation for future scale-up of the SSBC program and can inform future implementation projects. Overall, this work made important practical, theoretical, and methodological contributions to implementation science and diabetes prevention fields.

Text

2024-01-29

Attribution-NonCommercial-NoDerivatives 4.0 International

http://hdl.handle.net/2429/87388

Health and Exercise Sciences

University of British Columbia

UBCO

http://creativecommons.org/licenses/by-nc-nd/4.0/