The Pasifika Preventing Diabetes Programme: A lifestyle intervention through community activation and peer support among Pasifika people

Community activator (CAs) will receive extensive training on intervention delivery. This will include an initial 2 days of presentations and interactive individual and group activity based workshops to learn and practice motivational interviewing, behavioural science based behaviour change techniques and community activation techniques, to up-skill them in undertaking community-based work in a culturally sensitive and ethical manner and to ensure they have a thorough understanding of the trial design, overall intervention and their specific roles and responsibilities within the intervention. These training sessions will be delivered by the CI research team. CAs will be provided with a CA toolkit of resources (i.e. workshop intervention messages including discussion guides) that can be used to facilitate intervention delivery and a CA folder with copies of all of the content of the workshop sessions. The CA training will be provided before the Peer Support Facilitators (PSFs) within churches are recruited so that CAs can drive PSF recruitment after baseline and mid data collection but before the intervention commences delivery within the first step of churches. CAs will meet weekly, either face to face, online or via telephone to support each other through sharing experiences and to identify any barriers to intervention delivery. CAs will also have regular booster workshops (motivational interviewing/behavioural training) with the intervention support team on a monthly basis and additional support as required between booster sessions. PSFs will attend a 1-day workshop lasting 6 hours to up-skill them in delivering peer support. It is expected that these workshops will be delivered after baseline/mid data collection and 1-4 weeks prior to commencement of the intervention within their given church. The training will cover motivational interviewing skill development and how to use behaviour change techniques to guide peer support sessions, as well as an overview of the research and how to ensure ethical standards are maintained throughout intervention delivery. PSFs will receive a training manual and a similar toolkit as the CAs with the content of the sessions included. On completion of training, PSFs are required to complete a knowledge questionnaire capturing their competency. PSFs will have monthly booster sessions lasting 90 minutes each, facilitated by a CA. These will be church based or across multiple churches where churches express interest in doing so (e.g. some churches may wish to group together for such meetings by church denomination). PSFs will discuss their experiences of delivering the programme, particularly the barriers and facilitators of delivery, and booster motivational interviewing communications skill training will be provided to reinforce their initial training. A newsletter and short video summarising the content of booster session meetings will be created and circulated to all PSFs, so that those that are unable to attend are kept up to date. CAs will also have regular weekly contact with PSFs either face to face, online or over telephone in a group or one-to-one format depending on the availability of the PSFs within a given church. Each PSF will be allocated a given number of peers. The allocation ratio will depend on the total number of peers and PSFs within a church and the availability of the PSFs. It is expected that each PSF will have approximately 10 peers allocated to them. There will be no restriction on how many peers can join a peer support group session but we would recommend to PSFs that they aim to have approximately 10 peers within a given session, as this would limit the interactions possible within a group. Peers are not asked to attend the intervention activities in a highly structured way – PSFs will facilitate activities towards convenient times and choosing activities from the 12 lifestyle and 10 diabetes messages and other contemporary issues. Peers will have a weekly contact from their PSF and PSFs will be asked to run at least 1 peer group session per month each. Additional activities may run in addition to the monthly peer group sessions (eg group exercise activities such as Zumba or a cooking class). The 12 healthy lifestyle and 10 diabetes management messages will be translated and delivered to participants in Pasifika languages using multiple methods including peer support group sessions, PowerPoint presentations, demonstrations of healthy foods and cooking methods as well as various physical activity sessions (e.g. Zumba). All participants will receive a toolkit including a pedometer, water bottle and a diary, which includes details of resources available in the area (such as outdoor gyms and walking groups) as well as supporting materials relating to the messages (eg healthy lifestyle behaviour brochures and leaflets developed by the Australian government and other reliable sources such as the Heart Foundation). Churches select when and how they want to focus on each message, with the PSFs running peer support sessions and other activities aligned with the messages. Peer support sessions are based on Social Cognitive Theory, the Transtheoretical Model and the Stages of Change in relation to physical activity, diet and weight. The sessions incorporate motivational interviewing and behavioural science techniques (eg achievable goal setting, action planning, barrier identification and planning ways of overcoming barriers, to make reaching goals achievable, self-monitoring, progress reviewing and goal and action plan adjustment). The overall duration of the intervention for each church group will depend on when the block of churches are randomised into the intervention. The intervention time will be 6-33 months in 32 churches and 6-24 months in 16 churches depending on randomisation. In terms of adherence, attendance records will be requested at all intervention sessions . PSFs will be asked to record the number and duration of interactions they have with peers. The intervention will be delivered using a whole of community approach. Whilst there are sub-groups that will be compared, the intervention in terms of the healthy lifestyle messages will not be delivered in different ways to these sub-groups – all sub-groups be invited to attend any of these sessions and they will not be tailored to specific sub-groups. There are an additional 10 messages for those specifically that have known and newly diagnosed diabetes to manage their condition. PSFs that have diabetes will be asked to deliver peer group sessions that relate to these 10 messages only to peers that have diabetes, in addition to the 12 healthy lifestyle messages (there is some overlap between the diabetes management and lifestyle messages). Whilst children and adolescents are a sub-group within this study, no specific materials for these age groups will be developed but rather the filtration of the intervention through adults within the community down through to the children and adolescents will be explored.