Implementation and evaluation of the Small Steps for Big Changes Diabetes Prevention Program in South-East Queensland, Australia

Small Steps for Big Changes is a diet and exercise coaching intervention targeting adults at risk of type 2 diabetes. It is delivered in the community by community persons who have been trained to deliver the intervention. This use of community persons as health coaches is a key implementation strategy. These health coaches are trained, via online modules, in motivational interviewing in order to provide a person-led approach the promotes autonomy for diet and exercise changes. The intervention is designed to be delivered by this health coach one-on-one over six 1-on-1 sessions across a four week period. Each session incorporates guidance on healthy eating and active living (about 40 minutes) and structured, supervised moderate continuous activity or high intensity interval training aerobic exercise (20 to 30 minutes). The exercise intensity is measured through heart rate and the rate of perceived exertion (Borg test), with participants also taught the talk test. Delivery sites can choose to augment this core program with additional elements, such as strength training or a group-based offering or extend the delivery period out to up to six weeks. The core components of the SSBC intervention are: self-monitoring (achieved via a client workbook); goal setting (done in collaboration with the health coach and reviewed each session); relapse prevention planning (through action planning and goal setting); diet and exercise education (targeting areas of: hidden sugar; physical sensations felt with exercise; carbohydrates, low and high GI food choices and a health plate; benefits of physical activity for diabetes prevention, identifying supports and addressing barriers to active living; and, managing setbacks and plans for post intervention); supervised choice-based moderate (e.g., steady walking on a treadmill or steady pedalling on a stationary bike) or high intensity aerobic exercise (e.g., brisk walking on a treadmill or fast pedalling on a stationary bike), with the option to do strength training as a home exercise or other appropriate exercise; and, reflection of behaviour change (done through the health coaching session and client workbook activities). Provision and take-up of any additions will be tracked. Session attendance, and delivery of these core elements of the intervention (i.e., use of motivational interviewing strategies; development and check-in of goals; self-monitoring; attendance at sessions) is tracked by the health coach as part of the session, with the health coach supported in this via scripts and prompts in REDCap.