Small Steps for Big Changes - Healthy Cities Implementation Science

Small Steps for Big Changes (SSBC) is a diet and exercise counselling program that significantly reduces the risk of developing Type 2 Diabetes (T2D). In partnership with YMCAs in Canada spanning 8 provinces, the aim of this study is to scale-up program delivery and evaluate the implementation and effectiveness of SSBC. To evaluate implementation, the number of staff trained/patients enrolled, attendance, sessions delivered as planned, delivery costs, and number of sites continuing to deliver the program will be examined. To evaluate program effectiveness, changes in patient health (e.g., T2D status, blood glucose, weight, exercise, diet) will be measured over 2 years following program completion.

Patients Inclusion Criteria: * Community-dwelling adults aged 18 years or older * able to read and speak English * has prediabetes assessed by one of the following means: (a) physician-diagnosed prediabetes, (b) HbA1c values between 5.7 - 6.4% (American Diabetes Association, 2012), (c) an American Diabetes Association risk questionnaire score indicating increased risk (\>5) * Individuals who have previously been diagnosed with type 2 diabetes but who are in remission (defined as achieving glycated hemoglobin (A1C) of \< 6.4% without any diabetes-related medications for a minimum of 3 months) will be eligible to participate. Exclusion Criteria: \- Patients currently diagnosed type 2 diabetes with an HbA1c of 6.5% or greater. Organizational partners Inclusion criteria: \- Senior leadership and/or management of our Canadian YMCA delivery partner organizations Exclusion criteria: N/A Site leads/managers Inclusion criteria: \- YMCA staff who manage/coordinate programs (e.g., general manager of health programs) for each site willing to act as SSBC site lead champion. Exclusion criteria: N/A Coaches Inclusion criteria: Site staff certified as SSBC coaches to deliver the program. Exclusion criteria: N/A