BACKGROUND Rural and remote communities in Canada face a higher incidence and risk of developing type 2 diabetes (T2D) compared to urban populations (Government of Canada SC, 2022). Small Steps for Big Changes is an evidence-based diabetes prevention program designed to support individuals at risk of T2D in adopting and maintaining sustainable changes to their diet and exercise through the application of behavior change techniques. To expand the reach of Small Steps for Big Changes and address the significant gap in T2D prevention resources in rural and remote communities, the program was scaled out to rural and remote community organizations across British Columbia. The aim of this study was to describe the process used to scale out Small Steps for Big Changes and to identify the program and implementation strategy (IS) adaptations made during the pre-implementation phase to support delivery. METHOD Adoption rates were analyzed and reported according to the adoption dimension of the RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) framework (Glasgow et al., Am J Public Health 89(9):1322-1327, 1999 Sep) to describe the proportion of settings willing to deliver Small Steps for Big Changes. Data on adaptations were extracted from meeting notes and email correspondence. Adaptations to IS were identified by comparing these data to IS used in a previous Small Steps for Big Changes implementation project. All adaptations were deductively coded by two independent coders using the Framework for Reporting Adaptations and Modifications to Evidence-Based Interventions (S, Wiltsey Stirman et al., Implement Sci 14(1):58, 2019 Jun 6) and the Framework for Reporting Adaptations and Modifications to Implementation Strategies (CJ Miller et al., Implement Sci 16(1):36, 2021 Apr 7). RESULTS Three organizations in the Interior and two in the Northern region of British Columbia adopted Small Steps for Big Changes, representing adoption rates of 23% and 22%, respectively. Twenty-seven program adaptations were made with a primary goal of improving program oversight and quality improvement. 15 implementation strategy adaptations were identified and an additional 15 implementation strategies were added to support scale-out in attempts to improve reach, adoption, acceptability, or fidelity of the program. CONCLUSION These findings can inform targeted implementation efforts and guide decisions about scaling diabetes prevention programs, such as Small Steps for Big Changes, into diverse community settings.
To identify determinants of Physical activity (PA) promotion among healthcare professionals (HCPs) caring for patients with prediabetes (PD) and and type 2 diabetes mellitus (T2DM), using the Capability, Opportunity, Motivation–Behavior (COM-B) model. A cross-sectional online survey was conducted among 84 HCPs involved in diabetes care. The questionnaire assessed PA-promotion practices, knowledge of PA recommendations, personal PA levels, and COM-B model constructs. Descriptive, univariate, and multivariate analyses were performed. Of the 84 participants, 56
Psychosocial experiences such as loneliness and humor are associated with health in later life, but less is known about their relationship with everyday self-care. This study examined whether self-care was associated with mental and physical health beyond emotional loneliness and self-enhancing humor and whether self-care statistically accounted for indirect associations between these psychosocial factors and health-related quality of life in older adults. A cross-sectional community-based sample of 675 adults aged 60–99 years completed measures of emotional loneliness, self-enhancing humor, self-care, and health-related quality of life. Meaning and Life Purpose was examined separately as an exploratory predictor. Hierarchical regression models adjusted for age and sex were followed by bootstrapped indirect-effect analyses with 5000 resamples. Sensitivity analyses used overlap-reduced self-care scores to address potential conceptual and item-level overlap among measures. The self-care composite was strongly positively associated with both mental (r = 0.692) and physical health (r = 0.700; both p < 0.001). In hierarchical models, self-care added 13.7
Walking to school contributes to children’s health and development, yet its prevalence has declined in recent decades. Identifying factors associated with walking to school is essential for developing effective interventions. This study aimed to determine a context-specific feasible walking distance for children aged 6–10 years in Porto, Portugal, and to examine factors associated with walking to school among children living within this distance. This cross-sectional study included 596 children. Home-to-school walking distances were calculated using OpenRouteService. Four perceived neighborhood environmental attributes were assessed. Complex samples logistic regression models accounting for clustering within schools were estimated. A context-specific feasible walking distance of 1400 m was identified. Among children living within this distance, those whose mothers had a medium educational attainment were more likely to walk to school than those whose mothers had a high educational attainment (OR = 2.66, 95
