ABSTRACT:Implementation science has been gaining traction over the last decade to support health care systems in adopting and sustaining evidence-based interventions, programs, and policies. Given the inherent complexity of implementation research and practice, and their associated methodologies, implementation scientists play a central role in translating research into practice. However, many health care system stakeholders often struggle to understand how best to collaborate with implementation scientists. This commentary discusses the significant benefits of such collaboration, outlining ten critical actions drawn from the collective experience of 25 implementation scientists with over 173 years of combined expertise. This project was conducted under the SPHERE Implementation Science Platform, as part of the Sydney Partnership for Health, Education, Research and Enterprise (SPHERE).The ten recommendations for working with an implementation scientist to optimize implementation efforts include the following: (1) involve implementation scientists early during intervention design, (2) recognize the unique nature and value of implementation science data, (3) integrate implementation assessments into the research plan, (4) foster collaborative partnerships inclusive of implementation science, (5) differentiate between factors affecting implementation and wider constraints, (6) work with implementation scientists to address implementation challenges, (7) prioritize implementation scale and sustainment, (8) embrace that implementation requires continuous learning and adaptation, (9) promote knowledge exchange between implementation science and subject matter experts, and (10) focus on capability- and capacity-building for implementation within the system. By following these recommendations, researchers, clinicians, decision-makers, and implementation scientists can foster impactful collaborations that enhance the translation of research into clinical practice and improve the quality of health care delivery. SPANISH ABSTRACT:http://links.lww.com/IJEBH/A374.

Diabetes screening is vital for the early detection and management of the condition, aiming to improve prognosis and prevent disease progression and complications. However, evidence on population‑level uptake of diabetes screening and its determinants in low‑ and middle‑income countries (LMICs) remains limited. Therefore, this study assessed uptake of diabetes screening and the associated individual‑ and community‑level factors among adults in LMICs. We analysed recent Demographic and Health Surveys from 14 LMICs across Africa, South-East Asia, and the Americas. Weighted prevalence estimates of individuals who have ever undergone diabetes screening were calculated for each included country, by participant characteristics. Multilevel logistic regression models were fitted for each country to examine individual- and community-level determinants of diabetes screening uptake. Community variances, intraclass correlation coefficients, and proportional change in variance were used to measure community-level variability in diabetes screening uptake. Deviance, Akaike information criterion, and Bayesian Information criterion were used to select the best-fitting model for each survey. Adjusted odds ratios were used to estimate the association between covariates and diabetes screening uptake. The prevalence of diabetes screening uptake varied widely across countries, ranging from 5.9

Pasifika, migrant populations from Oceania in Australia, experience high prevalence of diabetes and obesity. Lifestyle interventions targeted at weight loss have shown beneficial effects in reducing the risk of type 2 diabetes (T2DM). To identify a weight loss component for a broader lifestyle clinical trial a study testing feasibility, acceptability and sustainability of a culturally tailored lifestyle intervention was delivered in Sydney, Australia. The study is a before-and-after single-arm feasibility study informed by a combined socio-ecological model and the newly developed Cultural and Sustainability Assessment of Intervention (CSAI) framework. Participants were adults from a Samoan church community who volunteered and provided consent. The intervention was a weight loss challenge delivered over 12-week sessions using 12 lifestyle messages targeting physical activity and healthy eating habits with an additional message on planning and tracking goals. Implementation was delivered by a peer-support and volunteer structure. The primary outcome was change in weight (kg) with secondary outcomes of change in physical activity and dietary behaviour and HbA1c, amongst others. Lead by the community, the intervention was repeated at 12-months. There was sustained engagement in the intervention, with low attrition rates (5.2

Background: Given the paucity of evidence on diabetes and associated risk factors among Pasifika communities in Australia, this analysis aimed to estimate the prevalence of diabetes and associated risk factors in this population. Methods: A whole-of-community-based cross-sectional analysis was conducted using baseline health screening data from adults aged ≥18 years in the Pasifika Preventing Diabetes Programme, a stepped-wedge randomised controlled trial evaluating the effectiveness of a “through the church” behaviour change intervention on diabetes prevention and management in Pasifika communities in Greater Sydney. HbA1c, random blood glucose, blood pressure, and anthropometric measurements were collected alongside sociodemographic, health behaviour, diabetes knowledge, and quality-of-life questionnaire data. Diabetes was defined by HbA1c ≥ 6.5% or self-reported diagnosis. Multivariable binary logistic regression was conducted to identify significant factors associated with the odds of having diabetes. Results: Among 1161 participants, 33.9% (95% CI: 31.1–36.7) had diabetes, of whom 34.3% were previously undiagnosed. Only 2.5% met fruit and vegetable guidelines; 34.3% met minimum physical activity recommendations, 95.8% were obese/overweight, and 68.0% had high blood pressure. The adjusted odds ratio (AOR) of having diabetes increased with family history of diabetes (AOR, 2.23; 95% CI: 1.56–3.20), high blood pressure (AOR, 1.65; 95% CI: 1.15–2.38), and older age (AOR, 1.06; 95% CI: 1.05–1.07). A high level of physical activity was associated with a 41% lower odds of diabetes compared to a low level of physical activity (AOR, 0.59; 95% CI: 0.38–0.94). Conclusions: This study demonstrates a high burden of diabetes among Pasifika adults in Australia, including a substantial proportion of previously undiagnosed cases. Older age, family history of diabetes, and high blood pressure were associated with higher odds of diabetes, while high physical activity was associated with lower odds. These findings highlight the need for culturally safe, community-based approaches to strengthen diabetes screening, early diagnosis, and integrated prevention strategies in this underserved high-risk population.

Physical activity (PA) benefits mental health, yet uptake and adherence are challenging, particularly for those affected by depression. Active virtual reality gaming (AVRG) may provide an engaging route to increase PA. To investigate the feasibility and acceptability of AVRG for increasing PA engagement and adherence in young men, and to explore effects on mental-health–related outcomes. In a randomised controlled feasibility trial (n = 30), physically inactive males aged 18–29, reporting mild to moderate depressive symptoms were allocated to Active AVRG (n = 14) or Waitlist (WL) control (n = 16). The intervention ran for 8 weeks with a 4-week post-trial follow-up. Exploratory analysis of secondary outcomes compared pre- and post-AVRG scores using paired t-test (normal), or Wilcoxon Signed-Rank test (non-normal); correlations used Pearson’s or Spearman’s coefficients. Both the feasibility and acceptability criteria were met with 67

A growing number of Australians are experiencing challenges accessing and affording healthy food due to climate-related disasters, global supply chain disruptions, and rapid inflation that is affecting the cost of healthy food (1) . There is limited understanding of how participation community-based food cooperatives can address these challenges and improve food security and dietary intake. This study investigated the motivations for joining and impact of participation in a community-based food cooperative called Box Divvy on self-reported food security status and intake of fruits and vegetables among a sample of Australian adults. A cross-sectional online survey was conducted among Box Divvy members, that measured sociodemographic characteristics, motivations for joining, self-reported fruit and vegetable intake (serves/week), and food insecurity status (USDA 6-item short form (2) ) before and while using Box Divvy. Participants were classified as being food secure, or experiencing marginal, moderate, or severe food insecurity. Logistic regression assessed demographic predictors and self-reported change in food security status, and ANOVA examined changes in dietary intake before joining and while using Box Divvy. Of participants (n = 2764, 37% aged 35–44 years, 83% European ethnicity, 92% New South Wales residents), most joined Box Divvy to support local farmers (87.3%), and save money on healthy foods (70.6%). Around half of respondents (50.8%) reported experiencing food insecurity before joining Box Divvy (24.5% marginal, 18.4% moderate, 7.9% severe food insecurity). Univariate logistic regression identified age, household structure, and income as significant predictors of food insecurity (p < 0.001). Participants experiencing food insecurity reported significantly lower consumption of fruits and vegetables prior to joining Box Divvy compared to those who were food secure (p < 0.001). While using Box Divvy, 28.2% of participants reported experiencing food insecurity (16.6% marginal, 9.6% moderate, 2.1% severe food insecurity). The odds of food insecurity while using Box Divvy were 62% lower than before joining (OR: 0.38; 95% CI 0.34–0.43; p < 0.001). On average, participants reported their fruit intake increased by 2.5 ± 5.6 serves/week (p < 0.001), and vegetable intake increased by 3.3 ± 5.7 serves/week (p < 0.001). The mean increase was significantly greater among moderately food insecure (fruit mean difference 3.2 ± 6.5 serves/week; vegetable mean difference 3.9 ± 6.9 serves/week) and severely food insecure groups (fruit mean difference 4.4 ± 6.9 serves/week; vegetable mean difference 5.5 ± 7.7 serves/week; p < 0.001). Participation in Box Divvy significantly improved self-reported food security status and fruit and vegetable intake among a large sample of Australian adults. Notably, fruit and vegetable intake significantly increased among those experiencing moderate and severe food insecurity. This underscores the potential of community-based food cooperatives to improve food security and promote healthier eating habits among Australian adults, especially households experiencing food insecurity.

Limited social networks in older adults are linked with increased dementia risk. However, there is a lack of knowledge on whether socially-based behavioural interventions (i.e., programs designed to increase individual’s social opportunities, engagement or networks) can improve cognitive function, as well as the role of applied behaviour change techniques (BCTs) in effective interventions. This systematic review and meta-analysis aimed to (i) quantify the effectiveness of social-based behavioural interventions in improving cognition in older adults, and (ii) identify which BCTs increase social activity behaviour of older adults. Six electronic databases were searched with restrictions for age (>65 years) and English language from inception to July 2023 (PROSPERO:CRD42021283382) for articles reporting social-based behavioural randomised controlled trials and using a measured outcome of cognitive function. Behaviour change techniques were mapped to the BCT V1 model and risk of bias was assessed. Pooled effect sizes from eligible studies were synthesised using RevMan. We identified 9528 records and included 15 studies (N=1785 participants). Meta-analyses showed that social-based interventions had a medium effect on global cognition (d=0.80, 95

BACKGROUND/OBJECTIVES:Type 2 diabetes (T2D) is a growing health epidemic. Innovative approaches such as digital technologies incorporating peer-supported coaching have shown promise in diabetes prevention. This study aimed to examine the feasibility and effect on weight of a digitally-enabled peer support program in inner-regional Sydney. METHODS:A pre-post study of a digitally-enabled peer support initiative promoted weight management and lifestyle changes in participants at risk of T2D in inner-regional Sydney. Participants were recruited primarily from general practices and community groups. Participants received initial guidance, educational videos, goal-setting tools, and self-assessment weights, while volunteer peer support facilitators provided ongoing support through action planning and monthly calls. Baseline and follow-up weights at 6 months were collected to determine program effectiveness, while feasibility was evaluated through short exit interviews and analytic website data. RESULTS:Most eligible participants (92.4%) were recruited through general practice. Program completers (n = 35, 43.8%) reported an average weight reduction of 3.7 kg (SD = 3.9, p < 0.001). Those who used the platform to log at least one achievement saw a greater reduction in weight than those who did not log achievements (mean difference = -2.9 kg, 95% CI -5.6 to -0.1, p = 0.049). Exploratory qualitative analysis of exit interviews revealed challenges surrounding technology, website interaction, scheduling conflicts, data collection, and attrition. CONCLUSIONS:Preliminary results indicate that this digital program was associated with significant weight reduction among individuals at risk of diabetes in an inner-regional area of Sydney. Recruitment was most effective via general practices, highlighting the potential for such a program to be promoted through this setting.

INTRODUCTION:Muslim women in Australia encounter substantial reproductive health disparities. Reasons include intersecting barriers, including distinct demographic features, modesty and privacy concerns, recency of migration, stigma, discrimination, distrust of health systems, fatalistic health beliefs and lack of culturally appropriate health services. In published literature, community-based participatory research (CBPR) has been used in health promotion in hardly reached Muslim populations along with culturally and/or religiously tailored health promotion programmes to disseminate health messages in mosque settings. Despite positive evidence internationally, mosque-based reproductive health programmes remain largely unexplored in Australia. The Women's Awareness in ReproDuctive 'Aafiya (WARDA) study seeks to address this gap by co-designing reproductive health resources tailored for Muslim women in Australia. METHODS AND ANALYSIS:WARDA employs a CBPR methodology, actively involving Muslim women aged 18-45 years, community stakeholders and Muslim health professionals in New South Wales. The study comprises two phases: Phase 1 involves co-designing reproductive health promotion resources through participatory workshops, online surveys and semi-structured interviews, followed by the creation of resources. Phase 2 entails delivering the resources through peer educators, and evaluating the acceptability, usability and perceived benefits of these resources through mosque-based community sessions. Qualitative and quantitative data collected during both phases will undergo thematic analysis and descriptive statistical analysis, respectively, ensuring iterative refinement of interventions based on participant feedback. A sustainable version of the resources will be made available online for continued community use. ETHICS AND DISSEMINATION:Ethics approval has been granted by Western Sydney University Human Research Ethics Committee (approval number H16274). Findings from WARDA will be disseminated through grassroots community organisations involved in the project.

Amid rapid inflation, a growing number of Australians are experiencing challenges affording healthy food, impacting dietary behaviours. Community-based food cooperatives are an emerging alternative to mainstream supermarkets for accessing more affordable, healthy foods. This study explored how participation in a community-based food cooperative (Box Divvy) impacted self-reported food insecurity and fruit and vegetable intake among Australian adults. A cross-sectional online survey of Box Divvy members measured sociodemographics, fruit and vegetable intake (serves/week), and food security status (USDA 6-item short form) reflecting on their status before and while using the cooperative. Participants were classified as food secure, or food insecure (marginally, moderately, and severely food insecure). Logistic regression assessed demographic predictors of food insecurity, paired proportions tests assessed change in food security status and ANOVA examined changes in diet. Of participants (n = 2277, 37 % aged 35-44 years, 83 % European ethnicity), 50.8 % reported food insecurity before joining Box Divvy (24.5 % marginal, 18.4 % moderate and 7.9 % severe food insecurity). Younger age, single parent households and lower income were significant predictors of food insecurity. While using Box Divvy, a significantly smaller proportion of participants reported food insecurity (-22.6 %; 95 % CI: 20.7 %, 24.5 %; p < 0.001). Higher fruit (+2.5 ± 5.6 serves/week p < 0.001) and vegetable (+3.3 ± 5.7 serves/week (p < 0.001) intake was reported while using Box Divvy, which was significantly greater among moderately and severely food insecure groups compared to the food secure group (p < 0.001). Our study highlights how community-based food cooperatives can positively influence dietary behaviours and food security by improving access to healthy foods.

Abstract Background For people living with Type 2 Diabetes Mellitus (T2DM), achieving optimal health outcomes requires optimal self-management and adherence to medical treatment. While some studies suggest an association between poor medication adherence and lower levels of health literacy, the evidence for this association remains inconclusive. This systematic review aimed to synthesise the evidence on the association between health literacy and medication adherence among adults from ethnic minority backgrounds living with T2DM. Methods Medline (Ovid), The Cochrane Library, Embase (Ovid), PsycInfo (EBSCO), and the Cumulative Index to Nursing and Allied Health Literature (CINAHL) (EBSCO) were searched systematically for peer-reviewed literature, published until January 2024. Studies were included in this review if they assessed health literacy and medication adherence among ethnic minority people with T2DM. Two reviewers independently screened and selected the studies, extracted data from the included articles, and assessed the methodological quality of the studies. The methodological quality and bias in designing, conducting, and analysis of each study were evaluated using a standardised JBI critical appraisal tool. Results Of the total 6,318 identified studies, seven studies were included in the review. The total participant sample sizes across these studies varied from 53 to 408 participants. All included studies incorporated cross-sectional design for the research, with the majority conducted in the USA. Of the seven unique studies, only one study observed a significant association between health literacy and medication adherence among people from an ethnic minority background. Conclusions Evidence on the association between health literacy and medication adherence in ethnic minority adults with T2DM is weak and inconsistent. To understand this association more clearly in ethnic minority populations and to address the disparities in cultural and linguistic considerations, well-designed studies are required. Trial registration This review is registered with PROSPERO (CRD42022328346).

Ethnic minorities, such as Pasifika, residing in high-income countries were at higher risk of COVID-19 infection during the pandemic. To understand the experiences of Pasifika, including message dissemination and barriers to tailored public health messaging during the pandemic, a qualitative study was undertaken, underpinned by Laswell's Model of Communication and Bandura's social cognitive theory with data collected using Pasifika methods. Pasifika adults (n = 65) were recruited across Sydney from July 2020 to March 2022. Health care professionals (HCP) (n = 17) employed by four local health districts (LHDs) and Pasifika community-based organizations delivering multicultural COVID-19-related work within the study catchment, were also recruited. Five themes were constructed from the data of: (i) prevailing fear and uncertainty over COVID-19 infection and losing employment; (ii) limited knowledge of government perpetuating distrust in Government as a benevolent source of information; (iii) faith and trust as priorities for health decision-making; (iv) 'Coconut wireless'-the role of family, friends and community in disseminating public health messages through word of mouth; and (v) limited health literacy affecting compliance with public health orders. Community members identified important messages and resources had not been sufficiently distributed. Most HCPs understood the necessity of grassroots-level engagement but reported existing approaches were inadequate to navigate challenges. These findings highlight the need for public health promotion and communication strategies that consider both the social and cultural determinants of health. We propose a 7-point checklist as a cultural appropriateness lens to assist the development and rating of existing or new health promotion messaging and resources.

BackgroundDiabetes and pregnancy studies have found better outcomes when interventions were developed with consumer (individuals with lived experience of diabetes) and community involvement. When consumers are central to development and delivery of interventions, study participants have better engagement and outcomes, particularly for individuals from culturally and linguistically diverse (CALD) and/or lower socio-economic backgrounds. Our study aims to examine the scope of consumer and community involvement (CCI) in the construction and implementation of pre-pregnancy care (PPC) interventions and discuss a framework for consumer-lead intervention development.MethodsA systematic literature review was conducted, examining 3 electronic databases. A meta synthesis analysis of tabulated data summarized in a literature matrix was undertaken with a phenomenological approach to develop a Pre-Pregnancy Care CCI-Driven Intervention Framework.ResultsOverall, 4642 papers were identified, with 29 meeting inclusion criteria. The meta-synthesis and literature matrix identified several common themes across previous studies. These were: barriers to accessing (PPC) such as negativity and stigma in care from behaviours, attitudes and perceptions of HCPs; limited appointment availability not aligning with work and family commitments; fear of losing a "normal" pregnancy journey; awareness of risk but unwillingness to discuss if consumers have not established trust with HCPs; inaccessibility to CALD appropriate PPC and contraception; and digitisation of PPC information resources including peer support and social media. From these results, a PPC Consumer-Driven Intervention Framework for Women with Pregestational Diabetes was developed with recommendations.ConclusionConsumers have been under-involved in the majority of previous developments and implementation of interventions for women with diabetes and pregnancy, and their representation as stakeholders in interventions is paramount to the longevity of intervention outcomes. To assist community involvement in diabetes pregnancy intervention design and delivery we created a new framework, for improving clinical and social outcomes in healthcare, empowering relationships between HCPs and consumers, and highlighting the value of lived experience and women-centred care for increased community engagement.

The first International Association of Diabetes and Pregnancy Study Groups Summit on the diagnosis of gestational diabetes in early pregnancy (Treatment of Booking Gestational Diabetes Mellitus (TOBOGM) Summit) was held on the 17 November 2022 in Sydney, Australia. It sought to use the TOBOGM trial findings to scope the issues involved with early screening, to inform future discussions over possible approaches for diagnosing gestational diabetes mellitus (GDM) in early pregnancy. Most delegates supported testing for early GDM using a one-step 75 g oral glucose tolerance test approach with Canadian Diabetes Association criteria preferred, but highlighted the importance of considering resources, cost, consumer perspectives and equity in translating TOBOGM results into a clinical approach to screening for, and diagnosing, early GDM.

BACKGROUND:The UK Diabetes Remission Clinical Trial (DiRECT) study was replicated in an Australian primary care setting. This qualitative study aimed to explore and understand the perceptions and experiences of both participants and healthcare professionals (HCPs) involved in the DiRECT-Australia Type 2 Diabetes Remission Service.METHODS:All participants and HCPs delivering the service were invited to participate in semi-structured interviews via online videoconferencing. The interview guides explored perceptions and experiences in DiRECT-Australia, covering aspects such as barriers and facilitators to recruitment and participation, motivations and challenges across service phases, adequacy of support provided and the overall acceptability of the service. All interviews were audio-recorded, transcribed verbatim and analysed using thematic analysis.RESULTS:Eight DiRECT-Australia participants and six HCPs (three general practitioners, two practice nurses and one dietitian) participated. Four overarching themes were identified: (1) Enablers and barriers to recruitment and continuous participation in DiRECT-Australia; (2) Motivators and overcoming barriers across the total diet replacement, food reintroduction and weight maintenance phases; (3) Importance of participant-HCP interactions and continuous support; (4) Acceptance and long-term need for DiRECT-Australia. Adherence to total diet replacement was less challenging than anticipated by participants. Transitioning to the food reintroduction phase was difficult but overcome through HCP support. DiRECT-Australia was well accepted by both participants and HCPs, and participants expressed willingness to continue with the service, if provided on a long-term basis.CONCLUSIONS:Both participants and HCPs were highly interested in the new diabetes remission service set up in an Australian primary care setting. The acceptability of DiRECT-Australia was underscored by participants emphasising the effectiveness of the service in achieving significant weight loss and diabetes remission. There is a need for long-term and wider implementation of the service to ensure that anyone with recent onset type 2 diabetes is offered the best possible chance to achieve remission.

PurposeAfter breast cancer diagnosis and treatment, the majority of women will gain weight. The aim of this study was to describe the experiences of weight management among Australian women with breast cancer.MethodsThis is a secondary analysis of data from a qualitative study evaluating the feasibility of novel interventions for weight management after breast cancer. Participants were recruited via email invitation from a breast cancer consumer organization and breast cancer centre in Australia. Eligible participants had received treatment for breast cancer, and were fluent in English. Discussions were audio-recorded, transcribed verbatim and analysed using thematic analysis with the constant comparison method.ResultsThirty-seven women provided data in five focus groups and one semi-structured interview. Four themes were identified: Timing, milestones and turning points; Making sense of the journey; Factors leading to weight gain; and Information and health professional support. Varying trajectories of weight gain were described, the most common being gradual or fluctuating weight gain. Weight gain was attributed to a number of related factors including becoming postmenopausal, and the impact of treatment effects. Achieving a sense of autonomy and agency assisted with weight management. An overall lack of information and support relating to weight management was highlighted.ConclusionsThere is a need for a coordinated and systematic approach to weight management after breast cancer. Further research on the role of supportive care and systems-level support is warranted to mitigate the significant public health burden of excess weight after breast cancer treatment.

Objectives: Some geographic regions in high-income countries (HIC), including Australia, have poor healthy food access and a high burden of diet-related chronic disease. Scalable and sustainable strategies to strengthen community food systems have the potential to address these inequities. To inform future interventions in regions with poor healthy food access in Sydney, Australia, and beyond, we systematically reviewed randomised controlled trials of community-based food access interventions in HIC, to identify effects on dietary behaviours and health outcomes. Methods: Four electronic databases were searched. Studies involving community-based healthy food access strategies (solely or combined with education/behaviour change) and measuring effects on dietary behaviours and/or health outcomes were identified. Data on dietary behaviours, health outcomes and intervention descriptions were extracted, and the risk of bias was assessed. Results: Seven studies met inclusion criteria, with most conducted in the US (n = 6). Intervention strategies included food pantry-based interventions (n = 2), mobile produce markets (n = 2) and community farms (n = 3). Most interventions (n = 6, 85%) incorporated educational and/or behavioural change aspects. All studies measured fruit and vegetable (F&V) intake, with nearly all (n =6, 85%) reporting significant beneficial effects. Conclusion: Preliminary evidence in our synthesis demonstrates that multicomponent community-based food system interventions promise to improve F&V intake in regions of HICs. Recommendations for improving future evaluations are identified to build evidence for policymakers and urban planners to enact upstream and downstream strategies to strengthen community healthy food, particularly in geographic regions with the greatest health inequities.

Background: 'Food is medicine' strategies aim to integrate food-based nutrition interventions into healthcare systems and are of growing interest to healthcare providers and policy makers. 'Medically Tailored Meals' (MTM) is one such intervention, which involves the 'prescription' by healthcare providers of subsidized, pre-prepared meals for individuals to prevent or manage chronic conditions, combined with nutrition education.'Objective: This study will test the efficacy of an MTM program in Australia among participants with type 2 diabetes (T2D) and hyperglycemia, who experience difficulties accessing and eating nutritious food.Methods: This study will be a two-arm parallel trial (goal n = 212) with individuals randomized in a 1:1 ratio to a MTM intervention group or a control group (106 per arm). Over 26 weeks, the intervention group will be prescribed 20 MTM per fortnight and up to 3 sessions with an accredited dietitian. Controls will continue with their usual care. The primary outcome is glycated hemoglobin (HbA1c, %) and secondary outcomes include differences in blood pressure, blood lipids and weight, all measured at 26 weeks. Process and economic data will be analyzed to assess the feasibility, acceptability, scalability, and cost-effectiveness of the intervention. Recruitment commenced in the first quarter of 2023, with analyses and results anticipated to be available by March 2025. Discussion: Few randomized controlled trials have assessed the impact of MTM on clinical outcomes. This Australian-first trial will generate robust data to inform the case for sustained, large-scale implementation of MTM to improve the management of T2D among vulnerable populations. ANZCTR: ACTRN12622000852752. Protocol version: Version 1.1, July 2023.