Dissertation Defence: Examining the Implementation of Diabetes Prevention Programs to the Community

Tineke Dineen, supervised by Dr. Mary Jung, will defend their dissertation titled “Examining the Implementation of Diabetes Prevention Programs to the Community” in partial fulfillment of the requirements for the degree of Doctor of Philosophy in Kinesiology.

An abstract for Tineke Dineen’s dissertation is included below.

Examinations are open to all members of the campus community as well as the general public. Registration is not required for in person defences.

---

ABSTRACT

Type two diabetes (T2D) is one of the fastest growing chronic conditions worldwide and has negative health consequences and high costs for healthcare systems. Prediabetes, which precedes T2D, offers an opportunity for early intervention to delay and/or prevent progression to T2D. Diet and exercise are the cornerstones of diabetes prevention and have a large research base demonstrating their efficacy at reducing T2D risk. To combat the rising prevalence of T2D worldwide, diabetes prevention programs need to be implemented in practice within real-world settings.

Moving research to practice is notoriously slow. Introducing an established program to a new setting involves various variables that can influence the process and the program’s ultimate effectiveness. Evidence of successful translation of diabetes prevention programs within real-world contexts exists and there are a few large-scale demonstrations of the institutionalization of programs nationally. However, reporting on implementation factors, such as implementation strategies, determinants, and outcomes, is low. Implementation science focuses on studying the methods and strategies used to facilitate the uptake of evidence-based innovations into regular use within real-world practice settings. Moving beyond program details, implementation science uses a broad approach to understand the system which the evidence-based innovation works within. This dissertation focuses on implementation of diabetes prevention programs in the real world.

The first three studies examine implementation of the Small Steps for Big Changes (SSBC) diabetes prevention program. The program was systematically developed and demonstrated effectiveness from small pilot study to community implementation. I investigated the implementation process, community coach training, and fidelity of program implementation within the community organization. Results from my research support SSBC scale-up initiatives currently underway and contribute to understanding key implementation factors within the project. To further contextualize my results, a systematic search and review was conducted to understand what implementation strategies have been used within diabetes prevention program translations to community contexts to date. Together, results from this dissertation establish the foundation for future scale-up of the SSBC program and can inform future implementation projects. Overall, this work made important practical, theoretical, and methodological contributions to the implementation science and diabetes prevention fields.