Table 1 Identification and description of implementation strategies used in SSBC

Develop and implement tools for quality monitoring

Developed session-specific fidelity checklists for staff to complete after every session. Data is collected, inputted, and evaluated for fidelity purposes by research team.

Staff are instructed to audio record every session to be reviewed by study staff for motivational interviewing fidelity and program fidelity.

Audit and feedback

Staff audio-recorded every session and research staff reviewed randomly selected sessions to assess for motivational interviewing fidelity and program fidelity.

To assess program fidelity, after each session staff completed session-specific checklists documenting what was delivered to their client.

Provided feedback through evaluation reports.

Centralize technical assistance

A project coordinator dedicated to assisting the implementation efforts. All staff, site leads, and site managers had the contact information for the project coordinator.

Organize clinician implementation team meetings

Project coordinator planned and led mandatory 1-h monthly site meetings with all program staff.

Create a learning collaborative

Project coordinator planned and led monthly team meetings with staff involved in the project.

Project coordinator provided a skeleton framework of support and encouraged staff to seek support from each other beyond site meetings.

Capture and share local knowledge

Local knowledge from implementation sites was shared through the project coordinator from site to site. In addition, this local knowledge was shared at the implementation team meetings. This sharing of information generated interest and led to the confirmation of the third site in the local area, as well as with the region and beyond.

Build a coalition

During the planning process an implementation team formed. This team consisted of three stakeholders from the YMCA and three stakeholders from the research team committed to the project. The team met monthly.

Use advisory boards and workgroups

Monthly implementation team meetings discussed implementation progress, solved challenges that arose, developed marketing and communication plans and continued to plan future scale-up strategies.

A client advisory committee provided feedback on intervention content and tools (e.g., recruitment letter, client workbook)

A stakeholder advisory committee provided feedback on program promotion, recruitment, and marketing.

Tailor strategies

Continuous feedback was collected from site leads, monthly meetings, and individual interviews with staff after 3 clients. Feedback was collected and used to tailor implementation strategies (e.g., training program, additions to training manual)

Purposely re-examine the implementation

Implementation strategies were reviewed at monthly site meetings and implementation team meetings, minor adjustments were made (e.g., adaptations to the training based on staff feedback).

Conduct educational meetings

Two local community events were held with multiple stakeholder groups attending (e.g., physicians, local health authority staff, university staff, community members, YMCA staff). Goals of these meetings were to provide updates to the community on study progress, distribute results, share success stories, and inform the community on the overall initiative to support stakeholder involvement, recruitment and support.

Conduct educational outreach visits

Research staff met with local physicians to educate practitioners about the program, promote recruitment and review process for referring eligible patients.

Develop a formal implementation blueprint

An implementation plan was created to support the program including standard operating procedures, a document describing the short- and long-term goals, roles and responsibilities, timeline, outcomes, and strategies for the project. The document was reviewed iteratively by both partners.

Develop academic partnerships

In 2017, the research team partnered with the YMCA. In 2019, an official memorandum of understanding was signed to signify long-term commitment to the partnership.

Develop educational materials

Developed a staff manual with details on the communication style (motivational interviewing), the program content (prediabetes, diabetes, diet and exercise), and additional supplementary information to support implementation (e.g., frequently asked questions section).

Developed educational videos on program content, how-to videos and videos of senior research staff facilitating the program to clients to supplement the in-person training. All staff have ongoing access to videos on an online training platform.

Distribute educational materials

Each staff was provided a hard-copy program manual in addition to access to an online training platform with additional educational, how-to, and senior research staff facilitating the program videos.

Identify and prepare champions

Identified and trained one site lead per site to oversee and support staff, liaise with research team and support the program.

Selected and trained a project coordinator to oversee sites and liaise with site leads and staff.

Identify early adopters

Training was conducted in three rounds. First-round staff were early adopters who conveyed their experiences to others at their organization and provided support to the subsequent round of staff.

Make training dynamic

In-person training was delivered with a variety of tasks such as PowerPoint slides, role-play, videos, discussion, and hands-on learning, practicing, and skill demonstration. In addition, ongoing access was provided to an online training platform with additional videos (shadowing, educational, and how-to videos).

Obtain and use patients/consumers and family feedback

All clients in the program were offered to participate in an optional interview at the end of the program. In addition, all clients were provided with surveys that collect program outcomes and program feedback at multiple time-points.

Promote adaptability

Staff were taught to deliver core program content (diet, exercise content, and exercise protocols) in a client-centered manner, providing flexibility on delivery. Key program content must be provided to each client but can be tailored to the client, e.g., order of content delivery, specific details. In addition, clients get a choice of exercise protocols (high-intensity interval training or moderate-intensity continuous training) and exercise mode (walking, cycling, elliptical).

Shadow other experts

Videos were created with a senior research staff facilitating the program to a client. As part of the mandatory training, all staff viewed segments of the videos demonstrating delivery of core program content. Full length videos were also added, and staff were encouraged to watch the full-length videos of a counseling session to understand session flow.

As part of the mandatory training, all new staff had a senior research staff shadow them while they facilitated their first client through the program (expert shadows new staff).

Stage implementation scale up

During the planning process two local sites were selected for the first stage. Building on the success and lessons learned from the first sites, a third local site would launch. The project would continue to scale-up in a such a staged process, continually building on lessons learned.