Peel Family Diabetes Prevention Program

Implementation Outcome: Intervention Acceptability

Definition: The perception among our intervention participants (SA and BAC) and coaches that the delivery of the intervention curriculum is agreeable, palatable, or satisfactory. Level and unit of analysis: At the provider (coaches) and study participant level. Measure: Level of rating and perceived intervention's approval, appeal, likeness, and welcoming. Data will be collected from intervention participants and study coaches using semi-structured interviews and surveys. Interviews will use open-ended questions to explore perceived acceptability, including appropriateness, appeal, likeability, and a sense of welcome. Acceptability will also be measured using the 4-item Acceptability of Intervention Measure (AIM), rated on a 5-point Likert scale ranging from 1 (completely disagree) to 5 (completely agree), with higher scores indicating greater acceptability.

Implementation Outcome: Intervention Appropriateness

Definition: The perceived fit, relevance, or compatibility among our intervention participants and coaches (frontline intervention providers) of the intervention content and format in addressing their needs for T2D prevention associated with T2D risk factors. Level and unit of analysis: At the provider (coaches) and study participants' level. Measure: Level of rating and perceived fit, relevance, compatibility, suitability, and usefulness. Data collection and instruments: Data collected through individual semi-structured interviews and surveys. Interviews will explore perceived fit, relevance, compatibility, suitability, usefulness and practicality of the intervention content and format. The survey includes a 4-item Acceptability scale with a 1-5 score (1 = Completely disagree, 2 = Disagree, 3 = Neither agree nor disagree, 4 = Agree, 5 = Completely agree), as well as qualitative questions.

Implementation Outcome: Intervention Reach

Definition: The proportion of and representation of the targeted SA and BAC participants in the intervention. Level and unit of analysis: At the study participant level. Measure: Reach rates and related factors. Data collection and instruments: Measured as the reach rate of the targeted population (percentage of eligible families with children aged 25 years or under in Peel of BAC and SA communities that were enrolled in the study), and the percentage of representativeness of the enrolled participants in relation to the SA and BAC population as related to socio-demographic and T2D risk. Qualitative questions exploring drivers of participation will be assessed at screening and enrolment using the expression of interest form, eligibility assessment form, and/or consent form. For example, participants will be asked: "What motivated you to participate in this study?"

Implementation Outcome: Intervention Adoption (Uptake)

Definition: The decision or effort to begin using/implementing the plans/advice from the coaches. Level and unit of analysis: At the study participant level. Measure: Level of rating and perceived intervention's approval, appeal, likeness, and welcoming. Data collection and instruments: Quantitative measures will include enrolment rates; initial uptake (defined as the proportion of intervention participants and family dyads attending at least two sessions within the first month of enrolment); uptake at the end of the active intervention stage; and uptake at the end of the sustainability stage. Qualitative data will be collected through interviews using open-ended questions to explore reasons for enrolment, initiation of the health and wellness T2D coaching intervention, and factors influencing participation, adherence, and completion.

Effectiveness Outcome: Diabetes Prevention Knowledge

Measure: 1) Diabetes Prevention Knowledge level for the "Causes" and "Duration" of diabetes using the Diabetes Knowledge Questionnaire (DKQ). The DKQ dimension questions are rated using a three-response format: true (T), false (F), and don't know (DK). A score with a range of 0-100 will be calculated using the following formula: Number of correct responses /maximum possible score in that dimension, multiplied by 100. Assessment participant unit: Adult family caregiver participants and optional youth participants. Analytical level: At the dimension-specific score.

Effectiveness Outcome: Intervention Contribution to Diabetes Knowledge

Measure: It will be measured using qualitative open-ended questions such as follows: 1. Since participating in this program, what new information have you learned about T2D that you didn't know before? 2. Has your awareness of how to manage or prevent diabetes improved? If yes, in what ways? 2\) Which aspects of diabetes prevention (e.g., diet, exercise, stress management, seek help) do you feel more confident about now compared to before the intervention? 3) Have your attitudes or intentions toward diabetes prevention changed due to your participation in this program? Assessment participant unit: Adult family caregiver participants and optional youth participants. Analytical level: Salient drivers of diabetes prevention knowledge will be identified from the qualitative data.

Effectiveness Outcome: Lipids

Measure: The lipid panel will include total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), triglycerides (TG), and non-high-density lipoprotein-cholesterol (non-HDL-C). It will be obtained using the participant's capillary blood (finger-prick) sample with a validated Point-of-Care (POC) device. Assessment participant unit: Adult family caregiver participants and optional youth participants. Analytical level: 1) Quantitative (continuous) outcome measure (mm/L) for each of the lipid panel components (TC, HDL, LDL, TG, non-HDL). 2) As a clinically significant range (category) according to the 2021 Canadian Cardiovascular Society Guidelines using the Framingham Risk Score (FRS) stratification and paediatrics guidelines.

Effectiveness Outcome: Blood Pressure

Measure: Three blood pressure (SBP) and diastolic blood pressure (DBP) measurements will be taken using a digital blood pressure device. Assessment participant unit: Adult family caregiver participants and optional youth participants. Analytical level: As continuous measures, the average systolic blood pressure (SBP, mmHg) and diastolic blood pressure (DBP, mmHg) were calculated from three readings. Then, the optimal blood pressure level will be analyzed by categorizing SBP and DBP values into clinically significant ranges according to the Hypertension Canada Guidelines (2025): Optimal blood pressure is defined as the mean of three readings: \<130 (SBP)mmHg/80 (DBP) mmHg.

Other Effectiveness Outcome: Extended Family Well-Being Impact

Measure: It will be assessed with a yes/no closed-ended question to determine whether a positive effect is present at the broader family level. If yes: a) Impact will be assessed using multiple-choice options and a self-reported rating on a 7-point Likert scale (1 = very low positive impact; 7 = maximum positive impact); b) Impact areas will be measured using a closed-ended question covering nine domains (e.g., healthier eating habits, increased physical activity, improved knowledge of diabetes prevention, reduced stress or improved emotional well-being, better communication about health and lifestyle, increased family support for healthy behaviours); and c) Respondents will indicate which family members were impacted. If no family members were impacted, an open-ended question will explore the reasons why. Assessment participant unit: Adult family caregiver participants and optional youth participants. Analytical level: Categorical, ordinal impact levels, and salient insights.