A Randomized Controlled Trial to Evaluate the Effectiveness of the Pure Prairie Living Program - A Lifestyle Intervention

Overall Goal: To implement and evaluate the effectiveness of a lifestyle intervention (LI) tailored to Albertans' environment called the Pure Prairie Living Program (PPLP) in primary care network (PCN) settings. The PPLP delivers innovation in the concept (based on the 4-A Framework), the setting (PCNs) and nutrition evaluation tools (for Dietary Adherence - PDAQ).

Background: In Canada, there is a growing burden of type 2 diabetes (T2D). One in four Canadians has diabetes or pre-diabetes and this number is projected to be 1 in 3 by 2020. The associated economic burden is estimated to be $16.9 billion in 2020.

Adopting a healthy lifestyle can prevent and also help effectively manage T2D. Several dietary LI in the recent decades have targeted achieving a healthy body weight, participation in physical activity, and healthy eating as primary goals of their intervention trials to delay the progression of the disease or to minimize co-morbidities associated with T2D. Although some of the programs have achieved success in improving health outcomes and delaying the risk of co-morbidities, sustaining long-term changes by the participants after completion of intervention trials is challenging.

Many interventions attempt to personalize treatment based on an individual's preferences and circumstances but fewer consider individual factors within a broader framework of health determinants that includes local food Availability, financially/physically Accessibility, culturally Acceptability and nutritionally Adequacy (4A Framework). Failure to achieve long-term adherence may be influenced by these social and environmental health determinants. Further, Healthcare Professionals (HCP) are designated with the primary responsibility of educating patients to prevent, treat and manage chronic diseases. However HCPs often lack the training, skills, confidence, and time required to implement effective LI and primary care delivery models often lack the required structure and organization for such LI. Few studies consider the health care system-level changes that are required to offer sustainable, high quality LI or programs. Hence to achieve sustained adoption and maintenance of the effects of a LI at a system level requires careful planning (considering the barriers for change, ongoing support to personnel and participants, adopting a framework for behaviour change, improving self-efficacy), implementation and evaluation of the interventions.

In Alberta, Primary Care Networks (PCNs) were implemented to provide citizens access to a multi-disciplinary care team of clinicians, including dietitians. One of the goals of PCNs is to increase the emphasis on health promotion, disease and injury prevention, and care of patients with complex problems or chronic disease. Therefore, the PCN setting is ideal for implementation of LI. The investigators will use the RE-AIM (Reach, Effectiveness, Adoption, Implementation and Maintenance) framework in planning and evaluating the PPLP.