Improving the Recruitment and Retention in the Intensive Diabetes Prevention Program at Hong Kong in District Health Centers (IDPP-DHC)

Participant will receive the one year IDPP with enhanced nurse consultations and follow-up.

The implementation includes an enhanced nurse consultations. Nurses will help participants understand prediabetes, set personal goals and review lifestyle changes. DHC staff will send reminders three days before scheduled consultations. Provider training and ongoing feedback will support program delivery.

Participants will receive the one year IDPP according to existing DHC services.

The usual IDPP offers four voluntary group education sessions delivered by DHC staffs. There is also a nurse consultation at the DHC.

Feasibility (Primary outcome: Recruitment and Retention rates) Recruitment will be calculated as the proportion of eligible patients who agree to participate in the IDPP out of the total eligible population that reached the DHCs.

Retention rate will be defined as the proportion of participants who complete both nurse consultation sessions and at least two of the four group-based educational sessions over a one-year period.

Acceptability will be evaluated using semi-structured interviews with participants and providers following the implementation phase.

Adoption will assess the extent to which participants and providers engage with and adhere to the optimized IDPP strategies.

The perceived relevance and compatibility of the implementation strategies with participant needs, existing workflows, and center resources. Data will be collected through semi-structured interviews with participants and staff.

Fidelity, or the extent to which the implementation strategies are delivered as consistently and as intended

Implementation cost will be assessed from an organizational perspective, capturing direct cost associated with delivering the optimized IDPP. Data will be collected through tracking staff time and operational expenses, and by conducting analysis of incremental cost-effectiveness.

Sustainability will be assessed as the extent to which the optimized strategies remain integrated into routine DHC operations after external research support ends.

Mean change in HbA1c level will be measured from blood samples drawn by DHC nurses and analyzed to reflect average blood glucose levels over the previous 2-3months.

Change from baseline in BMI, calculated as weight in kilograms divided by height in meters squared.

Lipid profile ( including cholesterol level, high-density lipoprotein, and low-density lipoprotein) will be collected by DHC nurses.

Perceptions of empowerment will be measured using the Chinese version of the Patient Perceptions of Empowerment Scale (PPES) , an 11-item validated tool with a content validity index of 0.93. The PPES evaluates empowerment across four domains: information (three items), decision-making (two items), individualized autonomy (three items), and staff-management (three items). This tool has proven reliable for assessing empowerment in clinical and research settings.

QoL will be assessed using the Chinese version of the 12-item Short Form Health Survey version 2 (SF-12), which has demonstrated reliability in local populations.

Health services utilizations will be assessed by tracking unscheduled visits to general outpatient departments, general practitioners, emergency departments, and hospitals during the six months preceding each data collection timepoint.