Table 1.

Kerala Diabetes Prevention Program objectives, theory-based methods and practical strategies

Program Objectives	Participant learning and environmental change objectives	Theory- and evidence-based determinants as per the Health Action Process Approach [47]	Behavior change techniques as per Michie et al.’s Taxonomy v1 [48] (BCT number)	Feasible and culturally acceptable strategies to enhance engagement and implementation
1. Increase the consumption of fruit, vegetables and fibre 2. Reduce intake of carbohydrates with high glycaemic index and total and saturated fats 3. Increase physical activity 4. Reduce tobacco use with emphasis on chewing tobacco 5. Reduce alcohol consumption, particularly among men 6. Set realistic goals and associated targets for weight loss and other lifestyle risks 7. Improve sleep	Participant learning objective • Increase awareness of the risk factors of T2DM • Improve risk perception on T2DM • Improve self-efficacy in making lifestyle changes Environmental change objective • Enhance peer support for behavior change • Enhance household / family support for behavior change • Enhance neighborhood and community support • Facilitate opportunities for healthy life style with collaboration at group-community level.	• Outcome expectations • Risk perception • Self-efficacy • Action planning • Coping planning	• Goal setting (behavior) (BCT #1.1), action planning (BCT #1.4) and review of behaviour goal(s) (BCT #1.7) e.g. participants are assisted to set realistic behavioral goals and prompted to detail a plan of how they will achieve it. The goals are reviewed within the sessions. • Instruction on how to perform a behaviour (BCT #4.1) e.g. experts advised and up-skilled participants in yoga classes and kitchen garden development • Information about health consequences (BCT #5.1) e.g. information is provided in the DPES sessions and small group sessions on diabetes and potential complications • Problem solving/coping planning (BCT #1.2) e.g. barriers to physical activity and healthy eating are discussed and planned for throughout the small group sessions • Social support (practical) (BCT #3.2), social support (general) (BCT #3.1), and social support (emotional) (BCT #3.3) e.g. inclusion of family members and peer-based intervention is designed to enhance social support	Individual-level • Educational sessions that focus on ‘modifiable’ determinants of risk on diabetes • Provide information on the risk factors of T2DM • Sessions scheduled in local neighborhoods (e.g. a reading room or anganwadi) according to work, family and other cultural needs of participants • Inclusion of strategies to attract more male participation Interpersonal-level • Group-based delivery/ peer-support • Inclusion of family members in the K-DPP sessions • Provide information on the dietary and physical activity targets for individuals as well as family members • Enabling ongoing peer and social support, with family members and friends of participants • Kitchen gardening training and seeds • Forming of walking groups • Yoga training sessions Community-level • Community mobilization activities • Forming partnerships with community stakeholders and organizations • Clearing of walking paths with peer group and community members