Table 1.

Summary of program domains and key considerations for adapting DPP style programs for the management of CMDs.

Program Domain	Key Considerations
Program content	Suitability of goals to mental health populations. Integrating the most up-to-date evidence from lifestyle psychiatry is critical. A one-size-fits-all approach is likely unsuitable. Flexibility around the nomination of additional lifestyle targets that are critical to achievement of the core goals.
b.Personalisation	Acknowledging the shared pathways between T2DM and CMDs, studies investigating the mechanisms underpinning treatment response in diabetes may provide key insights. Personalisation based on individual characteristics (e.g., psychiatric, genetic, biological, social profile) and environmental factors (e.g., settings, availability) may help maximise benefits as well as reduce adverse events. Behavioural change techniques should be utilised by appropriately qualified facilitators with advanced training in motivation interviewing, lifestyle counselling, and communication skills.
c.Recruitment and retention	Potential recruitment and retention difficulties need to be considered. Due to the prominent symptoms of CMDs, there is a potential need to utilise different methods for delivering the intervention that do not require in-person attendance, such as telehealth. Programs need to invest in designing recruitment strategies that ensure high program reach and explore factors that optimize engagement and retention.
d.Effect maintenance and program sustainability	Individuals with CMDs may require a different schedule of intervention that considers illness trajectory, including remission prevention. Peer support from individuals with lived experience may help achieve sustained lifestyle changes. Identifying socioeconomic constraints around lifestyle modification, uptake, adherence and completion of health promotion interventions is critical. For successful scale-up, require external project funding, and unified acceptance and understanding of CMDs by key stakeholders and the general public.
e.Evaluation, quality indicators	Embedding biomarker testing within lifestyle interventions can advance our understanding of risk assessment and treatment response and aid the development and validation of risk equations. Define quality indicators to ensure program fidelity. Also allows for ongoing monitoring, benchmarking, evaluation and improvement of evidence-based clinical care.