Researchers found that a diabetes prevention program called Small Steps for Big Changes was successfully adapted for rural British Columbia communities through 27 program changes and 15 new support strategies. Five rural organizations adopted the program, representing adoption rates of 23% in the Interior region and 22% in the Northern region. The adaptations focused on improving program oversight, quality, and community acceptance to help prevent type 2 diabetes in areas with fewer health resources.
Rural and remote areas of British Columbia have fewer resources to help people prevent type 2 diabetes, even though people living there face higher risk. Researchers studied how a successful diabetes prevention program called Small Steps for Big Changes was adapted and brought to rural communities across the province. The program teaches people how to make healthy changes to their diet and exercise habits. The study found that five organizations in rural British Columbia adopted the program, and researchers made 27 changes to the program itself and added 15 new support strategies to help it work better in these communities. According to Gram Research analysis, these findings show how diabetes prevention programs can be customized to fit different communities’ needs.
Key Statistics
A 2026 research article found that five community organizations in rural and remote British Columbia adopted the Small Steps for Big Changes diabetes prevention program, with adoption rates of 23% in the Interior region and 22% in the Northern region.
Researchers made 27 adaptations to the Small Steps for Big Changes program and added 15 new implementation strategies to support delivery in rural British Columbia communities, with most changes focused on improving program oversight and quality.
According to a 2026 study of diabetes prevention program scale-out in British Columbia, rural and remote communities in Canada face higher incidence and risk of developing type 2 diabetes compared to urban populations, highlighting the need for adapted prevention programs.
The Quick Take
- What they studied: How a diabetes prevention program was changed and adapted to work in rural and remote areas of British Columbia where people have less access to health resources.
- Who participated: Five community organizations in rural and remote British Columbia (three in the Interior region and two in the Northern region) that agreed to offer the Small Steps for Big Changes program.
- Key finding: Researchers made 27 changes to the program and added 15 new support strategies to help the program work better in rural communities. About 23% of organizations in the Interior region and 22% in the Northern region adopted the program.
- What it means for you: If you live in a rural area and are at risk for type 2 diabetes, diabetes prevention programs can be tailored to fit your community’s specific needs and challenges. This research shows that programs designed for cities can work in rural areas with the right adjustments.
The Research Details
Researchers studied how Small Steps for Big Changes, an evidence-based diabetes prevention program, was adapted and brought to rural and remote communities in British Columbia. The program teaches people at risk for type 2 diabetes how to make lasting changes to their eating and exercise habits using proven behavior change techniques. The research team looked at what changes were made to the program and what new support strategies were added during the planning phase before the program started in these communities. They reviewed meeting notes and emails to identify all the adaptations and used two separate researchers to code and categorize the changes to make sure the results were accurate and unbiased.
Understanding how to adapt successful health programs for different communities is crucial because rural and remote areas often have different challenges than cities. These communities may have fewer health professionals, less public transportation, and different cultural needs. By studying how Small Steps for Big Changes was adapted, researchers can help other diabetes prevention programs scale out to underserved areas more effectively.
This study used a structured framework to identify and categorize program changes, which adds credibility to the findings. Two independent researchers reviewed the data to reduce bias. However, the study focused on the adaptation process rather than measuring whether the program actually reduced diabetes risk in rural participants. The relatively low adoption rates (22-23%) suggest that bringing programs to rural areas faces real barriers that future research should explore.
What the Results Show
Five community organizations in rural British Columbia adopted Small Steps for Big Changes: three in the Interior region and two in the Northern region. This represented adoption rates of 23% in the Interior and 22% in the Northern region. The research team made 27 changes to the program itself, with most changes focused on improving how the program was overseen and ensuring quality. These changes included adjustments to how the program was delivered, who could participate, and how success was measured. Additionally, 15 new support strategies were added to help the program reach more people, be accepted by communities, and be delivered consistently. The researchers also identified 15 changes to the implementation strategies that had been used in previous versions of the program.
The adaptations fell into two main categories: changes to the program content and delivery, and changes to the strategies used to help organizations adopt and implement the program. The primary goal of most program changes was to improve oversight and quality control. The addition of new implementation strategies suggests that rural and remote communities needed extra support beyond what had been provided in previous implementations. These findings indicate that scaling a diabetes prevention program to rural areas requires significant customization and additional resources.
This study builds on previous implementations of Small Steps for Big Changes in other settings. By comparing the adaptations made in this rural scale-out to adaptations from a previous implementation project, researchers could identify what was unique about bringing the program to rural communities. The study used established frameworks for reporting adaptations, which allows the findings to be compared with other programs being scaled to new communities.
The study did not measure whether the program actually helped rural participants prevent or delay type 2 diabetes. The adoption rates were relatively low (22-23%), which means most organizations approached did not adopt the program, and the study did not explore why. The research focused only on the adaptation process in British Columbia, so findings may not apply to other provinces or countries with different healthcare systems. The study did not include information about the specific characteristics of the five organizations that did adopt the program or how many people actually participated in the program once it was implemented.
The Bottom Line
If you live in a rural or remote area and are at risk for type 2 diabetes, look for adapted versions of evidence-based diabetes prevention programs in your community. Work with local health organizations to bring these programs to your area. Healthcare providers and community leaders should recognize that bringing diabetes prevention programs to rural areas requires significant planning, customization, and additional support strategies. Strong evidence supports using behavior change techniques to prevent type 2 diabetes, and these approaches can work in rural settings with proper adaptation.
Rural and remote community leaders, healthcare providers, and people at risk for type 2 diabetes in underserved areas should pay attention to these findings. Public health officials planning to expand diabetes prevention programs should use this research to guide their adaptation and implementation strategies. Urban-based health programs should consider how their programs might need to change to work in rural communities.
Diabetes prevention programs typically show benefits over several months to a year. Participants usually need to engage with the program for at least 3 to 6 months to see meaningful changes in diet and exercise habits. Long-term success depends on maintaining these healthy changes, which may require ongoing support from the program or community.
Frequently Asked Questions
How can diabetes prevention programs work in rural areas where there are fewer doctors and health services?
Programs can be adapted by adding extra support strategies, changing how they’re delivered, and working with local community organizations. A 2026 study found that 27 program changes and 15 new support strategies helped Small Steps for Big Changes work in rural British Columbia communities.
What is Small Steps for Big Changes and how does it help prevent type 2 diabetes?
Small Steps for Big Changes is an evidence-based program that teaches people at risk for type 2 diabetes how to make lasting changes to their diet and exercise habits using proven behavior change techniques. The program focuses on making small, sustainable changes rather than drastic lifestyle overhauls.
Why do rural communities have higher rates of type 2 diabetes?
Rural and remote communities in Canada face higher incidence and risk of type 2 diabetes compared to urban areas, partly due to fewer health resources, less access to preventive programs, and different lifestyle factors. This gap in prevention resources is why programs like Small Steps for Big Changes are being adapted for rural areas.
How long does it take to see results from a diabetes prevention program?
Most diabetes prevention programs show benefits over several months to a year. Participants typically need to engage for at least 3 to 6 months to see meaningful changes in diet and exercise habits, with long-term success depending on maintaining these healthy changes.
What changes were made to Small Steps for Big Changes for rural communities?
Researchers made 27 changes to the program itself, primarily focused on improving oversight and quality, and added 15 new support strategies to help reach more people and ensure consistent delivery in rural British Columbia communities.
Want to Apply This Research?
- Track weekly diet and exercise goals set by your diabetes prevention program. Log the number of days per week you meet your exercise target and the number of healthy meals you prepare. Monitor your progress toward program milestones and note any barriers you face in rural or remote settings.
- Use the app to set small, achievable weekly goals for healthy eating and physical activity based on your program’s recommendations. Connect with other program participants in your community through the app to share tips and encourage each other. Log your daily activities and get reminders about program sessions or health tips tailored to rural living.
- Check in weekly with your progress toward diet and exercise goals. Review monthly summaries of your healthy habits and identify patterns. Share your progress with your program coach or healthcare provider during regular check-ins to adjust goals as needed and stay motivated.
This research describes how a diabetes prevention program was adapted for rural communities, but it does not measure whether the program actually prevented type 2 diabetes in participants. If you are at risk for type 2 diabetes or have concerns about your health, consult with your healthcare provider before starting any new diet or exercise program. This article is for informational purposes and should not replace professional medical advice. Results may vary based on individual circumstances, and the findings are specific to British Columbia communities.
This research translation is published by Gram Research, the science division of Gram, an AI-powered nutrition tracking app.