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Feasibility and implementation of a healthy lifestyles program in a community setting in Ontario, Canada: protocol for a pragmatic mixed methods pilot study
  1. Elizabeth Alvarez1,2,
  2. Majdi Qutob3,
  3. Lawrence Mbuagbaw2,
  4. John Lavis1,2,4,
  5. Cynthia Lokker2,
  6. Marjan Walli-Attaei5,
  7. Zainab Samaan6,
  8. Arielle Sutton2,
  9. Japteg Singh2,
  10. David Feeny1,7,
  11. John Fortuna2,8
  1. 1 Centre for Health Economics and Policy Analysis (CHEPA), McMaster University, Hamilton, Ontario, Canada
  2. 2 Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
  3. 3 Innovation Science and Medicine (ISM), Burlington, Ontario, Canada
  4. 4 McMaster Health Forum, McMaster University, Hamilton, Ontario, Canada
  5. 5 Population Health Research Institute, Hamilton, Ontario, Canada
  6. 6 Department of Psychiatry and Behavioral Neurosciences, McMaster University, Hamilton, Ontario, Canada
  7. 7 Department of Economics, McMaster University, Hamilton, Ontario, Canada
  8. 8 City of Hamilton Public Health Services, Hamilton, Ontario, Canada
  1. Correspondence to Dr Elizabeth Alvarez; alvare{at}


Introduction Rates of chronic conditions, such as diabetes, cardiovascular disease and obesity are increasing in Canada and internationally. There are effective lifestyle interventions that are known to improve chronic conditions. However, there is often a gap in ‘how to’ make lifestyle changes. Mental health and other determinants of health play a role in the development and progression of chronic conditions. Changing habits takes time and requires the use of multiple techniques, including mental health and behavioural change strategies, based on a person’s needs. A new, multidisciplinary, person-centred and evidence-based and practice-based programme has been created to address these needs. This proposal aims to evaluate the feasibility and implementation of this programme and to determine changes in participant-directed and clinical outcomes through a pilot study.

Methods and analysis A pragmatic mixed methods design will be used to study multiple dimensions of the year-long healthy lifestyles programme. The pilot study includes a randomised controlled trial, with 30 participants randomised to either the programme or to a comparator arm, and qualitative components to determine the feasibility of the programme, including recruitment and retention, data missing rates and resources needed to run this programme. Changes in participant-directed and clinical outcomes will be measured. Descriptive statistics, t-tests and repeated measures analysis of variance (ANOVA) for within group comparisons and generalised estimating equations for between group analyses will be used. Qualitative interviews of programme staff and healthcare providers and family focus groups will be used to further enhance the findings and improve the programme.

Ethics and dissemination Approval from the Hamilton Integrated Research Ethics Board (HiREB) has been obtained. Informed consent will be obtained prior to enrolling any participant into the study. Participant IDs will be used during data collection and entry. Peer-reviewed publications and presentations will target researchers, health professionals and stakeholders.

Trial registration number Identifier: NCT03258138.

HiREB project number: 3793.

  • primary care
  • mental health
  • preventive medicine
  • health services research
  • patient-centred medicine

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  • Contributors EA developed the research question and protocol. EA and MQ drafted the manuscript. JS, AS and EA revised the manuscript. EA, MQ, LM, JL, CL, MW-A, ZS and DF contributed to the design of the protocol. JF contributed to the conceptual design of the work. All authors read and approved the final manuscript.

  • Funding This project received a grant from HUI, Inc. to cover the cost of using the Health Utilities Index (HUI). HUI Inc. was not involved in the design of the study, any aspect of data collection, analysis or interpretation, or in the writing of the manuscript. Programmatic aspects of this project are provided in-kind or through resources provided through McMaster University as part of an academic appointment. Research support is provided by students, supervised by EA, at McMaster University as part of program requirements or on a volunteer basis.

  • Competing interests DF has a proprietary interest in Health Utilities Incorporated, Dundas, ON, Canada. HUI Inc. distributes copyrighted Health Utilities Index (HUI) materials and provides methodological advice on the use of the HUI.

  • Patient consent for publication Not required.

  • Ethics approval Approval from the Hamilton Integrated Research Ethics Board (HiREB) has been obtained. Project number: 3793.

  • Provenance and peer review Not commissioned; externally peer reviewed.