Understanding How to Make Type 2 Diabetes Prevention Programs More Inclusive: An Equity-Oriented Qualitative Case Study of Small Steps for Big Changes

Background/Objectives: Diabetes prevention programs (DPPs) reduce type 2 diabetes (T2D) risk, yet their reach often remains misaligned with the populations most affected by social and structural diabetes risk. This study examined inclusivity barriers within Small Steps for Big Changes (SSBC), a Canadian DPP developed at the University of British Columbia, through an in-depth qualitative case study of a participant whose age, ethnicity and gender identity differed from the program’s typical participant profile. Methods: The participant was purposively selected for the present case analysis from individuals enrolled in SSBC and completed the standard 4-week intervention, consisting of one-on-one motivational interviewing-informed counseling, supervised exercise, fitness-tracker- and mobile-app-supported self-monitoring, and planned long-term follow-up. Data were collected from two semi-structured Zoom interviews, six session-day journal entries and two optional non-session journal entries between July and September 2022. Data were analyzed in NVivo using interpretive description. Results: The participant was a young South Asian adult who self-identified as male. Five themes were identified: lack of access, limitations and barriers, lack of support, mental health implications, and SSBC-related takeaways. Barriers included culturally irrelevant nutrition resources, the university food environment, cost constraints, a one-year wait for dietetic care, isolation from peers managing prediabetes, and prediabetes-related guilt and stress. Supportive, non-judgmental coaching strengthened accountability and motivation but did not fully address culture-, age-, student-life-, and mental-health-related needs. Conclusions: This case identifies practical equity targets for DPP redesign, including culturally adaptable dietary resources, peer support, inclusive coaching training and mental health-responsive prevention care.