Ready, Set, Go? A Qualitative Case Study Exploring Implementation Readiness of a Type 2 Diabetes Remission Program in a Primary Care Setting Using a Scalability Assessment.

BACKGROUND

Type 2 diabetes (T2D) treatment is increasingly viewed through a remission lens, reflecting a shift from chronic management to disease regression. This study examined pre-implementation conditions, including barriers and facilitators, to adopt, implement, and scale a T2D remission program in primary care using a scalability assessment.

METHODS

Using the Intervention Scalability Assessment Tool (ISAT), a descriptive qualitative case study was conducted and included semi-structured interviews with a purposeful sample of 11 multidisciplinary professionals within one Ontario (Canada) Family Health Team (FHT) (January-March 2025). Framework analysis was used to code, categorize and develop overarching themes related to scale-up elements and how to optimize program delivery and acceptance.

RESULTS

The thematic analysis generated 3 themes, outlining the primary conditions perceived to be needed for successful implementation and scale-up: (1) Effectively conceptualizing and positioning a health coach within primary care; (2) Site readiness to adopt T2D remission implementation; and (3) Perceived opportunities for fostering positive health outcomes. Participants supported integrating a T2D remission program into the existing FHT, citing broad benefits. Participants unanimously agreed that there was a strong demand for such a program, both from individuals living with T2D and healthcare providers, and was well-warranted in comparison to the lengthy treatments that can be accrued throughout a diagnosis of T2D.

DISCUSSION: Using a single site FHT to understand the potential to scale-up, a T2D remission program in primary care was acceptable and feasible if context-specific barriers and facilitators are addressed, with strategic planning around role integration, capacity, and sustained patient engagement.