Original Article From rural beginnings to statewide roll-out: Evaluation of facilitator training for a group-based diabetes prevention program Clare Vaughan, Prasuna Reddy and James Dunbar Greater Green Triangle University, Department of Rural Health, Warrnambool, Victoria, Australia Abstract Objective: To evaluate the approach used to train facilitators for a large-scale group-based diabetes pre- vention program developed from a rural implementa- tion research project. Participants: Orientation day was attended by 224 health professionals; 188 submitted the self-learning task; 175 achieved the satisfactory standard for the self- learning task and attended the workshop; 156 com- pleted the pre- and post-training questionnaires. Main outcome measures: Two pre- and post-training scales were developed to assess knowledge and confi- dence in group-based diabetes prevention program facili- tation. Principal component analysis found four factors for measuring training effectiveness: knowledge of dia- betes prevention, knowledge of group facilitation, confi- dence to facilitate a group to improve health literacy and confidence in diabetes prevention program facilitation. Self-learning task scores, training discontinuation rates and satisfaction scores were also assessed. Results: There was significant improvement in all four knowledge and confidence factors from pre- to post- training (P < 0.001). The self-learning task mean test score was 88.7/100 (SD = 7.7), and mean assignment score was 72.8/100 (SD = 16.1). Satisfaction with train- ing scores were positive and ‘previous training’ inter- acted with ‘change in knowledge of diabetes prevention program facilitation’ but not with change in ‘confidence to facilitate.’ Conclusions: The training program was effective when analysed by change in facilitator knowledge and confi- dence and the positive mean satisfaction score. Learning task scores suggest tasks were manageable and the requirement contributed to facilitator self-selection. Improvement in confidence scores in facilitating a group-based diabetes prevention program, irrespective of previous training and experience, show that program- specific skill development activities are necessary in curriculum design. KEY WORDS: diabetes, health professionals, preven- tion, training. Introduction Clinical trials have demonstrated that weight loss and moderate exercise can reduce the incidence of type 2 diabetes mellitus (T2DM) for people at high risk, 1 and the impact lasts for years. 2 Translation of diabetes pre- vention research into health service practice was demon- strated by the successful Greater Green Triangle Diabetes Prevention Program (GGT DPP), a lifestyle modification implementation trial conducted in three rural centres of south-eastern Australia in 2004–2006. 3 Participants in the GGT DPP (n = 237) achieved a mean reduction in weight of 2.52 kg and waist circumference of 4.17 cm: an imputed risk reduction in diabetes of 40%. The small-scale rural GGT DPP program was scaled up for statewide roll-out as the Life! Taking Action on Diabetes program (Life!). 4 Both programs had the same sequence of lifestyle change activities in six sessions (Table 1) underpinned by the Health Action Process Approach and self-regulation theory. 5–7 The Life! program is funded by the Victorian Government, through Diabetes Australia – Victoria from 2007 to 2011. Life! aims to recruit 25 000 adults aged 50 years and over who are at high risk of developing T2DM. The facilitator training curriculum and materials were created by the authors. The training program was con- ducted by a team from the Greater Green Triangle Uni- versity Department of Rural Health (GGT UDRH). Trainers included the three authors of this paper, a dia- betes nurse educator, psychologists and dieticians. To be eligible to attend the Life! training, candidates had to be registered nurses, dieticians, physiotherapists Correspondence: James Dunbar, Greater Green Triangle Uni- versity, Rural Health, PO Box 423, Warrnambool, Victoria, 3280, Australia. Email: director@greaterhealth.org Ethics approval: Deakin University Human Research Ethics Committee Project EC 66-2009 Accepted for publication 2 February 2010. Aust. J. Rural Health (2010) 18, 59–65 © 2010 The Authors Journal compilation © 2010 National Rural Health Alliance Inc. doi: 10.1111/j.1440-1584.2010.01126.x