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Context In 2004, the English Public Health White Paper Choosing Health introduced 'health trainers' as new members of the National Health Service (NHS) workforce. Health trainers would offer one-to-one peer-support to anyone who wished to adopt and maintain a healthier lifestyle. Choosing Health implicitly envisaged health trainers working in community settings in order to engage 'hard-to-reach' individuals and other groups who often have the poorest health but who engage the least with traditional health promotion and other NHS services. Methods During longitudinal case studies of 6 local health trainer services, we conducted in-depth interviews with key stakeholders and analyzed service activity data. Findings Rather than an unproblematic and stable implementation of community-focused services according to the vision in Choosing Health, we observed substantial shifts in the case studies' configuration and delivery as the services embedded themselves in the local NHS systems. To explain these observations, we drew on a recently proposed conceptual framework to examine and understand the adoption and diffusion of innovations in health care systems. Conclusions The health trainer services have become more 'medicalized' over time, and in doing so, the original theory underpinning the program has been threatened. The paradox is that policymakers and practitioners recognize the need to have a different service model for traditional NHS services if they want hard-to-reach populations to engage in preventive actions as a first step to redress health inequalities. The long-term sustainability of any new service model, however, depends on its aligning with the established medical system's (ie, the NHS's) characteristics. [ABSTRACT FROM AUTHOR]

Policy PointsAlthough preventable chronic conditions such as type 2 diabetes carry a significant cost and health burden, few lifestyle interventions have been scaled at a national policy level.The translation of the National Diabetes Prevention Program lifestyle intervention from research to a Medicare‐covered service can serve as a model for national adoption of other interventions that have the potential to improve population health.The successful translation of the National Diabetes Prevention Program has depended on the collaboration of government agencies, academic researchers, community‐based healthcare providers, payers, and other parties. Context: Many evidence‐based health interventions never achieve national implementation. This article analyzes factors that supported the translation and national implementation of a lifestyle change intervention to prevent or delay type 2 diabetes in individuals with prediabetes. Methods: We used the Knowledge to Action framework, which was developed to map how science is translated into effective health programs, to examine how the evidence‐based intervention from the 2002 Diabetes Prevention Program trial was translated into the Centers for Disease Control and Prevention's large‐scale National Diabetes Prevention Program, eventually resulting in payment for the lifestyle intervention as a Medicare‐covered service. Findings: Key findings of our analysis include the importance of a collaboration among researchers, policymakers, and payers to encourage early adopters; development of evidence‐based, national standards to support widespread adoption of the intervention; and use of public input from community organizations to scale the intervention to a national level. Conclusions: This analysis offers timely lessons for other high‐value, scalable interventions attempting to move beyond the evidence‐gathering phase and into translation and institutionalization. [ABSTRACT FROM AUTHOR]