Aim
To develop a diabetes prevention educational intervention for 12-14 year olds for use across five European countries (Germany, Greece, Portugal, Spain and UK) for testing in a randomised controlled trial (RCT).
Method
A framework for developing this intervention was followed.  Firstly, ideas from all countries regarding content was gathered.  This led to countries agreeing a draft programme outline of eight, 90 minute sessions.  Topics covered: increasing physical activity, healthy eating and less sitting. A document detailing shared theories and philosophies underpinning the intervention was developed to standardise educator delivery.  Learning outcomes for each session were developed and the curriculum was drafted using minimal narrative to allow for easy translation.  This allowed countries to make country specific changes to session content but not overall learning outcomes.  Focus groups were run in the UK and the curriculum was refined based on observation and feedback.  Visits to countries for meetings to discuss the curriculum were invaluable to prevent understanding being lost in translation. A pilot intervention was run in the UK and more refinements were made to the curriculum.
Results
Following a systematic approach to intervention development has meant that the intervention is ready for testing within an RCT.  The focus now is to provide educator training across all countries to ensure consistent delivery.
Discussion
Working across countries to develop an educational intervention that is suitable for all is challenging.  Having a more flexible curriculum with shared learning outcomes to allow country specific changes works well.  Having shared underpinning theories and philosophies is key to ensure the intervention is delivered by educators across and within countries in a consistent way.

PRE-STARt: development of a diabetes prevention educational intervention for 12-14 year olds in five European countries