The Hans Kai trial is a mixed methods randomized controlled trial evaluating the effectiveness of the peer-led health promotion Hans Kai program for Canadian adults with or without chronic health conditions. The Hans Kai trial also aims to identify the strengths and weaknesses of the Hans Kai program as well as the facilitators and barriers to its implementation from the perspectives of the program participants and facilitators. The intervention (Hans Kai program) consists of an 8-week health school that program participants attend to develop health knowledge and skills. Next, program participants form Hans Kai groups of 3 or more people, who meet on a monthly basis independently in a peer-led self-sustaining model. The trial will measure the impact of Hans Kai, compared to waitlist control, on program participants' mental health; social connections; health-related knowledge and empowerment (i.e., self-efficacy and self-determination); health-promoting behaviors (i.e., diet, alcohol consumption, tobacco use, physical activity, and sleep); and clinical measures of cardio-metabolic health.

The Hans Kai trial will follow a prospective mixed methods intervention design involving an RCT and an interpretative descriptive qualitative study. The mixed methods intervention design is a mixed methods approach to research in which the collection, analysis, and integration of both quantitative and qualitative data are embedded within an experimental quantitative research design. The objective of gathering qualitative data within an experiment, along with the quantitative data on the outcome measures, is to gain an understanding of the personal, contextual experiences of the study participants.

In this mixed methods intervention study design, quantitative data on the outcomes of interest will be collected along with qualitative data on the experiences of program participants and facilitators, and integrated within an intervention trial (i.e., RCT) to address the research objectives (see next section for details). The primary research design in this study will be a quantitative intervention trial or RCT that will follow a pragmatic randomized wait-list-control design with an 18-month follow-up. The RCT will involve the collection, analysis, and interpretation of quantitative data (self-reports and objective indicators) on primary, secondary, and tertiary outcomes that will be gathered to evaluate the effectiveness of the Hans Kai program in promoting the health and wellbeing of Canadian adults. To enrich the RCT results, the secondary qualitative strand of the study will be added during and after the intervention by embedding a combination of convergent and explanatory sequential designs into the RCT.

Inclusion Criteria. Participants may enter the trial if all the following apply.

• Age 18 years or above.
• Any gender.
• Willingness and ability to give informed consent for participation in the trial.
• Ability to speak and read English at a grade 6 level.
• Motivation to make a lifestyle change as indicated on the research study consent form.
• Stable health status that allows participation in the group context, including performing light exercise, to be determined by the participant and study Hans Kai staff.
• Ability and willingness to comply with all trial requirements, to be determined by the research team.

Exclusion Criteria. Participants may not enter the trial if any of the following apply.

• Age under 18 years.
• Cognitive impairment that prevents the person from providing informed consent or participating in the program.
• Existing relationship with the research team, such as supervisory relationship (e.g., student or employee) or familial relationship (e.g., child or spouse).
• Frailty that prevents the person from participating in group activities or exercise.
• Participation in another research trial in the past 12 weeks.
• Unstable health or serious illness, for example, dementia, terminal illness, or recent significant medical diagnosis.
• Inability to attend the scheduled Hans Kai Health School and assessment sessions.

Following deidentification, all of the individual participant data (IPD) collected during the trial will be shared.

The IPD will be available beginning immediately following publication and ending 5 years following article publication.

Researchers who provide a methodologically sound proposal and whose proposed use of the data has been approved by the trial PI.