A Mixed Methods Randomized Controlled Trial Evaluating the Hans Kai Program

Mental health will be measured using the Mental Health Continuum Short Form (MHC-SF). The MHC-SF is a standardized self-report questionnaire that measures emotional, social, and psychological well-being by assessing the regularity with which respondents experience symptoms of positive mental health. The questionnaire includes 14 items asking respondents to indicate on a 6-point Likert scale (ranging from 0 = never to 5 = everyday) how often in the previous month they experienced symptoms of emotional, social, and psychological wellbeing. Item responses are summed, yielding a total score ranging from 0 to 70, with higher scores indicating more positive wellbeing.

Feelings of loneliness and social isolation will be measured using the revised UCLA Loneliness Scale. This is a standardized 20-item scale designed to measure one's subjective feelings of loneliness and social isolation by asking respondents to rate each item on a scale from 1 (Never) to 4 (Often). Single-item scores are summed to obtain a total score ranging from 20 to 80, with lower scores indicating greater loneliness and/or social isolation.

Health-related knowledge and empowerment in the form of self-efficacy and self-determination will be measured using the Perceived Health Competence Scale (PHCS). This is a standardized measure of general health management self-efficacy beliefs designed to assess respondents' self-perceived ability to accomplish health-related goals and manage their health positively. The 8 items ask respondents to rate on a 5-point Likert scale ranging from 1 = strongly disagree to 5 = strongly agree the degree to which they feel capable of effectively managing their health outcomes. Single item scores are summed to create an overall score ranging from 8 to 40, with higher scores indicating a higher self-perceived health competence.

Changes in nutritional behavior (diet), alcohol consumption, and tobacco use will be measured using a modified version of the Healthy Eating Assessment. The adapted self-report scale includes a total of 22 items divided into two main sections: (1) a first section that includes 18 items evaluating respondents' eating habits, and (2) a second section including four items that assess respondents' alcohol consumption and tobacco use.

The standardized self-report questionnaire Pittsburgh Sleep Quality Index (PSQI) will be used to subjectively measure sleep quality, habits, and patterns. This scale includes nine items that assess seven aspects of sleep: (1) subjective sleep quality; (2) sleep latency; (3) sleep duration; (4) habitual sleep efficiency; (5) sleep disturbances; (6) use of sleeping medications; and (7) daytime dysfunction over the last month. Scoring varies across items; however, an overall score can be calculated by summing the seven component scores, yielding a Global PSQI score ranging from 0 to 45, with higher scores indicating poorer sleep quality. Sleep quality and patterns will also be measured objectively using data provided by the Fitbits that participants will wear for a week at each assessment point. The average of these seven measurements will be used as an indicator of sleep patterns and quality

Physical activity levels will be measured by recording the minutes of moderate-to-vigorous physical activity (MVPA) study participants engage in each day over a 7-day period using a Fitbit that study participants will wear for 1 week. The average of these seven measurements will be used as an indicator of participants' level of physical activity.

At each assessment point, a daily step count will be recorded over a 7-day period. The average of these seven measurements will be used as an indicator of participants' level of physical activity at that timepoint of data collection.

Waist circumference in cm will be measured in triplicate, to the nearest 0.1 cm at the umbilicus, between the last rib and the iliac crest using a fibreglass tape measure by a registered nurse.

Systolic blood pressure in mmHg will be measured in triplicate, on the non-dominant arm in a sitting position by a registered nurse using a validated oscillometric blood pressure monitor.

Diastolic blood pressure in mmHg will be measured in triplicate, on the non-dominant arm in a sitting position by a registered nurse using a validated oscillometric blood pressure monitor.

Blood glucose will be measured in mmol/L by finger stick capillary blood sampling using a calibrated glucometer.

Heart Rate in beats per minute will be measured in triplicate, on the non-dominant arm in a sitting position by a registered nurse using a validated oscillometric blood pressure monitor.