Community-based Diabetes Prevention Program Research Articles

Process evaluation of a multi-institutional community-based program for diabetes prevention among First Nations

Epidemic rates of diabetes among Native North Americans demand novel solutions. Zhiiwaapenewin Akino'maagewin: Teaching to Prevent Diabetes was a community-based diabetes prevention program based in schools, food stores and health offices in seven First Nations in northwestern Ontario, Canada. Program interventions in these three institutions included implementation of Grades 3 and 4 healthy lifestyles curricula; stocking and labeling of healthier foods and healthy recipes cooking demonstrations and taste tests; and mass media efforts and community events held by health agencies. Qualitative and quantitative process data collected through surveys, logs and interviews assessed fidelity, dose, reach and context of the intervention to evaluate implementation and explain impact findings. School curricula implementation had moderate fidelity with 63% delivered as planned. Store activities had moderate fidelity: availability of all promoted foods was 70%, and appropriate shelf labels were posted 60% of the time. Cooking demonstrations were performed with 71% fidelity and high dose. A total of 156 posters were placed in community locations; radio, cable TV and newsletters were utilized. Interviews revealed that the program was culturally acceptable and relevant, and suggestions for improvement were made. These findings will be used to plan an expanded trial in several Native North American communities.

Practical Strategies for Treating Obesity in Mexican Americans

Obesity ManagementVol. 1, No. 6 Practical Strategies for Treating Obesity in Mexican AmericansChermaine Tyler, Craig A. Johnston, Megha Madhukar, and John P. ForeytChermaine TylerSearch for more papers by this author, Craig A. JohnstonSearch for more papers by this author, Megha MadhukarSearch for more papers by this author, and John P. ForeytSearch for more papers by this authorPublished Online:24 Jan 2006https://doi.org/10.1089/obe.2005.1.247AboutSectionsPDF/EPUB Permissions & CitationsPermissionsDownload CitationsTrack CitationsAdd to favorites Back To Publication ShareShare onFacebookTwitterLinked InRedditEmail FiguresReferencesRelatedDetailsCited byEnsuring Children Eat a Healthy Diet: A Theory-Driven Focus Group Study to Inform Communication Aimed at ParentsJournal of Pediatric Nursing, Vol. 26, No. 1Development, Implementation, and Effects of Community-Based Diabetes Prevention Program for Obese Latino Youth30 September 2010 | Journal of Primary Care & Community Health, Vol. 1, No. 3Weight Loss in Overweight Mexican American Children: A Randomized, Controlled Trial1 December 2007 | Pediatrics, Vol. 120, No. 6Quality of Life in Mexican-American Children Following a Weight Management Program**Obesity, Vol. 15, No. 11 Volume 1Issue 6Dec 2005 InformationCopyright 2005, Mary Ann Liebert, Inc.To cite this article:Chermaine Tyler, Craig A. Johnston, Megha Madhukar, and John P. Foreyt.Practical Strategies for Treating Obesity in Mexican Americans.Obesity Management.Dec 2005.247-250.http://doi.org/10.1089/obe.2005.1.247Published in Volume: 1 Issue 6: January 24, 2006PDF download

A longitudinal assessment of inter-sectoral participation in a community-based diabetes prevention programme

To understand the development of inter-sectoral participation in the three intervention municipalities of Stockholm Diabetes Prevention Programme (SDPP) case studies with a longitudinal assessment were conducted using the spidergram method, document analysis and group discussions. At three time points, the members of the local steering committees assessed the extent of participation from narrow to wide inter-sectoral participation in five key areas: planning, resources, leadership, network and implementation. Wide participation of various interest groups was recognised in planning and implementing activities whereas local resources, the representation of the leadership and the extent of the network were perceived as more restricted. Expert involvement varied during the programme period but was not regarded as exerting control over the local programmes. Participation within the local steering committees decreased, with a stronger focus on the project co-ordinator and other local partners in latter years. The extent of partner engagement increased due to focusing on activities approaching multi-sector collaboration and institutionalisation. Overall, communication and shared responsibility appeared critical in influencing both the development and perception of participation. In conclusion, to understand the dynamic process of participation at different times, areas and levels, the development and use of evaluation designs combining different methods and information sources throughout the lifespan of a project are recommended.

Impact of a Diabetes Prevention Program on Body Size, Physical Activity, and Diet Among Kanien'kehá:ka (Mohawk) Children 6 to 11 Years Old: 8-Year Results From the Kahnawake Schools Diabetes Prevention Project

Report the 8-year impact on body size, physical activity, and diet of a community-based diabetes prevention program for elementary-school children in a Kanien'keha:ka (Mohawk) community in Canada. Follow-up (1994-1996) of subjects in the intervention and comparison community and repeat cross-sectional measurements in the intervention community alone from 1994 to 2002. Measures included triceps and subscapular skinfold thicknesses, body mass index (BMI), weekly number of 15-minute episodes of physical activity, run/walk test times, television watching, and consumption of sugared foods, fatty foods, and fruits and vegetables. The longitudinal data of 1994-1996 showed some early positive effects of the program on skinfold thickness but not on BMI, physical activity, fitness, or diet. Repeat cross-sectional measures from 1994 to 2002 showed increases in skinfold thickness and BMI. Physical activity, fitness, and television watching showed favorable trends from 1994 to 1999 that were not sustained in 2002. Key high-fat and high-sugar foods consumption decreased, as did consumption of fruits and vegetables. Although early results showed some successes in reducing risk factors for type 2 diabetes, these benefits were not maintained over 8 years.

Kahnawake Schools Diabetes Prevention Project

The Kahnawake Schools Diabetes Prevention Project Center for Research and Training — funded — by the Canadian Institutes of Health Research- is offering scholarships for Masters, Doctoral and Post-Doctoral candidates interested in undertaking research in the area of community prevention of type 2 diabetes. The KSDPP Center is a partnership between the Kanien’keha’ka of Kahnawake Territory, located in Kahnawake, Quebec, Canada, with McGill University and the Université de Montréal. The KSDPP Center is an expansion of the Kahnawake Schools Diabetes Prevention Project (KSDPP), which since 1994 has developed and implemented a school-based and community-based diabetes prevention program to promote healthy lifestyles by incorporating the principles of participatory research and community ownership of the project.

A stage model for assessing a community-based diabetes prevention program in Sweden

Type 2 diabetes is the most common type of diabetes, with a prevalence of at least 4% in Sweden. Aiming at primary prevention of the disease, the Stockholm Diabetes Prevention Program (SDPP) was developed as a joint program between the Departments of Endocrinology, Social Medicine and Epidemiology at the Karolinska Institute. The program was designed to include three stages, i.e. a combined baseline and aetiological study, a community-based intervention program and a follow-up study after 10 years. In 1995, the intervention program was initiated in Stockholm County with the aim of reducing the incidence of type 2 diabetes. The intervention has focused on the whole adult population in three intervention municipalities, where the local authorities have been involved in planning, initiating and implementing the program. Activities to prevent diabetes, aiming at risk factors such as obesity, low physical activity, dietary habits and tobacco use, have been initiated together with people from different fields and backgrounds, and with different ideas and approaches to health promotion and diabetes prevention. This paper provides a description and reflects upon the development and implementation process of SDPP as well as its interaction with the intervention communities. The stage model that was used for planning SDPP will be used for describing the various phases of the program. Over the period of the program, interest and responsibility has grown at the municipal authorities. The program has been a concern for the municipalities, as the program intermediate goals are also important for other health promotion issues.

Specific Patterns of Food Consumption and Preparation Are Associated with Diabetes and Obesity in a Native Canadian Community

We examined the relationship between usual patterns of food intake, fattiness of food preparation and consumption, and diabetes and obesity status in a Native Canadian reserve in northwestern Ontario. Patterns of intake were estimated using a 34-item food frequency instrument. Scales and scores were developed using factor analysis procedures and were tested for reliability using coefficient alpha. Impaired glucose tolerance (IGT) and diabetes status was determined by administering a 75-g glucose tolerance test. A number of the food groups appear to have a protective effect in regard to IGT and diabetes, including vegetables [odds ratio (OR) = 0.41, confidence interval (CI) = 0.18–0.91], breakfast foods (OR = 0.41, CI = 0.18–0.93) and hot meal foods (OR = 0.29, CI = 0.11–0.78). Most of these foods are relatively high in fiber and low in fat. High consumption of junk foods and the bread and butter group was associated with substantial increases in risk for diabetes (OR = 2.40, CI = 1.13–5.10; OR = 2.22, CI = 1.22–4.41, respectively). These foods tend to be high in simple sugars, low in fiber and high in fat. More fatty methods of food preparation are also associated with increased risk for diabetes in this population (OR = 2.58, CI = 1.11–6.02). This information has been incorporated into an ongoing community-based diabetes prevention program in the community.

The Kahnawake Schools Diabetes Prevention Project: Intervention, Evaluation, and Baseline Results of a Diabetes Primary Prevention Program with a Native Community in Canada

Objectives.Kahnawake Schools Diabetes Prevention Project is a 3-year community-based, primary prevention program for non-insulin-dependent diabetes mellitus in a Mohawk community near Montreal, Canada. Objectives are to improve healthy eating and encourage more physical activity among elementary school children.Methods.Intervention incorporates behavior change theory, Native learning styles, the Ottawa Charter for Health Promotion, and a health promotion planning model. Evaluation uses a mixed longitudinal and cross-sectional design to measure obesity, fitness, eating habits, and physical activity of elementary school children in the experimental and comparison communities. Intermediate variables are self-efficacy and perceived parental support. Process evaluation provides feedback to the intervention.Results.During 3 years, 63 distinct interventions that included a Health Education Program reinforced by school events, a new Community Advisory Board, a recreation path, and community-based activities promoting healthy lifestyles were implemented. Baseline consent rates were 87 and 71% in the experimental and comparison schools. As expected, anthropometric data increase with age. Between 9 and 10 years there are increased weight, height, BMI, and skinfold thicknesses; decreased fitness; and increased television watching.Conclusions.Implementing a Native community-based diabetes prevention program is feasible through participatory research that incorporates Native culture and local expertise.

Use of Ethnographic Methods for Applied Research on Diabetes Among the Ojibway-Cree in Northern Ontario

This article presents the results of applied ethnographic research aimed at developing a community-based diabetes prevention program in an isolated Ojibway-Cree community in northern Ontario. Using qualitative techniques, the authors describe diabetes in its sociocultural context and underlying belief systems that affect related activity and dietary behaviors. Local concepts of food and illness are dichotomized into "Indian" and "white man's" groupings, with Indian foods perceived as healthy and white man's foods felt to be unhealthy. Diabetes is believed to result from consumption of white man's "junk foods" (sugar, soda); some believe the disease can be avoided by eating traditional Indian foods such as game animals (moose, beaver, duck). While dietary linkages to diabetes are recognized, physical activity as a means of controlling obesity and decreasing the risk for diabetes is not part of the local ethnomedical model. This information is being used to develop culturally appropriate health education interventions.