Peer-led Diabetes Prevention Program for TASC in Melbourne

Nabil Sulaiman

“International Congress on CDSM, Melbourne Nov 2008”

Aims of Peer-led

Develop an evidence based, culturally appropriate peer-led diabetes prevention resources and program for TASC

Trial the program

Evaluate the program

Methodology- how?

Design: Pre and post intervention trial (action research methods)

• Advisory Group

• Peer- leaders

• Diabetes prevention program

• Participants

• Evaluation

Methodology- how?

• 12 peer leaders recruited from TASC

• Program was developed (food, exercise,

group dynamics ..etc)

• 2- full days training of leaders

• Each leader engage 10 people

Program components

• Principles of peer-led program

• Role of diet, physical activity and stress

• Group facilitation, engaging

• Motivational techniques and chronic

disease self-management

• Leaders were paid for their training time,

recruitment of participants and

implementing the program.

Outcome Indicators

• Changes in knowledge and attitudes

• Changes in behaviours

• Changes in body weight and waist

circumference

Data collection• Questionnaire and interviews:

knowledge, attitudes and behaviour

"Three-day Food Diary" and physical activity”

• Weight, waist circumference were

measured

• Pedometer to act as incentive for walking

RESULTS (N= 94)

Gender: females (73%)Age: 47% (40-45 y) and 25% (>55 y ) COB: Turkey (45%) Iraq (39%) Lebanon (12%)

Obesity: 50% (BMI=30+)

Knowledge of risk of diabetes?

54.8% said yes post intervention compared to 29.8% pre-intervention (p=.069).

Why do you think you are at risk factors of DM?

59.658.5

38.3

45.7

54.3

40.4

56.4

28.7

8.5

72.3 71.3

48.9

64.9

60.6

48.9

68.1

51.1

11.8

0

10

20

30

40

50

60

70

80

Overw

eight

Family

mem

ber

Blood p

ress

ure

Cholest

erol

Little

Exe

rcis

e

Fast F

ood

Stress

Smoki

ng

Other

%

PRE

POST

39.1

60.9

20.4

79.6

0

10

20

30

40

50

60

70

80

%

No

Yes

No 39.1 20.4

Yes 60.9 79.6

PRE POST

Have you done anything to lower risk during last 3 months (P<0.001)

Lifestyle changes after program

• 89% in food preparation

• 79% dietary intake

• 82% shopping

• 81% feeling of well being

• 79% physical activity

• 69% body weight

Mean walking time last week pre and post intervention

Exercise Pre Post P-value

Walking 180 258 0.007

Moderate 249 269 0.722

Vigorous 161 185 0.85

Weight and Waist

• Weight (kg): significant reduction in weight [mean weight pre=78.1, post=77.3; Z score=-3.415 (P=0.001)

• Waist circumference (cm): mean pre=99.5cm, post =96.5

Z=-2.569 (P=0.010)

Effectiveness of the program using 10-points scale

• 68% gave 9 or 10 points

• 18% gave 7 or 8 points

• 2% gave 5 points (undecided)

• 2% gave 3 or 4 points

What are the main reasons for not taking any actions to lower your risks?

Reasons Pre Post p-value

No time to cook

37.2% 20% 0.004

Like to eat fast food

24.5% 11.1% 0.029

What did you like?77% appreciated the information

69% the skills learned

63% the support provided

95% learned healthy eating skills

70% maintaining healthy weight

75% how to loose weight

73% value regular exercise

48% information access and

42% attitudinal change

Source of diabetes knowledge

Doctors (92%) Television (70%) Friends (54%) Nurses (35%) Brochures (35%) Family (36%) Internet (29%) Ethnic media (29%).

Comparison with other studies

Meta-analysis of 11 RCTs in CALD:

1. Improved HbA1c 3m after intervention

2. Weight Mean Difference -0.3% at 3m and 0.6% at 6m

3. Knowledge scores improved at 3m

4. Healthy life style improvement at 3m

Hawthorne K, Robles Y, Cannings-John R, Edwards S. Culturally appropriate health

education for type 2 diabetes in ethnic minority groups. Cochrane Database of Systematic Revies 2008 (3)

Limited intervention• Administered by trained peers equipped

with culturally appropriate education • Native language Significant improvement in:

• knowledge and attitudes• limited changes in lifestyle behaviour • The changes were maintained three

months after the intervention.

Conclusions

• The peer-led DPP was effective in improving knowledge and changeing behaviour

• The program could be replicated in other CALD

Conclusions