A pilot urban church-based programme to reduce risk factors for diabetes among Western Samoans in New Zealand

Abstract

We have assessed the impact of a 2‐year pilot church‐base diabetes risk reduction programme on major lifestyle predictors of future Type 2 diabetes mellitus: exercise and weight control in a prospective non‐randomized controlled study of a modular lifestyle and diabetes awareness intervention programme using a community development model. The study involved two complete church congregations from an ethnic group at high risk of diabetes (Western Samoans) (intervention church n = 78; control church n = 144). Weight remained stable (0 ± 4.8 kg) in the intervention church but increased by 3.1 ± 9.8 kg in the control church (p = 0.05). In the intervention church, there was an associated reduction in waist circumference (−4 ± 10 cm vs +2 ± 7 cm in control, p < 0.001), an increase in diabetes knowledge (46 ± 26 % vs 4 ± 17 % in control, p < 0.001) and an increase in the proportion exercising regularly (+22 % vs −8 % in control, p < 0.05). Consumption of key fatty foods was also reduced in the intervention church. We conclude that diabetes risk reduction programmes based upon lifestyle change, diabetes awareness, and empowerment of high risk communities can significantly reduce risk factors for future Type 2 diabetes. © 1998 John Wiley & Sons, Ltd.

Development and piloting of a community health worker-based intervention for the prevention of diabetes among New Zealand Maori in Te Wai o Rona: Diabetes Prevention Strategy

“…The major additional strategy in Te Wai o Rona: Diabetes Prevention Strategy beyond our past approaches (8,(11)(12)(13) was the addition of the MCHW trainer, expected to be of most use in the first year and to be supplemented by group sessions, improvements in access to healthy food and physical activity options, and shifts in community attitude. The MCHW intervention was seen as the key to the downstream intervention activities.…”

“…The 'intensive' intervention included personal support delivered by a MCHW (built upon previous experience (25) ) employed across eleven Maori Health Providers. In the intensive areas, social mobilisation to maximise support for lifestyle change was planned based upon previous experience (8,(11)(12)(13) . The MCHW was trained to deliver the intervention using principles based upon social cognitive theory (26) and tailored to the stage of change for any individual lifestyle behaviour (13,22,27) .…”

“…Lesser degrees of weight control (reductions in weight gain), potentially of use for sustaining diabetes prevention, are possible through community-based programmes (8)(9)(10)(11) , although these are often fraught with difficulties (8,9,12,13) . Interruption of the supply of energy-dense foods in isolated communities and promotion of traditional lifestyles can also have an effect on diabetes risk (10,14) , although these are unlikely to be practical in most populations and particularly in urban areas.…”

“…The intervention was built upon our previous work in Polynesian communities (11,12) . With such prior experience and as the intervention was expected to evolve through the trial (being action research) and become increasingly tailored to the participating communities, we undertook the pilot as a 'Vanguard Study', i.e.…”

Nutrition interventions for the prevention of type 2 diabetes

“…Indigenous American Indian population in British Columbia (49) 105 high-risk individuals Design: quasi experimental, community-based 2 year programme targeted at the Indian population of rural Okanagan region in Canada Intervention: single intervention community matched to two comparison communities; intervention community, workers conducted interviews of individuals with or at risk for DM for 7 months (pre-intervention phase); programme used a participatory approach and included strategies to improve the environment and to change behaviour; cohorts tracked over a 16-month intervention phase; cross-sectional population surveys of DM risk factors were conducted at baseline and post intervention Results: the project yielded few changes in quantifiable outcomes, which was thought to be a result of the short planning and intervention phases and the level of penetration was too limited Pilot study in Pima Indians (3) n 95, obese, normoglycaemic, age 25-54 years Design: RCT, 12 months Aim: to determine the relative effectiveness of two interventions in altering risk factors for DM Intervention: two lifestyle Pima interventions: action (intervention group), structured activity and nutrition; pride(control group), activities emphasising Pima history, received basic printed information on healthy eating and exercise habits Results: after 12 months increased physical fitness in both groups; BP, BMI, 2 h glucose and insulin all increased significantly in action members compared with pride members Conclusion: sustaining adherence in behavioural interventions over a long term was challenging; Pima Indians may find a less-direct less-structured approach and more participative intervention more acceptable than a direct and highly-structured approach Church-based Programme (50) n 78, South Auckland, New Zealand Design: open-prospective non-RCT Aim: to evaluate the impact of a comprehensive DM-related lifestyle programme on DM knowledge, exercise habits, dietary habits and body size among a Samoan church congregation Intervention: two church congregations (one intervention and one control church), intervention congregation coordinated by a DM nurse specialist and one of two Samoan women, one as a DM fieldworker and the other as an aerobics instructor; four DM-awareness sessions held as part of a church service with the DM educator as the main presenter; also formed exercise groups that included sitting exercises, low-impact aerobics, walking and sports; sessions held weekly for the first year and twice weekly thereafter Results: reduction in waist circumference and consumption of fatty foods reduced in the intervention church; increased DM knowledge and an increase in the proportion exercising regularly Conclusion: DM risk-reduction programmes based on lifestyle change, DM awareness and empowerment of high-risk communities can significantly reduce risk factors for future type 2 DM Looma Healthy Lifestyle (51) n 199, over 4 years in Western Australia, adults aged ‡ 15 years Design: Cross-sectional risk-factor surveys Aim: To evaluate the effectiveness of a community-directed intervention programme to reduce CHD risk through dietary modification Intervention: intervention process included store management policy changes, health promotion, and nutrition education aimed at high-risk individuals; programme focused initially on a group of individuals at high risk of DM and CHD, consisted of education sessions by a DM nurse educator Results: significant reduction in the prevalence of hypercholesterolemia; significant increases in plasma concentrations of a-tocopherol, lutein and zeaxanthin, cryptoxanthin and b-carotene across the population Conclusion: the community-directed intervention programme reduced the prevalence of CHD risk factors related to diet...…”