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

Abstract

Objective: The progression from impaired glucose tolerance (IGT)/impaired fasting glucose (IFG) to type 2 diabetes can be prevented or delayed through intensive lifestyle changes. How to translate this to implementation across whole communities remains unclear. We now describe the results to a pilot of a personal trainer (Maori Community Health Worker, MCHW) approach among Maori in New Zealand. Design, setting and subjects: A randomised cluster-controlled trial of intensive lifestyle change was commenced among 5240 non-pregnant Maori family members without diabetes from 106 rural and 106 urban geographical clusters. Baseline assessments included lifestyle questionnaires, anthropometric measurements and venesection. A pilot study (Vanguard Study) cohort of 160 participants were weighed before and during MCHW intervention, and compared with fiftytwo participants weighed immediately before intervention and with 1143 participants from the same geographical area. Interactions between participants and the MCHW were reported using personal digital assistants with a programmed detailed structured approach to each interview. Results: During the Vanguard Study, participants and MCHW found the messages, toolkit and delivery approach acceptable. Those with IGT/IFG diagnosed (n 27) experienced significant weight loss after screening and during the Vanguard Study (5?2 (SD 6?6) kg, paired t test P , 0?01). Significant weight loss occurred during the Vanguard Study among all participants (21?3 (SD 3?6) kg, P , 0?001). Conclusions: Comparable initial weight loss was shown among those with IGT/ IFG and those from existing trials. Community-wide prevention programmes are feasible among Maori and are likely to result in significant reductions in the incidence of diabetes.

Challenges to addressing obesity for Māori in Aotearoa/New Zealand

“…29 In terms of obesity and related illnesses, a small number of research projects with Māori communities trialled interventions during the 2000s designed to improve Māori health outcomes. [30][31][32][33] The Ngāti and Healthy diabetes prevention intervention was able to achieve significant reductions in the prevalence of pre-diabetes among Māori living in the largely rural Tairāwhiti region (east coast of the North Island) by means of a communitydriven intervention focusing on reducing weight by increasing exercise and making healthy diet changes. 33,34 .…”

“…32 In this study, the intensive lifestyle intervention was based around 12 lifestyle goals for diet and exercise that were developed from international research and adapted for Māori communities in a consultative process with local Māori elders and health workers. The intervention was delivered by Māori community health workers trained in behavioural change theory.…”

An innovative team-based weightloss competition to reduce cardiovascular and diabetes risk among Māori and Pacific people: rationale and method for the study and its evaluation

“…One large prospective survey and two pilot studies specific to Māori include the Ngati and Healthy community programme that was effective in reducing insulin resistance, [17,18] the Vanguard pilot study, which utilised a Māori community health personal trainer and achieved weightloss [19] and a pilot community programme that improved insulin sensitivity, and reduced weight and systolic blood pressure [20]. For NZ Pacific people, three church-based pilot interventions have been conducted that showed promising effectiveness in reducing diabetes for Pacific people [21][22][23].…”

Role of nurse practitioner in addressing aboriginal diabetes prevention

“…Group interactions and activities (Simmons, Rush, & Crook, 2008). Each CHW managed a caseload of community members whom they visited to provide specific lifestyle change messages and personal encouragement.…”

“…Each CHW managed a caseload of community members whom they visited to provide specific lifestyle change messages and personal encouragement. The intervention was associated with weight loss among participants (Simmons et al, 2008). Alternatively, in the Pasos Adelante diabetes prevention program, community members facilitated education seminars (Staten et al, 2005).…”