Piloting a culturally appropriate, localised diabetes prevention program for young Aboriginal people in a remote town

Abstract

Lifestyle changes are central to preventing type 2 diabetes. Embarking upon and sustaining change is challenging, and translation of prevention approaches into a wider range of real-world settings is needed. In this study, a locally adapted community-led diabetes prevention program with local young Aboriginal facilitators was created and trialled through the Derby Aboriginal Health Service (DAHS). The 8-week program highlighted causes and consequences of diabetes, incorporated physical activity and healthy eating topics with a focus on practical activities, and included stress management to support healthy lifestyles. Ten Aboriginal women and men aged 18–38 years participated in the pilot program. The program was found to be acceptable and appropriate, and other community members and organisations expressed interest in future participation. Participants reported that they gained important new knowledge and made changes in behaviours including shopping choices, portioning and soft drink consumption. Limitations included participant recruitment and attendance difficulties, which were attributed to program timing and competing demands. While this program was designed to be sustainable, and there were indications of feasibility, resource constraints impeded its integration into routine primary health care. Prevention of diabetes is a high priority for DAHS, and this program, with appropriate resources, provides a basis for ongoing practical prevention strategies.

The Adaptation of a Youth Diabetes Prevention Program for Aboriginal Children in Central Australia: Community Perspectives

“…There was evidence of already existing readiness by the community to receive and facilitate the program. This aligns with previous reports that highlight the benefits of community-owned programs in remote Aboriginal settings [37][38][39]. Community-owned programs that embraced the authority and autonomy shared across community members were highlighted as successful and effective in the Australian setting [40][41][42][43].…”

Cultural adaptation of health interventions including a nutrition component in Indigenous peoples: a systematic scoping review

“…The majority of interventions were conducted in the USA among Native American ( n = 27 ) [ 28 , 32 , 33 , 37 , 38 , 42 , 43 , 46 , 48 , 50 , 52 , 56 – 58 , 61 – 63 , 65 , 70 , 72 – 74 , 82 , 83 , 87 , 89 , 92 ], Alaskan ( n = 4 ) [ 47 , 64 , 75 , 93 ] & Hawaiian ( n = 2 ) [ 54 , 71 ] populations. Together with Australian Aboriginal and/or Torres Strait Islander ( n = 14 ) [ 27 , 29 – 31 , 40 , 44 , 51 , 68 , 78 , 80 , 85 , 86 , 88 , 91 ] and Canadian First Nations People ( n = 11 ) [ 35 , 36 , 41 , 45 , 49 , 55 , 67 , 69 , 76 , 84 , 90 ] these three groups accounted for 85% of the literature included in this review. Figure 2 illustrates the interventions published by year and by Indigenous population and location.…”

“…Most interventions were designed for adults ( n = 29 ) [ 27 , 28 , 36 , 39 , 40 , 42 , 46 , 51 – 54 , 58 , 60 – 63 , 66 , 71 , 74 – 77 , 80 , 81 , 83 , 85 – 87 , 91 ], with less than a third ( n = 19 ) [ 29 – 31 , 34 , 35 , 38 , 44 , 47 , 48 , 50 , 59 , 65 , 68 , 69 , 73 , 78 , 79 , 88 , 90 ] designed for both adults and children. Most interventions aimed to change health outcomes for diabetes prevention ( n = 19 ) [ 27 , 28 , 36 , 38 , 44 , 55 , 56 , 60 , 62 , 67 , 69 , 70 , 79 , 81 , 82 , 88 , 89 , 92 , 93 ], obesity prevention or treatment ( n = 11 ) [ 32 , 34 , 42 , 50 , 57 , 59 , ...…”

“…Table 3 summarises the intervention characteristics and cultural adaptation strategies employed ( n = 66). Interventions that incorporated both individual and community level approaches were the most common ( n = 32 ) [ 28 , 29 , 33 , 34 , 37 , 41 , 44 , 47 , 49 , 50 , 52 – 56 , 58 – 63 , 66 – 68 , 70 , 71 , 74 – 76 , 88 , 92 , 93 ]. Two studies each employed community only [ 43 , 90 ], system only [ 35 , 57 ] and individual plus system [ 39 , 91 ] level interventions.…”

“…Visual adaptation strategies were the most frequently used ( n = 57 ) such as ensuring print materials had pictures of Indigenous peoples, native foods, or colours of cultural significance [ 28 , 29 , 32 – 34 , 36 – 49 , 51 – 76 , 78 , 79 , 81 – 89 ]. The second most frequently used strategy was constituent involving ( n = 51 ) which ranged from the surface level strategies of requesting participant feedback, incorporation of participant stories or engagement of local media and businesses ( n = 20 ) [ 27 , 33 , 36 , 39 , 42 , 44 , 46 , 47 , 61 , 63 , 68 , 78 , 80 – 84 , 86 – 88 ], through to the deep level strategies of training of respected community members to deliver an intervention ( n = 31 ) [ 28 – 30 , 32 , 34 , 37 , 38 , 41 , 45 , 48 – 51 , 53 , 55 – 60 , 64 , 65 , 67 , 69 , 70 , 72 , 73 , 90 – 92 ]. Socio-cultural strategies were also widely employed ( n = 50 ) and included a range of activities such as incorporating traditional activities and ceremonies in the intervention, and ensuring childcare was available for participants [ 27 – 47 , 49 – 66 , 68 –…”