Toronto Public Health Diabetes Prevention Strategy
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1 Toronto Public Health Diabetes Prevention Strategy Canadian Public Health Association Conference Tuesday, June 15, 2010 Presented by: Robert Coughlin Jill Cheyne
2 Diabetes Prevention Strategy In February 2009, Toronto Public Health embarked on the first phase of a community based Diabetes Prevention Strategy (DPS) funded by the Ministry of Health Promotion Target audience: people living in high risk communities that have not already been diagnosed with the disease.
3 Project Goal Diabetes Prevention Strategy To reduce individual risk for developing type 2 diabetes by planning and implementing culturally appropriate, accessible programs that increase awareness of the risk factors for diabetes and provide opportunities to reduce these risk factors
4 Strategies Environmental Support Community Health Centre Partnerships Neighbourhood Advisory Committees Community Outreach Workers Education and Skill Building Type 2 Diabetes Risk Assessment Workshops Food Skills Workshops Physical Activity Interventions Social Marketing Local Media Campaigns
5 Activities Environmental Support Engaged 22 community partners and hired four ethno-culturally specific outreach workers Education & Skill Building Delivered 50 type 2 diabetes risk assessment workshops Canadian Diabetes Risk Assessment Questionnaire (CANRISK) Pilot tested food skills and physical activity interventions Social Marketing Ads placed in 15 local and ethnic newspapers Interior bus ads on targeted routes
6
7 Outcome Evaluation Outcomes 1. Increased awareness and understanding of risk factors for type 2 diabetes 2. Increased physical activity 3. Improved healthy eating behaviours and attitudes
8 Evaluation Methods Administration of CANRISK at the type 2 diabetes risk assessment sessions. CANRISK tool informs a person about their risk of contracting type 2 diabetes depending on their score. Score can range from 0 to 26 Pre-post intervention physical activity (IPAQ) and eating choices (Fat and Fruit and Vegetable Diet Habits Scale) questionnaires Six month follow-up Collection of qualitative data from type 2 risk assessment sessions participants Tracking project activities
9 Outcome 1- Increased Awareness and Understanding of Risk Factors for Type 2 Diabetes Newspaper circulation 641,180; readership 1,602,950 people Bus advertising - 988,000 impressions The project has outreached to over 5,000 residents in the two selected communities CANRISK screening tool completed by over 600 residents attended diabetes prevention education workshops. Approximately 245 community residents have been referred to food skill and physical activity programs Obtained comments from people attending workshops regarding what they learned
10 Distribution of CANRISK Scores CANRISK Scores Distribution Frequency Mean = Std. Dev. = N =544 CANRISK Score
11 CANRISK- Estimated Risk of Getting Diabetes in the Next 10 Years Your score Your risk Chance you will get diabetes Lower than 7 Low Risk 1 in Slightly Elevated 1 in Moderate Risk 1 in High Risk 1 in 3 Over 20 Very High Risk 1 in 2
12 Percent of Respondents At Risk 40.0% 30.0% Percent 20.0% 10.0% 60.0% 50.0% 0.0% Low Risk -1 in 100 Slightly Elevated -1 in 25 Moderate Risk -1 in 6 CANRISK Score Grouped High Risk -1 in 3 Very High Risk -1 in % Error bars: 95% CI Percent 30.0% 20.0% 10.0% 0.0% Low Risk -1 in 25 or Less At Risk -1 in 6 or Higher CANRISK Score Grouped into Low Risk and At Risk Error bars: 95% CI
13 Ethnicity and Risk of Diabetes Percentage At Risk by Ethnicity % 90.00% 80.00% 70.00% 60.00% % 50.00% 40.00% 30.00% 20.00% 10.00% 0.00% Caribbean Latin American South Asian
14 Birth Weight, Gestational Diabetes and Risk Baby Over 9 Lbs. Gestational Diabetes % 90.00% 80.00% 70.00% 60.00% 50.00% 40.00% 30.00% 20.00% 10.00% % % % 80.00% 60.00% 40.00% 20.00% 0.00% Yes No 0.00% Yes No
15 Perceived Health Status and Risk Perceived Health Status % % 80.00% 60.00% 40.00% 20.00% 0.00% Excellent Very Good Good Fair Poor
16 Outcome 2 - Increased Physical Activity (Preliminary Findings) Changes in Minutes Walking & Sitting Before and After Physical Activity Interventions
17 Outcome 3 - Improved Eating Behaviours 60 residents have participated in food skills interventions Evaluation preliminary and still underway
18 Learnings Difficult to deliver a diabetes prevention strategy in a multi-cultural setting Each cultural group has different needs and expectations Eating patterns and attitudes to physical activity also differ Validated dietary and physical activity questionnaires are western biased and extremely difficult for target audience to complete Conclusion Need to plan and develop a strategy that is more indigenous to the community Need to modify evaluation approach
19 Next Steps: A More Sustainable Approach Enhance project sustainability: Education & Skill Building Peer health educator program for diabetes prevention Increased access to physical activity and food skills programs Increased number of CANRISK completions Environmental Supports Build supportive environments that assist in the prevention of diabetes Social Marketing Increase awareness and knowledge of risk factors for diabetes Evaluation Expand evaluation to assess effectiveness of the broader strategies
20 Questions
21 Contact Information Robert Coughlin Researcher/Evaluator Toronto Public Health Jill Cheyne Health Promotion Consultant Toronto Public Health
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