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) Obesity: 50% (BMI=30+) 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? 59.6 58.5 38.3 45.7 54.3 40.4 56.4 28.7 8.5 72.3 71.3 48.9 64.9 60.6 68.1 51.1 11.8 10 20 30 40 50 60 70 80 Overweight Family member Blood pressure Cholesterol Little Exercise Fast Food Stress Smoking Other % PRE POST

Have you done anything to lower risk during last 3 months (P<0.001) 39.1 60.9 20.4 79.6 10 20 30 40 50 60 70 80 % No Yes PRE POST

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? 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: Improved HbA1c 3m after intervention Weight Mean Difference -0.3% at 3m and 0.6% at 6m Knowledge scores improved at 3m 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)

Conclusions 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