1. Peer-led Diabetes Prevention Program for TASC in Melbourne
Nabil Sulaiman
“International Congress on CDSM, Melbourne Nov 2008”

2. 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

3. Methodology- how?
Design: Pre and post intervention trial (action research methods)
Advisory Group
Peer- leaders
Diabetes prevention program
Participants
Evaluation

4. 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

5. 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.

6. Outcome Indicators Changes in knowledge and attitudes
Changes in behaviours
Changes in body weight and waist circumference

7. 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

8. 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+)

9. Knowledge of risk of diabetes?
54.8% said yes post intervention compared to 29.8% pre-intervention (p=.069).

10. 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

11. 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

12. Lifestyle changes after program
89% in food preparation
79% dietary intake
82% shopping
81% feeling of well being
79% physical activity
69% body weight

13. 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

14. Weight and Waist
Weight (kg): significant reduction in weight [mean weight pre=78.1, post=77.3; Z score= (P=0.001)
Waist circumference (cm):
mean pre=99.5cm, post =96.5
Z= (P=0.010)

15. 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

16. 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

17. 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

18. Source of diabetes knowledge
Doctors (92%)
Television (70%)
Friends (54%)
Nurses (35%)
Brochures (35%)
Family (36%)
Internet (29%)
Ethnic media (29%).

19. Comparison with other studies

20. 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)

21. 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.

22. Conclusions
The peer-led DPP was effective in improving knowledge and changeing behaviour
The program could be replicated in other CALD