Articlebronze2008

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

David S Simmons · Elaine Carolyn Rush · Nic Crook

58 citations0/0 files storedPublic Health Nutrition

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Indigenous Health, Education, and Rights Diabetes, Cardiovascular Risks, and Lipoproteins Diabetes Management and Education

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 5,240 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 fifty-two participants weighed immediately before intervention and with 1,143 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 (-1.3 (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.

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References

1982Self-efficacy mechanism in human agency.1994Strong and weak principles for progressing from precontemplation to action on the basis of twelve problem behaviors.2003Costs Associated With the Primary Prevention of Type 2 Diabetes Mellitus in the Diabetes Prevention Program 2000Effectiveness of a community-directed ‘healthy lifestyle’ program in a remote Australian Aboriginal community 1999Effectiveness of community-directed diabetes prevention and control in a rural Aboriginal population in British Columbia, Canada 1999Community development through partnership: promoting health in an urban indigenous community in New Zealand

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2020Seeing the unseen: evidence of kaupapa Māori health interventions 2010Type 2 diabetes in Indigenous populations: Quality of intervention research over 20years 2015Challenges to addressing obesity for Māori in Aotearoa/New Zealand 2022Family-centred interventions for Indigenous early childhood well-being by primary healthcare services

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