From rural beginnings to statewide roll-out : evaluation of facilitator training for a group-based diabetes prevention program

Objective: To evaluate the approach used to train facilitators for a large-scale group-based diabetes prevention program developed from a rural implementation research project.

Participants: Orientation day was attended by 224 health professionals; 188 submitted the self-learning task; 175 achieved the satisfactory standard for the self-learning task and attended the workshop; 156 completed the pre- and post-training questionnaires.

Main outcome measures: Two pre- and post-training scales were developed to assess knowledge and confidence in group-based diabetes prevention program facilitation. Principal component analysis found four factors for measuring training effectiveness: knowledge of diabetes prevention, knowledge of group facilitation, confidence to facilitate a group to improve health literacy and confidence in diabetes prevention program facilitation. Self-learning task scores, training discontinuation rates and satisfaction scores were also assessed.

Results: There was significant improvement in all four knowledge and confidence factors from pre- to post-training (P < 0.001). The self-learning task mean test score was 88.7/100 (SD = 7.7), and mean assignment score was 72.8/100 (SD = 16.1). Satisfaction with training scores were positive and 'previous training' interacted with 'change in knowledge of diabetes prevention program facilitation' but not with change in 'confidence to facilitate.'

Conclusions: The training program was effective when analysed by change in facilitator knowledge and confidence and the positive mean satisfaction score. Learning task scores suggest tasks were manageable and the requirement contributed to facilitator self-selection. Improvement in confidence scores in facilitating a group-based diabetes prevention program, irrespective of previous training and experience, show that program-specific skill development activities are necessary in curriculum design.

Sustained gains from a diabetes prevention program and the role of telephone support

Background
An evaluation of the sustainability of lifestyle changes was undertaken for participants completing a 12 month diabetes prevention program. This second part of the study also tested whether regular structured telephone calls could be effective in maintaining lifestyle changes.

Methods
Originally, 237 participants completed a 12 month group-based lifestyle intervention study. They were aged 40–75 years, with a moderate to high risk of developing type 2 diabetes. Participants were then randomised to telephone support (n = 107) or self-care only (n = 98) for 18 months, and re-assessed using anthropometric, clinical, psychological and general health measures.

Results
A total of 164 participants (85 telephone support and 79 self-care only) completed the follow-up. Changes between 12 and 30 months for the telephone support group were not significantly different from those found in the self-care only group. Beneficial lifestyle changes achieved by participants were generally sustained after the diabetes prevention program, with the exception of fasting plasma glucose and some psychological measures.

Conclusions
Positive outcomes achieved at 12 months were generally maintained after a further 18 months. Telephone support did not appear to produce additional benefits.