Implementation of diabetes prevention programs in rural areas : Montana and south-eastern Australia compared

Objective: To identify the key elements that enabled the Greater Green Triangle Diabetes Prevention Project (GGT DPP) and the Montana Cardiovascular Disease and Diabetes Prevention (CDDP) programs successful establishment and implementation in rural areas, as well as identifying specific challenges or barriers for implementation in rural communities.
Methods: Focus groups were held with the facilitators who delivered the GGT DPP in Australia and the Montana CDDP programs in the USA. Interview questions covered the facilitators’ experiences with recruitment, establishing the program, the components and influence of rurality on the program, barriers and challenges to delivering the program, attributes of successful participants, and the influence of community resources and partnerships on the programs.
Results: Four main themes emerged from the focus groups: establishing and implementing the diabetes prevention program in the community; strategies for recruitment and retention of participants; what works in lifestyle intervention programs; and rural-centred issues.
Conclusions: The results from this study have assisted in determining the factors that contribute to developing, establishing and implementing successful diabetes prevention programs in two rural areas. Recommendations to increase the likelihood of success of programs in rural communities include: securing funding early for the program; establishing support from community leaders and developing positive relationships with health care providers; creating a professional team with passion for the program; encouraging participants to celebrate their small and big successes; and developing procedures for providing post-intervention support to help participants maintain their success.

The spread and uptake of diabetes prevention programs around the world : a case study from Finland and Australia

Type 2 diabetes is a major public health issue in most countries around the world. Efficacy trials have demonstrated that lifestyle modification programs can significantly reduce the risk of type 2 diabetes. Two key challenges are: [1] to develop programs that are more feasible for “real world” implementation and [2] to extend the global reach of such programs, particularly to resource-poor countries where the burden of diabetes is substantial. This paper describes the development, implementation, and evaluation of such “real world” programs in Finland and Australia, the exchange between the two countries, and the wider uptake of such programs. Drawing on the lessons from these linked case studies, we discuss the implications for improving the “spread” of diabetes prevention programs by more effective uptake of lifestyle change programs and related strategies for more resource-poor countries and settings.

Life! in Australia : translating prevention research into a large-scale intervention

The increasing prevalence of type 2 diabetes is of great public health concern. In the state of Victoria, Australia, a group-based lifestyle intervention programme, Life! – Taking Action on Diabetes, was developed for people over the age of 50 years who are at high risk of diabetes. It aims to reduce the risk of diabetes by providing practical skills, including goal setting and problem solving, to encourage participants to adopt a healthy diet and active lifestyle. The programme is delivered by specially trained facilitators who have undergone an accredited three-stage training programme. A quality assurance process is also in place to ensure that it is delivered to a consistently high standard. The Life! program
is a direct progression from the Finnish randomised controlled trial and the Greater Green Triangle Diabetes Prevention Project implementation trial. This paper describes how a diabetes prevention programme was implemented at a state-wide level and the training of facilitators to conduct the group sessions. Future studies are needed to examine the cost effectiveness and development of specific programmes for diverse population groups.

Parent–child interactions and obesity prevention : a systematic review of the literature

Child obesity research has generally not examined multiple layers of parent–child relationships during weight-related activities such as feeding, eating and play. A literature review was conducted to locate empirical studies that measured parent– child interactions and child eating and child weight variables; five papers met the inclusion criteria and were included in the review. The findings of the review revealed that parent–child relationships are an important element in explaining the unhealthy trend of childhood obesity. We argue that prevention/intervention strategies must extend on the current models of parenting by targeting the family from a bi-directional perspective, and focusing, specifically, on the mutually responsive orientation that exists in the parent–child relationship.

Parental influence and obesity prevention in pre-schoolers : a systematic review of interventions

Obesity is difficult to reverse in older children and adults and calls have been made to implement obesity prevention strategies during the formative pre-school years. Childhood obesity experts suggest that prevention of overweight in the pre-school years should focus on parents, because parental beliefs, attitudes, perceptions and behaviours appear to contribute to children’s development of excessive weight gain. While evidence suggests that parental variables may be instrumental in the development of obesity, there has been no systematic evaluation of whether intervening to change such variables will positively influence the development of excess adiposity during the pre-school years. This paper is a conceptual and methodological review of the literature on the parental variables targeted in interventions designed to modify risk factors for obesity by promoting healthy eating and/or physical activity and/or reducing sedentary behaviours in families of children aged 2–6 years. There were significant methodological limitations of existing studies and the scientific study of this area is in its infancy. However, the results suggest that the modification of parental variables known to be associated with obesity-promoting behaviours in pre-school children may show promise as an obesity prevention strategy; further research is needed.

The role of policy in improving diets : experiences from the Pacific obesity prevention in communities food policy project

There is global interest in using multisectoral policy approaches to improve diets, and reduce obesity and non-communicable disease. However, there has been ad hoc implementation, which in some sectors such as the economic sector has been very limited, because of the lack of quality evidence on potential costs and impacts, and the inherent challenges associated with cross-sectoral policy development and implementation. The Pacific Obesity Prevention in Communities food policy project aimed to inform relevant policy development and implementation in Pacific Island countries. The project developed an innovative participatory approach to identifying and assessing potential policy options in terms of their effectiveness and feasibility. It also used policy analysis methodology to assess three policy initiatives to reduce fatty meat availability and four soft drink taxes in the region, in order to identify strategies for supporting effective policy implementation.

Evaluation of the Living 4 Life project : a youth-led, school-based obesity prevention study

The Living 4 Life study was a youth-led, school-based intervention to reduce obesity in New Zealand. The study design was quasi-experimental, with comparisons made by two cross-sectional samples within schools. Student data were collected at baseline (n = 1634) and at the end of the 3-year intervention (n = 1612). A random-effects mixed model was used to test for changes in primary outcomes (e.g. anthropometry and obesity-related behaviours) between intervention and comparison schools. There were no significant differences in changes in anthropometry or behaviours between intervention and comparison schools. The prevalence of obesity in intervention schools was 32% at baseline and 35% at follow-up and in comparison schools was 29% and 30%, respectively. Within school improvements in obesity-related behaviours were observed in three intervention schools and one comparison school. One intervention school observed several negative changes in student behaviours. In conclusion, there were no significant improvements to anthropometry; this may reflect the intervention’s lack of intensity, insufficient duration, or that by adolescence changes in anthropometry and related behaviours are difficult to achieve. School-based obesity prevention interventions that actively involve young people in the design of interventions may result in improvements in student behaviours, but require active support from leaders within their schools.

The economic analysis of prevention in mental health programs

This article introduces the role economics can play in deciding whether programs designed to prevent mental disorders, which carry large disease and economic burdens, are a worthwhile use of limited healthcare resources. Fortunately, preventive interventions for mental disorders exist; however, which interventions should be financed is a common issue facing decision makers, and economic evaluation can provide answers. Unfortunately, existing economic evaluations of preventive interventions have limited applicability to local healthcare contexts. An approach to priority setting largely based on economic techniques— Assessing Cost-Effectiveness (ACE)—has been developed and used in Australia to answer questions regarding the economic credentials of competing interventions. Eleven preventive interventions for mental disorders and suicide, mostly psychological in nature, have been evaluated using this approach, with many meeting the criteria of good value for money. Interventions targeting the prevention of suicide, adult and childhood depression, childhood anxiety, and early psychosis have particular merit.

Healthy eating and obesity prevention for preschoolers : data collected from a randomised controlled trial

This data offers insights into child eating habits and daily dietary intake, duration of daily child physical and sedentary activities, parental knowledge of nutrition, child and parent Body Mass Index (BMI), parental behaviours and cognitions pertaining to feeding, eating and physical activity, parental concern for child weight, and child food neophobia.It includes survey data and physical measurements (height and weight) of participants.

Greater Green Triangle diabetes prevention project database

Data includes anthropometric and laboratory (lipid profile, glucose) measurements, and self-reported questionnaires including demographics, self-efficacy, social support, psychological well being (HADS, K10, SF-36 v2), diet (three-day food diaries, food frequency questionnaire), physical activity (seven-day diary, Active Australia Survey), smoking, and alcohol consumption. Most data is measured at baseline, 3 months, 12 months, and 30 months. Some blood samples are still stored at -80 degrees Celsius.

Applications of nutrient profiling : potential role in diet-related chronic disease prevention and the feasibility of a core nutrient-profiling system

Background/objectives: A number of different nutrient-profiling models have been proposed and several applications of nutrient profiling have been identified. This paper outlines the potential role of nutrient-profiling applications in the prevention of diet-related chronic disease (DRCD), and considers the feasibility of a core nutrient-profiling system, which could be modified for purpose, to underpin the multiple potential applications in a particular country.

Methods: The ‘Four ‘P’s of Marketing’ (Product, Promotion, Place and Price) are used as a framework for identifying and for classifying potential applications of nutrient profiling. A logic pathway is then presented that can be used to gauge the potential impact of nutrient-profiling interventions on changes in behaviour, changes in diet and, ultimately, changes in DRCD outcomes. The feasibility of a core nutrient-profiling system is assessed by examining the implications of different model design decisions and their suitability to different purposes.

Results and conclusions: There is substantial scope to use nutrient profiling as part of the policies for the prevention of DRCD. A core nutrient-profiling system underpinning the various applications is likely to reduce discrepancies and minimise the confusion for regulators, manufacturers and consumers. It seems feasible that common elements, such as a standard scoring method, a core set of nutrients and food components, and defined food categories, could be incorporated as part of a core system, with additional application-specific criteria applying. However, in developing and in implementing such a system, several country-specific contextual and technical factors would need to be balanced.