The CDM-Net project : the development, implementation and evaluation of a broadband-based network for managing chronic disease

<b>Background.</b> In Australia most chronic disease management is funded by Medicare Australia through General Practitioner Management Plans (GPMPs) and Team Care Arrangements (TCAs). Identified barriers may be reduced effectively using a broadband-based network known as the Chronic Disease Management Service (CDMS). <br /><br /><b>Aims.</b> To measure the uptake and adherence to CDMS, test CDMS, and assess the adherence of health providers and patients to GPMPs and TCAs generated through CDMS. <br /><br /><b>Methods.</b> A single cohort before and after study. <br /><br /><b>Results.</b> GPMPs and TCAs increased. There was no change to prescribed medicines or psychological quality of life. Attendance at allied health professionals increased, but decreased at pharmacies. Overall satisfaction with CDMS was high among GPs, allied health professionals, and patients. <br /><br /><b>Conclusion.</b> This study demonstrates proof of concept, but replication or continuation of the study is desirable to enable the impact of CDMS on diabetes outcomes to be determined.<br />

Predicting changes in lifestyle and clinical outcomes in preventing diabetes : The Greater Green Triangle Diabetes Prevention Project

<b>Objectives : </b>To analyse how psychosocial determinants of lifestyle changes targeted in the Greater Green Triangle Diabetes Prevention Project conducted in Southeast Australia in 2004&ndash;2006 predict changes in dietary behaviour and clinical risk factors.<br /><b><br />Methods : </b>A longitudinal pre-test and post-test study design was used. The group program was completed by 237 people at high risk of type 2 diabetes. Associations between changes in the variables were examined by structural equation modelling using a path model in which changes in psychological determinants for lifestyle predicted changes in dietary behaviours (fat and fibre intake), which subsequently predicted changes in waist circumference and other clinical outcomes. Standardised regression weights are presented, with &beta; = &plusmn; 0.1 and &beta; = &plusmn; 0.3 representing small and medium associations, respectively.<br /><br /><b>Results :</b> Improvements in coping self-efficacy and planning predicted improvements in fat (&beta; = &minus; 0.15, p &lt; 0.05 and &beta; = &minus; 0.32, p &lt; 0.001, respectively) and fibre intake (&beta; = 0.15, p &lt; 0.05 and &beta; = 0.23, p &lt; 0.001, respectively) which in turn predicted improvements in waist circumference (&beta; = 0.18, p &lt; 0.01 and &beta; = &minus; 0.16, p &lt; 0.05, respectively). Improvements in waist circumference predicted improvements in diastolic blood pressure (&beta; = 0.13, p &lt; 0.05), HDL (&beta; = &minus; 0.16, p &lt; 0.05), triglycerides (&beta; = 0.17, p &lt; 0.01), and fasting glucose (&beta; = 0.15, p &lt; 0.05).<br /><b><br />Conclusions : </b>Psychological changes predicted behaviour changes, resulting in 12-month biophysical changes. The findings support the theoretical basis of the interventions.<br />

Conducting field research in a primary school setting : methodological considerations for maximizing response rates, data quality and quantity

<b>Background</b>: Schools are an ideal setting in which to involve children in research. Yet for investigators wishing to work in these settings, there are few method papers providing insights into working efficiently in this setting.<br /><br /><b>Objective</b>: The aim of this paper is to describe the five strategies used to increase response rates, data quality and quantity in the TRansport Environment and Kids (TREK) project.<br /><br /><b>Setting</b>: The TREK project examined the association between neighbourhood urban design and active transport in Grade 5&ndash;7 school children (n = 1480) attending 25 primary schools in metropolitan Perth, Western Australia during 2007.<br /><br /><b>Method</b>: Children completed several survey components during school time (i.e. questionnaire, mapping activity, travel diary and anthropometric measurements) and at home (i.e. pedometer study, parent questionnaire).<br /><br /><b>Results</b>: Overall, 69.4% of schools and 56.6% of children agreed to participate in the study and, of these, 89.9% returned a completed travel diary, 97.8% returned their pedometer and 88.8% of parents returned their questionnaire. These return rates are superior to similar studies. Five strategies appeared important: (1) building positive relationships with key school personnel; (2) child-centred approaches to survey development; (3) comprehensive classroom management techniques to standardize and optimize group sessions; (4) extensive follow-up procedures for collecting survey items; and (5) a specially designed data management/monitoring system.<br /><br /><b>Conclusion</b>: Sharing methodological approaches for obtaining high-quality data will ensure research opportunities within schools are maximized. These methodological issues have implications for planning, budgeting and implementing future research.<br />