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Title & Content |
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Partners Reducing the Effects of Diabetes:
Initiatives through Collaboration and Teamwork
P.R.E.D.I.C.TDavid L. Katz, MD, MPH, FACPM, FAAC
Georgia Jennings, MPH
Margot Zaharek, MS
Ann Agro, MPH
Lindsey Greene, BA
Valentine Yanchou Njike, MD, MPH
Zubaida Faridi, MBBS, MPH
Yale Prevention Research Center
Yale University School of Medicine
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Sponsors
- Centers for Disease Control and Prevention (CDC)
- Connecticut Health Foundation (CHF)
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| 3 |
Proposed Project
- Diabetes prevention and management among African Americans
- Highly participatory, 3-phase intervention
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Background and Significance
- 7th leading cause of death in CT
- Disproportionate burden: African Americans are 2 times as likely as whites to get diabetes
- Hospitalization is 3.5 times in African Americans as compared to the whites
- 27% more likely to die of complications
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Methods
Consisted of 3 Phases
I. Formative Research
II. Design and implement intervention
III. Evaluation
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Phase I. Formative Research
- Literature Search of Best Practices
- Formation of Community Partnership Team
- Focus Groups
- Environmental Audit
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Phase II. Intervention Description
Purpose
- Demonstrate the efficacy of using a Community Health Advisor (CHA) model
- Improve diabetes prevention and management behaviors in an urban African American community
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Church Based Component
- Setting:
- 13 churches in New Haven (intervention site)
- 6 churches in Bridgeport (control site)
- Participants:
- 21 CHAs in New Haven
- 17 CHAs in Bridgeport
- 134 congregation members in New Haven
- 125 congregation members in Bridgeport
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Church Based Component, Con't
CHA Training
- 10-week training session on diabetes prevention and management
- Each session lasted 2 hours and was conducted by a Certified Diabetes Educator
- About the disease, healthy dietary patterns, increased physical activity
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What are the Danger Signs and Symptoms of Diabetes?
(Think of HUT)
Hunger
Frequent Urination
Thirst
Other signs include:
- Rapid weight loss with increased appetite
- Visual disturbance, blurring
- Slow healing of cuts and bruises
- Skin disorders, itching
If you have any of these symptoms, make an appointment with your doctor to be tested.
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(image: graphic titled "What are the Danger Signs and Symptoms of Diabetes?")
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Church Based Component, Con't
(image: photo of people at church)
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Phase III. Evaluation
Quantitative
- CHA training: Pre/post diabetes knowledge survey
- Church based component:
7 Day Physical Activity Recall
Harvard Food Frequency Questionnaire
Nutrition Self Efficacy
Physical activity self efficacy
Medical Outcomes Social Support Survey
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Demographic Characteristics and Baseline values
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Variable
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New Haven (n=121)
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Bridgeport (n=125)
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p-value
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Gender
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Female, n (%)
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101 ( 84.87)
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95 ( 77.87)
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0.1630
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Male, n (%)
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18 ( 15.13)
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27 ( 22.13)
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Education Level
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Some High School or High School Diploma, n (%)
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56 (47.46)
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35 (28.46)
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0.0098
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Some College, n (%)
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38 (32.20)
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54 (43.90)
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Associate or Bachelor Degree, n (%)
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24 (20.34)
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34 (27.64)
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Household Income
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Less than $29.999, n (%)
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55 (51.89)
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37 (32.17)
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0.0105
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$30.000- $49.000, n (%)
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23 (21.70)
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39 (33.91)
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More than $50.000, n (%)
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28 (26.42)
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39 (33.91)
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Body Weight (lbs)
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204.63 ± 52.40
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193.92 ± 43.74
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0.0939
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Body Mass Index (kg/m²)
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33.86 ± 8.4
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31.90 ± 7.15
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0.0603
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Social Support
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Emotional/Information Support
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31.79 ± 7.58
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30.62 ± 7.91
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0.2395
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Tangible Support
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15.97 ± 3.89
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14.79 ± 4.45
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0.0283
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Affectionate Support
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12.91 ± 2.67
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12.06 ± 3.42
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0.0313
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Positive Social Interaction
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12.59 ± 2.88
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11.75 ± 3.19
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0.0316
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Overall Support Index
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76.97 ± 15.16
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72.41 ± 18.08
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0.0329
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Diabetic Knowledge (%)
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65.99 ± 9.93
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68.12 ± 10.27
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0.1004
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Physical Activity self-efficacy
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13.42 ± 4.02
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14.02 ± 3.73
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0.2315
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Energy Expenditure (kcal/kg/wk)
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124.87 ± 109.92
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134.35 ± 110.47
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0.5051
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Nutrition self-efficacy
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14.99 ± 3.92
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15.54 ± 3.62
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0.1648
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Baseline values of selected nutrients
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Variable
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Bridgeport (n=124)
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New Haven (n=122)
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p-value
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Total calories
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2232.1 ± 2029.6
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2656.2 ± 2802.6
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0.1760
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Total Protein
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101.4 ± 90.2
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114.0 ± 112.1
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0.3322
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Total Carbohydrates
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278.9 ± 298.2
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348.2 ± 402.6
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0.1269
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Fats
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Trans fats
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81.2 ± 67.9
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93.3 ± 96.2
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0.2571
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Saturated fatty acid
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25.9 ± 19.8
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30.7 ± 32.8
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0.1665
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Mono-unsaturated fatty acid
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30.5 ± 26.5
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34.9 ± 34.9
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0.2889
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Poly-unsaturated fatty acid
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16.4 ± 17.1
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17.8 ± 18.6
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0.5378
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Total Cholesterol
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334.7 ± 262.6
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385.5 ± 425.1
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0.2619
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Change in Outcome measures
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Variable
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New Haven (n=83)
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Bridgeport (n=78)
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p-value
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Body Weight (lbs)
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0.32 ± 25.92
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0.82 ± 19.30
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0.8974
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Body Mass Index (kg/m²)
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-0.63 ± 6.72
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0.13 ± 3.18
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0.4191
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Social Support
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Emotional/Information Support
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0.99 ± 7.74
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0.32 ± 7.48
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0.5757
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Tangible Support
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-0.52 ± 4.49
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0.09 ± 3.38
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0.3312
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Affectionate Support
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-0.33 ± 3.09
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-0.17 ± 3.55
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0.7648
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Positive Social Interaction
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-0.33 ± 3.18
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-0.49 ± 3.77
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0.7743
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Overall Support Index
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0.14 ± 15.45
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0.20 ± 16.40
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0.9816
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Diabetic Knowledge (%)
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2.45 ± 11.22*
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1.76 ± 0.87
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0.6896
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Physical Activity self-efficacy
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0.23 ± 5.46
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0.38 ± 3.49
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0.8400
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Physical Activity Level, past 3 months
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Increased, n (%)
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20 (25.64)
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25 (32.05)
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0.6652
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Decreased, n (%)
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14 (17.95)
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12 (15.38)
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About the same, n (%)
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44 (56.41)
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41 (52.56)
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Nutrition self-efficacy
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0.31 ± 4.66
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0.64 ± 2.82*
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0.5858
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Change in outcome measures from baseline of selected nutrients
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Variable
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Bridgeport (n=78)
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New Haven (n=83)
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p-value†
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Total calories
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-198.2 ± 1263.3
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-375.5 ± 1553.1
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0.3287
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p-value‡
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0.0832
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0.0089
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Total Protein
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-9.0 ± 60.1
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-11.3 ± 63.9
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0.7691
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p-value‡
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0.0982
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0.0537
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Total Carbohydrates
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-28.2 ± 180.1
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-64.1 ± 248.1
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0.1970
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p-value‡
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0.0843
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0.0053
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Fats
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Trans fats
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-6.1 ± 48.3
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-9.0 ± 47.0
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0.6358
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p-value‡
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0.1592
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0.0365
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Saturated fatty acid
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-1.5 ± 14.2
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-2.2 ± 14.0
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0.6940
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p-value‡
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0.2445
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0.0868
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Mono-unsaturated fats
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-2.2 ± 18.7
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-3.4 ± 19.5
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0.6255
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p-value‡
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0.1980
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0.0600
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Poly-unsaturated fats
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-1.8 ± 12.5
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-2.3 ± 11.2
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0.7375
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p-value‡
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0.1054
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0.0227
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Total Cholesterol
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-12.6 ± 194.9
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-16.4 ± 219.3
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0.8862
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p-value‡
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0.4732
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0.4127
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| 16 |
Challenges
- Re-engaging disengaged CHAs
- CHAs lack of education
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| 17 |
Thank you
- New Haven Churches
- Bridgeport Churches
- Survey Participants
- Bridgeport and New Haven Community Partnership Teams
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