UBC Theses and Dissertations
Effectiveness of community-directed diabetes prevention and control in a rural aboriginal population Daniel, Mark
In response to the increasing prevalence and impact of non-insulin-dependent diabetes mellitus (NIDDM) in Canadian Aboriginal populations, a community-based diabetes prevention and control project of 24 months duration was implemented in the interior of British Columbia. A participatory approach was used to plan strategies by which diabetes could be addressed in ways acceptable and meaningful to the intervention community. The strategies emphasised a combination of changing behaviours and changing environments. Project workers implemented programme initiatives. Researchers served as facilitators and advocates for community change processes. The project was quasi-experimental. The intervention community was matched to two comparison communities. Workers in the intervention community conducted interviews of individuals with or at risk for diabetes during a seven-month pre-intervention phase (n = 59). Qualitative analyses were conducted to elucidate strategies for intervention. Baseline measures were obtained in each community, and implementation began in the eighth month of the project. A population approach was taken to diabetes prevention and control. Trend measurements of diabetes risk factors were obtained in each community for "high-risk" cohorts (persons with or at familial risk for NIDDM) (n = 105). Cohorts were tracked over the 16-month intervention phase, with measurements at baseline, the midpoint and completion of the study. Cross-sectional surveys of diabetes risk factors were conducted in each community at baseline and the end of the intervention phase (n = 295). Surveys of community systems were conducted during the pre-intervention and early and late intervention phases. The project yielded few changes in quantifiable outcomes. Activation of the intervention community was insufficient to enable individual and collective change through dissemination of quality interventions for diabetes prevention and control. Theory and previous research were not sufficiently integrated with information from pre-intervention interviews, nor were qualitative results brought to bear on activation and intervention planning. Interacting with these limitations were the short planning and intervention phases, just eight and sixteen months, respectively. The level of penetration of the interventions mounted was too limited to be effective. Attention to process is warranted, as is the feasibility of achieving effects within 24 months.