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McMullen B, Duncanson K, Collins C, MacDonald-Wicks L. A systematic review of the mechanisms influencing engagement in diabetes prevention programmes for people with pre-diabetes. Diabet Med 2024; 41:e15323. [PMID: 38829966 DOI: 10.1111/dme.15323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 03/02/2024] [Accepted: 03/20/2024] [Indexed: 06/05/2024]
Abstract
AIMS To identify barriers and enablers that influence engagement in and acceptability of diabetes prevention programmes for people with pre-diabetes. The results will provide insights for developing strategies and recommendations to improve design and delivery of diabetes prevention programmes with enhanced engagement and acceptability for people with pre-diabetes. METHODS This review used a critical realist approach to examine context and mechanisms of diabetes prevention programmes. Medline, Embase, PsycInfo, Cinahl, Web of Science, Scopus and Pre-Medline were searched for English language studies published between 2000 and 2023. A quality assessment was conducted using Joanna Briggs Institute critical appraisal tools. RESULTS A total of 90 papers met inclusion criteria. The included studies used a variety of quantitative and qualitative methodologies. Data extracted focused on barriers and enablers to engagement in and acceptability of diabetes prevention programmes, with seven key mechanisms identified. These included financial, environmental, personal, healthcare, social and cultural, demographic and programme mechanisms. Findings highlighted diverse factors that influenced engagement in preventive programmes and the importance of considering these factors when planning, developing and implementing future diabetes prevention programmes. CONCLUSIONS Mechanisms identified in this review can inform design and development of diabetes prevention programmes for people with pre-diabetes and provide guidance for healthcare professionals and policymakers. This will facilitate increased participation and engagement in preventive programmes, potentially reducing progression and/or incidence of pre-diabetes to type 2 diabetes and improving health outcomes.
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Affiliation(s)
- Britney McMullen
- Mid North Coast Local Health District, University of Newcastle, Coffs Harbour, Australia
| | - Kerith Duncanson
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, Australia
| | - Clare Collins
- School of Health Sciences, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, Australia
- Food and Nutrition Research Program, Hunter Medical Research Institute, New Lambton Heights, Australia
| | - Lesley MacDonald-Wicks
- School of Health Sciences, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, Australia
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Kavian F, Benton F, Mcgill J, Luscombe-Marsh N. Characterizing screening strategies for type 2 diabetes in high-risk ethnic communities: a scoping review protocol. JBI Evid Synth 2021; 19:3402-3411. [PMID: 34545015 DOI: 10.11124/jbies-20-00492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE This review aims to identify the characteristics of screening strategies for type 2 diabetes to determine the most pragmatic approach to improve relevance to high-risk community groups from ethnically diverse backgrounds. INTRODUCTION Type 2 diabetes is increasingly contributing to the global burden of disease and is more common in some community groups. Although screening underpins the success of primary prevention programs for type 2 diabetes, screening of high-risk community groups from ethnically diverse backgrounds require different screening protocols and can be challenging. These strategies have never been systematically scoped. INCLUSION CRITERIA This scoping review will consider screening strategies for type 2 diabetes that target high-risk ethnic community groups. Studies with adults older than 18 years will be considered for inclusion. Screening strategies may include, but are not limited to, risk-assessment questionnaires, blood tests, or both, using an opportunistic approach involving general practices or a targeted approach toward high-risk community groups from ethnically diverse backgrounds. Experimental and observational quantitative studies and mixed methods studies will be included. METHODS MEDLINE, CINAHL, PsycINFO, Informit, ProQuest, Web of Science, and Scopus will be searched. Studies will be screened for inclusion by two independent reviewers, and data will be extracted using the Reach, Effectiveness, Adoption, Implementation, and Maintenance framework. Results will be summarized in tables accompanied by narrative text.
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Affiliation(s)
- Foorough Kavian
- Research and Program Development, Diabetes SA, Adelaide, SA, Australia
| | - Fiona Benton
- Research and Program Development, Diabetes SA, Adelaide, SA, Australia
| | - Josephine Mcgill
- Corporate Services, Library, Flinders University, Adelaide, SA, Australia
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Angeles R, Zhu Y, Pirrie M, Marzanek F, Agarwal G. Type 2 Diabetes Risk in Older Adults Living in Social Housing: A Cross-Sectional Study. Can J Diabetes 2020; 45:355-359. [PMID: 33288480 DOI: 10.1016/j.jcjd.2020.10.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Revised: 08/11/2020] [Accepted: 10/10/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVES This study aimed to describe the risk of developing diabetes and the probable prevalence of diabetes and prediabetes in residents of subsidized or social housing who were 55 years of age or older. METHODS We conducted a cross-sectional study using data collected from an ongoing community health program in social housing buildings-the Community Paramedicine at Clinic (CP@clinic) program. Community paramedics staffing the CP@clinic program conducted lifestyle-related modifiable risk factor assessments of participating social housing residents who were 55 years of age or older. The Canadian Diabetes risk assessment (CANRISK) tool was administered to all participants, and those with moderate-to-high risk of developing diabetes were asked to return for a fasting capillary blood glucose (CBG) measurement. Data were collected from program participants who attended the sessions between December 2014 and May 2018. RESULTS There were 728 participants. Most were women (80.5%), aged 65 to 84 (68.1%), white (85.4%) and educated to the high school level or less (69.2%). At baseline, 71.3% were identified as having overweight or obesity, and 12.5% were diagnosed with diabetes. Of participants not diagnosed with diabetes (N=632), 66.6% were at high risk of developing diabetes, and 30.1% were categorized as moderate risk. The CBG assessments showed that 37.7% (N=158) of those with high risk and 22.0% (N=42) of those with moderate risk had blood glucose readings indicating impaired fasting glucose or probable diabetes. CONCLUSIONS This study shows that 96.7% of low-income older adults in social housing buildings had moderate-to-high risk of developing diabetes and that the probable prevalence of undiagnosed prediabetes and diabetes was 32.0%.
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Affiliation(s)
- Ricardo Angeles
- Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Ying Zhu
- Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Melissa Pirrie
- Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Francine Marzanek
- Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Gina Agarwal
- Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada; Department of Health Research Methods, Evidence, and Impact, Hamilton, Ontario, Canada.
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Volunteers' Experiences Delivering a Community-University Chronic Disease Health Awareness Program for South Asian Older Adults. J Community Health 2018; 42:1148-1155. [PMID: 28509955 DOI: 10.1007/s10900-017-0364-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Volunteers and voluntary organizations can connect preventative health care programs to communities and may play an important role in addressing the health needs of older adults. Despite this, tensions may exist in the structures that drive volunteers and voluntary organizations representing immigrant communities to provide unpaid labour to augment and supplement health care services. Furthermore, organizational challenges may exist for community agencies relying on volunteers to sustain a health screening and education program. The intervention program was led by one voluntary agency specifically for South Asian communities in partnership with the university and five local organizations. This paper draws on volunteer surveys (n = 22) and key informant interviews (n = 12) to detail volunteer experiences providing this intervention. Volunteers were university students and other community volunteers. A total of 810 adults participated in the intervention within the Greater Toronto Area, Ontario, Canada between October 2014 and June 2016. We found that volunteers often used their experience as a 'stepping stone' position to other education or work. They also gained from the knowledge and used it to educate themselves and their family members and friends. This paper provides a critical reflection on the role of volunteers in a preventative and educational healthcare intervention program for older adults from the South Asian community. Tensions exist when relying on volunteer labour for the implementation of preventative community health care programming and must be explored to ensure program sustainability as well as equity within the health care system.
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Agarwal G, Angeles R, Pirrie M, McLeod B, Marzanek F, Parascandalo J, Thabane L. Evaluation of a community paramedicine health promotion and lifestyle risk assessment program for older adults who live in social housing: a cluster randomized trial. CMAJ 2018; 190:E638-E647. [PMID: 29807936 PMCID: PMC5973885 DOI: 10.1503/cmaj.170740] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/12/2018] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Low-income older adults who live in subsidized housing have higher mortality and morbidity. We aimed to determine if a community paramedicine program - in which paramedics provide health care services outside of the traditional emergency response - reduced the number of ambulance calls to subsidized housing for older adults. METHODS We conducted an open-label pragmatic cluster-randomized controlled trial (RCT) with parallel intervention and control groups in subsidized apartment buildings for older adults. We selected 6 buildings using predefined criteria, which we then randomly assigned to intervention (Community Paramedicine at Clinic [CP@clinic] for 1 yr) or control (usual health care) using computer-generated paired randomization. CP@clinic is a paramedic-led, community-based health promotion program to prevent diabetes, cardiovascular disease and falls for residents 55 years of age and older. The primary outcome was building-level mean monthly ambulance calls. Secondary outcomes were individual-level changes in blood pressure, health behaviours and risk of diabetes assessed using the Canadian Diabetes Risk Questionnaire. We analyzed the data using generalized estimating equations and hierarchical linear modelling. RESULTS The 3 intervention and 3 control buildings had 455 and 637 residents, respectively. Mean monthly ambulance calls in the intervention buildings (3.11 [standard deviation (SD) 1.30] calls per 100 units/mo) was significantly lower (-0.88, 95% confidence interval [CI] -0.45 to -1.30) than in control buildings (3.99 [SD 1.17] calls per 100 units/mo), when adjusted for baseline calls and building pairs. Survey participation was 28.4% (n = 129) and 20.3% (n = 129) in the intervention and control buildings, respectively. Residents living in the intervention buildings showed significant improvement compared with those living in control buildings in quality-adjusted life years (QALYs) (mean difference 0.09, 95% CI 0.01 to 0.17) and ability to perform usual activities (odds ratio 2.6, 95% CI 1.2 to 5.8). Those who received the intervention had a significant decrease in systolic (mean change 5.0, 95% CI 1.0 to 9.0) and diastolic (mean change 4.8, 95% CI 1.9 to 7.6) blood pressure. INTERPRETATION A paramedic-led, community-based health promotion program (CP@clinic) significantly lowered the number of ambulance calls, improved QALYs and ability to perform usual activities, and lowered systolic blood pressure among older adults living in subsidized housing. Trial registration: Clinicaltrials.gov, no. NCT02152891.
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Affiliation(s)
- Gina Agarwal
- Department of Family Medicine (Agarwal, Angeles, Pirrie, Marzanek, Parascandalo), and Department of Health Research Methods, Evidence, and Impact (Agarwal), McMaster University; Hamilton Paramedic Services (McLeod); Biostatistics Unit (Thabane), St. Joseph's Healthcare Research Institute, Hamilton, Ont.
| | - Ricardo Angeles
- Department of Family Medicine (Agarwal, Angeles, Pirrie, Marzanek, Parascandalo), and Department of Health Research Methods, Evidence, and Impact (Agarwal), McMaster University; Hamilton Paramedic Services (McLeod); Biostatistics Unit (Thabane), St. Joseph's Healthcare Research Institute, Hamilton, Ont
| | - Melissa Pirrie
- Department of Family Medicine (Agarwal, Angeles, Pirrie, Marzanek, Parascandalo), and Department of Health Research Methods, Evidence, and Impact (Agarwal), McMaster University; Hamilton Paramedic Services (McLeod); Biostatistics Unit (Thabane), St. Joseph's Healthcare Research Institute, Hamilton, Ont
| | - Brent McLeod
- Department of Family Medicine (Agarwal, Angeles, Pirrie, Marzanek, Parascandalo), and Department of Health Research Methods, Evidence, and Impact (Agarwal), McMaster University; Hamilton Paramedic Services (McLeod); Biostatistics Unit (Thabane), St. Joseph's Healthcare Research Institute, Hamilton, Ont
| | - Francine Marzanek
- Department of Family Medicine (Agarwal, Angeles, Pirrie, Marzanek, Parascandalo), and Department of Health Research Methods, Evidence, and Impact (Agarwal), McMaster University; Hamilton Paramedic Services (McLeod); Biostatistics Unit (Thabane), St. Joseph's Healthcare Research Institute, Hamilton, Ont
| | - Jenna Parascandalo
- Department of Family Medicine (Agarwal, Angeles, Pirrie, Marzanek, Parascandalo), and Department of Health Research Methods, Evidence, and Impact (Agarwal), McMaster University; Hamilton Paramedic Services (McLeod); Biostatistics Unit (Thabane), St. Joseph's Healthcare Research Institute, Hamilton, Ont
| | - Lehana Thabane
- Department of Family Medicine (Agarwal, Angeles, Pirrie, Marzanek, Parascandalo), and Department of Health Research Methods, Evidence, and Impact (Agarwal), McMaster University; Hamilton Paramedic Services (McLeod); Biostatistics Unit (Thabane), St. Joseph's Healthcare Research Institute, Hamilton, Ont
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Shawley-Brzoska S, Misra R. Perceived Benefits and Barriers of a Community-Based Diabetes Prevention and Management Program. J Clin Med 2018. [PMID: 29534005 PMCID: PMC5867584 DOI: 10.3390/jcm7030058] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
This study examined the perceptions of benefits of and barriers to participating in a community-based diabetes program to improve program effectiveness. The Diabetes Prevention and Management (DPM) program was a twenty-two session, 1-year program, modeled after the evidence-based National Diabetes Prevention Program and AADE7 Self-Care Behaviors framework. Community-based participatory research approach was used to culturally tailor the curriculum. Participants included overweight or obese adults with dysglycemia. A benefits and barriers survey was developed to gather information on participants' perception of the program, as well as information on demographics and health literacy levels. Eighty-nine adults participated in the DPM program (73% females; 62% diabetic; 77% had adequate health literacy); 79% of participants completed the benefits and barriers survey. Principal component analysis indicated two components representing benefits (Cronbach's α = 0.83) and barriers (α = 0.65). The majority perceived high benefits and low barriers to program participation; benefits included helpful interaction with health coach or program leader (73%), improved lifestyle modification (65%) due to the program, and satisfaction with the program (75%). Open-ended questions confirmed themes related to benefits of program participation, suggestion for programmatic improvements as well as barriers to participation. Participant feedback could be used to guide interventions and tailor future program implementation.
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Affiliation(s)
| | - Ranjita Misra
- School of Public Health, West Virginia University, Morgantown, WV 26506, USA.
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Kirkpatrick SI, Vanderlee L, Raffoul A, Stapleton J, Csizmadi I, Boucher BA, Massarelli I, Rondeau I, Robson PJ. Self-Report Dietary Assessment Tools Used in Canadian Research: A Scoping Review. Adv Nutr 2017; 8:276-289. [PMID: 28298272 PMCID: PMC5347105 DOI: 10.3945/an.116.014027] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Choosing the most appropriate dietary assessment tool for a study can be a challenge. Through a scoping review, we characterized self-report tools used to assess diet in Canada to identify patterns in tool use and to inform strategies to strengthen nutrition research. The research databases Medline, PubMed, PsycINFO, and CINAHL were used to identify Canadian studies published from 2009 to 2014 that included a self-report assessment of dietary intake. The search elicited 2358 records that were screened to identify those that reported on self-report dietary intake among nonclinical, non-Aboriginal adult populations. A pool of 189 articles (reflecting 92 studies) was examined in-depth to assess the dietary assessment tools used. Food-frequency questionnaires (FFQs) and screeners were used in 64% of studies, whereas food records and 24-h recalls were used in 18% and 14% of studies, respectively. Three studies (3%) used a single question to assess diet, and for 3 studies the tool used was not clear. A variety of distinct FFQs and screeners, including those developed and/or adapted for use in Canada and those developed elsewhere, were used. Some tools were reported to have been evaluated previously in terms of validity or reliability, but details of psychometric testing were often lacking. Energy and fat were the most commonly studied, reported by 42% and 39% of studies, respectively. For ∼20% of studies, dietary data were used to assess dietary quality or patterns, whereas close to half assessed ≤5 dietary components. A variety of dietary assessment tools are used in Canadian research. Strategies to improve the application of current evidence on best practices in dietary assessment have the potential to support a stronger and more cohesive literature on diet and health. Such strategies could benefit from national and global collaboration.
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Affiliation(s)
- Sharon I Kirkpatrick
- School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada;
| | - Lana Vanderlee
- Department of Nutritional Sciences, University of Toronto, Toronto, Ontario, Canada;
| | - Amanda Raffoul
- School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada
| | | | - Ilona Csizmadi
- Departments of Oncology and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Beatrice A Boucher
- Department of Nutritional Sciences, University of Toronto, Toronto, Ontario, Canada;,Prevention and Cancer Control, Cancer Care Ontario, Toronto, Ontario, Canada
| | | | | | - Paula J Robson
- Cancer Measurement, Outcomes, Research, and Evaluation (C-MORE), Alberta Health Services Cancer Control, Edmonton, Alberta, Canada
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Agarwal G, McDonough B, Angeles R, Pirrie M, Marzanek F, McLeod B, Dolovich L. Rationale and methods of a multicentre randomised controlled trial of the effectiveness of a Community Health Assessment Programme with Emergency Medical Services (CHAP-EMS) implemented on residents aged 55 years and older in subsidised seniors' housing buildings in Ontario, Canada. BMJ Open 2015; 5:e008110. [PMID: 26068514 PMCID: PMC4466604 DOI: 10.1136/bmjopen-2015-008110] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Chronic diseases and falls substantially contribute to morbidity/mortality among seniors, causing this population to frequently seek emergency medical care. Research suggests the paramedic role can be successfully expanded to include community-based health promotion and prevention. This study implements a community paramedicine programme targeting seniors in subsidised housing, a high-risk population and frequent users of emergency medical services (EMS). The aims are to reduce EMS calls, improve health outcomes and healthcare utilisation. METHODS/ANALYSIS This is a pragmatic clustered randomised control trial in four communities across Ontario, Canada. Within each, four to eight seniors' apartment buildings will be paired and within each pair one building will be randomly assigned to receive the Community Health Assessment Programme through EMS (CHAP-EMS) intervention, while the other building receives no intervention. During the 1-year intervention, paramedics will run weekly sessions in a common area of the building, assessing risk factors for cardiovascular disease, diabetes and falls; providing health education and referrals to community programmes; and communicating results to the participant's primary physician. The primary outcomes are rate of emergency calls per 100 residents, change in blood pressure and change in Canadian Diabetes Risk (CANRISK) score, as collected by the local EMS and study databases. The secondary outcomes are change in health behaviours, measured using a preintervention and postintervention survey and healthcare utilisation, available through administrative databases. Analysis will mainly consist of descriptive statistics and generalised estimating equations, including subgroup cluster analysis. ETHICS/DISSEMINATION This study is approved by the Hamilton Integrated Research Ethics Board and will follow the Tri-Council Policy Statement. Findings will be disseminated through reports to local stakeholders, publication in peer-reviewed journals and conference presentations. TRIAL REGISTRATION NUMBER NCT02152891.
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Affiliation(s)
- Gina Agarwal
- Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Beatrice McDonough
- Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada
- Public Health Services, Hamilton, Ontario, Canada
| | - Ricardo Angeles
- Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Melissa Pirrie
- Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Francine Marzanek
- Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Brent McLeod
- Hamilton Paramedic Services, Hamilton, Ontario, Canada
| | - Lisa Dolovich
- Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada
- Centre for Evaluation of Medicines, Hamilton, Ontario, Canada
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