ARCHIVED: Case study 6: Reducing health disparities related to diabetes: Lessons learned through the Canadian Diabetes Strategy Community-Based Program
Case Study 6: Diabetes Intervention Strategy for Quebec Minority English Speaking Communities: Increasing Access to Health Information for Rural and Isolated Regions
- Servizi Comunitari Italo-Canadesi del Quebec
- Committee for Anglophone Social Action—New Carlisle
- Council for Anglophone Magdalen Islander
- East Island Montréal
- Lower North Shore Coalition for Health
- Outaouais Health and Social Services Network
- Townshippers' Association-Cowansville and Estrie
- Vision Gaspé-Percé Now
- Public Health Agency of Canada
- English-speaking youth, adults and seniors
- Throughout Quebec
The prevention of obesity in children and older adults is key to the prevention of type 2 diabetes and several other chronic diseases. Access to health information and diabetes services is limited for certain English-speaking communities in Quebec, particularly those in isolated or rural regions.
This program aimed to increase awareness of the benefits of healthy eating and physical activity among high-risk populations and among decision-makers within the English-speaking minority communities. In addition, it sought to develop partnerships between community organizations and the health and social services centres (the "CSSS").
The regional English-speaking communities partnered with local health institutions to carry out various activities related to prevention and self-management, including:
- Presentations in elementary schools;
- Travelling kiosks on diabetes prevention;
- Diabetes screening and testing by nurses at all-ages festivals;
- Distribution of "survival bags" for individuals with type 2 diabetes;
- A cooking class for children on how to prepare cookies that are appropriate for diabetic diets, with proceeds donated to a local homeless shelter.
Process evaluation measures included maintaining a program diary; qualitative surveys of seniors and steering committee members, and pre- and post-surveys of knowledge, awareness and behaviour.
Age-appropriate pre- and post-test questionnaires and satisfaction forms were administered to high school students and seniors. In addition, focus groups were held with seniors and youth in two of the target communities. Seniors and youth were the main focus of the evaluation, as most of the project activities were aimed at these two populations.
Results indicated that knowledge and awareness of diabetes increased among participants, but it was difficult to assess whether any changes had been made to dietary or physical activity practices. The evaluation also confirmed that important partnerships were established between the project partners (community organizations) and the public health system.
Comments on the evaluations centred on three points:
- The importance of follow-up, particularly for seniors (who do not have the benefit of being in a continuous learning environment like a school);
- The need to use individualized approaches when teaching about healthy lifestyles, such as providing personal attention during presentations, and group support; and
- Targeting seniors caregivers' in future program activities, as they play a significant role in the nutrition and physical activity practices of seniors.
- Program activities were carried out in regions with a high proportion of English-speaking residents.
- To reach the general public, activities were carried out in shopping centres, grocery stores and at public events.
- To reach students, activities related to diabetes prevention were conducted at day camps and elementary schools.
- To reach seniors, the program team travelled to medical clinics and seniors' centres.
- It was initially more challenging to reach seniors than youth because they cannot all be reached at a single institution (i.e. a school); however, it was easier to collaborate with seniors' committees than school committees, as their decision-making processes were simpler than those in the school system.
- The presence of government health officials at English events was a success, as it helped to increase understanding between English minority communities and government decision-makers.
- In response to shifting priorities at the provincial and federal government levels, the lead organization and partnership communities are focusing on chronic disease care management in patients with type 2 diabetes. They are currently working on a distance telemonitoring project involving community networks across Quebec and local health centres, whereby patients transmit their blood glucose levels to nurses and project coordinators via handheld devices, such as the Blackberry. Dietitians are hired to answer questions and present information sessions via videoconference. The acquisition of self-monitoring skills among patients will be measured to determine the feasibility of using this technology.
"The public sector is beginning to realize the value of community groups. It was skeptical at first, but now it values them as partners and sees how far the little funds they [community groups] receive can go."
A number of resources were developed for this program:
- Training kits for youth on healthy eating and diabetes;
- Curriculum modules for elementary school children;
- Pamphlets for all age groups;
- Healthy recipe guides; and
- A rap DVD on healthy eating and diabetes prevention (YouTube site: bit.ly/oKdZ)
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