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Effectiveness of community-directed diabetes prevention and control in a rural Aboriginal population in British Columbia, Canada

Author

Listed:
  • Daniel, Mark
  • Green, Lawrence W.
  • Marion, Stephen A.
  • Gamble, Diane
  • Herbert, Carol P.
  • Hertzman, Clyde
  • Sheps, Sam B.

Abstract

This report presents the process and summative evaluation results from a community-based diabetes prevention and control project implemented in response to the increasing prevalence and impact of non-insulin-dependent diabetes mellitus (NIDDM) in the Canadian Aboriginal population. The 24-month project targeted the registered Indian population in British Columbia's rural Okanagan region. 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. The project was quasi-experimental. A single 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 yield strategies for intervention. Implementation began in the eighth month of the project. Trend measurements of diabetes risk factors were obtained for 'high-risk' cohorts (persons with or at familial risk for NIDDM) (n=105). Cohorts were tracked over a 16-month intervention phase, with measurements at baseline, the midpoint and completion of the study. Cross-sectional population surveys of diabetes risk factors were conducted at baseline and the end of the intervention phase (n=295). Surveys of community systems were conducted three times. 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. Interacting with these limitations were the short planning and intervention phases, just 8 and 16 months, respectively. The level of penetration of the interventions mounted was too limited to be effective. Attention to process is warranted and to the feasibility of achieving effects within 24 months.

Suggested Citation

  • Daniel, Mark & Green, Lawrence W. & Marion, Stephen A. & Gamble, Diane & Herbert, Carol P. & Hertzman, Clyde & Sheps, Sam B., 1999. "Effectiveness of community-directed diabetes prevention and control in a rural Aboriginal population in British Columbia, Canada," Social Science & Medicine, Elsevier, vol. 48(6), pages 815-832, March.
  • Handle: RePEc:eee:socmed:v:48:y:1999:i:6:p:815-832
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    Citations

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    Cited by:

    1. Mark Daniel & Margaret Cargo & Elisabeth Marks & Catherine Paquet & David Simmons & Margaret Williams & Kevin Rowley & Kerin O’Dea, 2009. "Rating Health and Social Indicators for Use with Indigenous Communities: A Tool for Balancing Cultural and Scientific Utility," Social Indicators Research: An International and Interdisciplinary Journal for Quality-of-Life Measurement, Springer, vol. 94(2), pages 241-256, November.
    2. Giles, Brian G. & Findlay, C. Scott & Haas, George & LaFrance, Brenda & Laughing, Wesley & Pembleton, Sakakohe, 2007. "Integrating conventional science and aboriginal perspectives on diabetes using fuzzy cognitive maps," Social Science & Medicine, Elsevier, vol. 64(3), pages 562-576, February.
    3. Worthman, Carol M. & Kohrt, Brandon, 2005. "Receding horizons of health: biocultural approaches to public health paradoxes," Social Science & Medicine, Elsevier, vol. 61(4), pages 861-878, August.

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