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

This report presents the process and summative evaluation results from a co mmunity-based diabetes prevention and control project implemented in respon se to the increasing prevalence and impact of non-insulin-dependent diabete s mellitus (NIDDM) in the Canadian Aboriginal population. The 24-month proj ect targeted the registered Indian population in British Columbia's rural O kanagan region. A participatory approach was used to plan strategies by whi ch diabetes could be addressed in ways acceptable and meaningful to the int ervention community. The strategies emphasised a combination of changing be haviours and changing environments. The project was quasi-experimental. A single intervention community was mat ched to two comparison communities. Workers in the intervention community c onducted interviews of individuals with or at risk for diabetes during a se ven-month pre-intervention phase (n = 59), Qualitative analyses were conduc ted to yield strategies for intervention. Implementation began in the eight h month of the project. Trend measurements of diabetes risk factors were ob tained for 'high-risk' cohorts (persons with or at familial risk for NIDDM) (n = 105). Cohorts were tracked over a 16-month intervention phase, with m easurements at baseline, the midpoint and completion of the study. Cross-se ctional population surveys of diabetes risk factors were conducted at basel ine and the end of the intervention phase (n = 295), Surveys of community s ystems were conducted three times. The project yielded few changes in quantifiable outcomes. Activation of the intervention community was insufficient to enable individual and collectiv e change through dissemination of quality interventions for diabetes preven tion and control. Theory and previous research were not sufficiently integr ated with information from pre-intervention interviews. Interacting with th ese limitations were the short planning and intervention phases, just 8 and 16 months, respectively. The level of penetration of the interventions mou nted was too limited to be effective. Attention to process is warranted and to the feasibility of achieving effects within 24 months. (C) 1999 Elsevie r Science Ltd. All rights reserved.