A mixed‐methods evaluation of an urban Aboriginal diabetes lifestyle program

Abstract

Objective: The objective of this study was to evaluate an Aboriginal‐led diabetes lifestyle program catering to urban Aboriginal people in an Aboriginal organisation. Methods: Mixed‐methods study that employed routinely collected physiological data and audio‐recorded focus group sessions. Physiological data were analysed using a multi‐level model to account for participant clustering. Qualitative data were subject to thematic analysis. Results: Participants were overwhelmingly positive about the program. They lost weight and improved their diastolic blood pressure and glycaemic control; however, it was the feelings of belonging and optimism about their ability to improve their health that they most valued. Qualitative analysis revealed three main themes. These were: ‘With the Mob’, ‘For the Mob’ and ‘Program Elements. The strengths of the program lay in its indigeneity, low‐cost and easy‐to‐prepare diet, and cultural and communication skills of the director. Conclusions: Recommendations for improvement included educating participants on the pathophysiology of diabetes, the refinement of online elements and the introduction of face‐to‐face group exercise. Implications for public health: Programs of this nature should be expanded and evaluated longitudinally with multiple cohorts.

Acceptability, feasibility and preliminary impact evaluation of a pilot text‐message study on improving the health of Aboriginal people with, or at risk of, chronic disease in Australia

“…Our minimally tailored text‐messages were considered culturally acceptable, similar to findings from an Aboriginal infant feeding mHealth program with minimal tailoring 13 . Despite the text‐messages being automated, they were perceived as personal and caring by participants; and the ability to save, re‐read and share text‐messages was valued; also reported in another Aboriginal study involving a text‐message component 11 …”

“…The other lifestyle factors of fruit, sugary drinks, alcohol, physical activity and smoking showed potentially promising results, and warrant further investigation with a larger study to determine efficacy. This would add to the limited literature regarding health text‐message programs for Aboriginal people, such as the Too Deadly for Diabetes study which reported significant improvements in HbA1c, systolic blood pressure and weight loss at 10 weeks after an intensive multi‐factorial intervention including meal plans and an online cooking program; tracking of weight loss, foods eaten and exercise into personalised diary; flexible exercise program; YouTube videos on motivation, barriers and exercise sessions; text‐messages; and face‐to‐face weekly group sessions 11 …”

“…High rates of program acceptability and engagement may have resulted from the intervention using cultural determinants of health, 10 with program delivery occurring within an established Aboriginal‐led program to enhance participant empowerment, self‐determination, connectivity and cultural safety 11 . Offering all clients the text‐messages may have enhanced program acceptability, as positive outcomes are reported with inclusive interventions 11 which are preferred over randomised control trials 12 . Our minimally tailored text‐messages were considered culturally acceptable, similar to findings from an Aboriginal infant feeding mHealth program with minimal tailoring 13 .…”

“…High use of mobile phones among Aboriginal people, 5 and the fact that text-messages T A B L E 2 Self-report behavioural measures at baseline to 3 months and baseline to 6 months for complete cases can be received without phone credit or data, provide significant potential for access to health support. 14 The ease and convenience of text-messages may also be preferred over health apps for Aboriginal people who have reported computer literacy issues 11 and poor engagement. 12 The sharing of text-messages by participants with their community demonstrated program reach outside of the study group.…”

“…13 Despite the text-messages being automated, they were perceived as personal and caring by participants; and the ability to save, re-read and share text-messages was valued; also reported in another Aboriginal study involving a text-message component. 11 The low-cost, automated text-message program was reported as feasible by both program facilitators, with requests for the program to become embedded into standard practice and suggestions to offer it to other community-led Aboriginal organisations. High use of mobile phones among Aboriginal people, 5 and the fact that text-messages T A B L E 2 Self-report behavioural measures at baseline to 3 months and baseline to 6 months for complete cases can be received without phone credit or data, provide significant potential for access to health support.…”