A Randomized-Controlled, Pilot Intervention on Diabetes Prevention and Healthy Lifestyles in the New York City Korean Community

Abstract

Asian Americans experience diabetes at a higher rate than non-Hispanic whites. Diabetes prevention programs using lifestyle interventions have been shown to produce beneficial results, yet there have been no culturally-tailored programs for diabetes prevention in the Korean community. We explore the impact and feasibility of a pilot Community Health Worker (CHW) intervention to improve health behaviors and promote diabetes prevention among Korean Americans using a randomized controlled trial. Between 2011 and 2012, a total of 48 Korean Americans at risk for diabetes living in New York City (NYC) participated in the intervention. Participants were allocated to treatment or control groups. A community-based participatory research approach guided development of the intervention, which consisted of 6 workshops held by CHWs on diabetes prevention, nutrition, physical activity, diabetes complications, stress and family support, and access to health care. Changes over 6 months were examined for clinical measurements (weight, BMI, waist circumference, blood pressure, glucose, and cholesterol); health behaviors (physical activity, nutrition, food behaviors, diabetes knowledge, self-efficacy, and mental health); and health access (insurance and self-reported health). In this small pilot study, changes were seen in weight, waist circumference, diastolic blood pressure, physical activity nutrition, diabetes knowledge, and mental health. Qualitative findings provide additional contextual information that inform ways in which CHWs may influence health outcomes. These findings demonstrate that a diabetes prevention program can be successful among a Korean American population in NYC, and important insight is provided for ways that programs can be tailored to meet the needs of vulnerable populations.

Systematic review of physical activity promotion by community health workers

“…A further twelve articles were excluded for the following reasons: incompatible age range (adolescents) (n= 4), lack of response from authors to requests for full texts (n= 3), publications based on the same study (n= 3), intervention not conducted by CHW (n= 1) and having a sample of patients with diseases such as autism, cerebral palsy, epilepsy and developmental disabilities (n= 1) ( Figure 1). The descriptive synthesis was based on the data of 26 original trials (Staten et al, 2004;Balcázar et al, 2005;Becker et al, 2005;Staten et al, 2005;Larkey, 2006;Gomes and Duarte, 2008;Plescia et al, 2008;Babamoto et al, 2009;Folta et al, 2009;Castillo et al, 2010;Comellas et al, 2010;Treadwell et al, 2010;Allen et al, 2011;Ayala, 2011;Mier et al, 2011;Ruggiero et al, 2011;Shlay et al, 2011;Spencer et al, 2011;Coleman et al, 2012;Cene et al, 2013;Islam et al, 2013a;Islam et al, 2013b;Jennings et al, 2013;Krantz et al, 2013;Duggan et al, 2014;Ursua et al, 2014).…”

“…Regarding study design, the majority of trials had no control group (n= 15, 57.7%) (Balcázar et al, 2005;Staten et al, 2005;Larkey, 2006;Castillo et al, 2010;Comellas et al, 2010;Treadwell et al, 2010;Ayala, 2011;Mier et al, 2011;Ruggiero et al, 2011;Shlay et al, 2011;Cene et al, 2013;Islam et al, 2013a;Jennings et al, 2013;Krantz et al, 2013;Ursua et al, 2014) and eight were pilot studies (Castillo et al, 2010;Comellas et al, 2010;Treadwell et al, 2010;Mier et al, 2011;Cene et al, 2013;Islam et al, 2013b;Krantz et al, 2013;Ursua et al, 2014). Only two studies were performed outside the United States, one in Brazil (Gomes and Duarte, 2008) and the other in England (Jennings et al, 2013) (Table 1).…”

Evaluation of physical activity reporting in community Diabetes Prevention Program lifestyle intervention efforts: A systematic review

“…Session content related to physical activity varied, but included the key principles of the DPP such as ways to safely increase PA, addressing barriers to PA, and changing environmental and social cues relating to PA. Thirteen studies included PA sessions or supervised exercise as an option for participants (Amundson et al, 2009;Guyse et al, 2011;Harwell et al, 2011;Islam et al, 2013;Jaber et al, 2011;Ma et al, 2013;Matvienko and Hoehns, 2009;McBride et al, 2008;Vadheim et al, 2010a;Vadheim et al, 2010b;Endevelt et al, 2015;Kutob et al, 2014;Swanson et al, 2012), three studies offered free fitness center membership (Aldana et al, 2005;Seidel et al, 2008;Nicklas et al, 2014), and two studies offered participants access to onsite resources for PA (Ackermann et al, 2008;Barham et al, 2011).…”

“…The proportion of participants meeting goal prior to intervention ranged from 19.6-53.6% (Islam et al, 2013;Jaber et al, 2011;Matvienko and Hoehns, 2009;Whittemore et al, 2009;Jiang et al, 2013). After the initial phase of intervention, or at the first follow-up assessment, the range was 41.2-75% (Amundson et al, 2009;Guyse et al, 2011;Islam et al, 2013;Jaber et al, 2011;Kramer et al, 2011;Kramer et al, 2013;Vadheim et al, 2010a;Vanderwood et al, 2010;Whittemore et al, 2009;Jiang et al, 2013). After intervention completion, or at the final assessment, the range was 61.5-78% Matvienko and Hoehns, 2009;Vadheim et al, 2010a;Vanderwood et al, 2010).…”

Culturally Tailored Nutrition And Lifestyle Intervention Can Effectively Reduce The Cardio-metabolic Risk Factors In Korean Migrants Living In Australia

“…However there are limited studies on nutrition education intervention focused on a combination of eating behaviour and physical activity among Korean migrants worldwide [17,18]. The aim of this study was to investigate the effect of an 8-week nutrition and lifestyle intervention focused on improving cardio-metabolic risk factors including central obesity, blood pressure, blood lipids and glucose on Korean migrants in Australia.…”