¡Viva Maryvale!: A Multilevel, Multisector Model to Community-Based Diabetes Prevention

Abstract

Introduction: Latino communities are disproportionately affected by type 2 diabetes and experience disparities in access to diabetes prevention programs. The purpose of this study was to test the preliminary efficacy of a culturally grounded, diabetes prevention program for high-risk Latino families delivered through an integrated research–practice partnership. Study design: The integrated research–practice partnership was established in a predominantly Latino community and consisted of a Federally Qualified Health Center, a YMCA, an accredited diabetes education program, and an academic research center. Data were collected and analyzed from 2015 to 2018. Setting/participants: Latino families consisting of a parent with an obese child between age 8 and 12 years. Intervention: The 12-week lifestyle intervention included nutrition education and behavioral skills training (60 minutes, once/week) and physical activity classes (60 minutes, three times/week) delivered at a YMCA. Main outcome measures: Outcomes included measures of adiposity (BMI, waist circumference, and body fat); HbA1c; and weight-specific quality of life. Results: Over the course of the 2-year project period, 58 families (parents n=59, children n=68) were enrolled with 36% of parents and 29% of children meeting the criteria for prediabetes at baseline. Feasibility and acceptability were high, with 83% of enrolled families completing the program, 91% of the intervention sessions attended, and 100% of families stating they would recommend the program. The intervention led to significant decreases in percentage body fat among parents (46.4% [SD=10.8] to 43.5% [SD=10.5], p=0.001) as well as children (43.1% [SD=8.0] to 41.8% [SD=7.2], p=0.03). Additionally, HbA1c was significantly reduced in parents (5.6% [SD=0.4] to 5.5% [SD=0.3], p=0.03), and remained stable in children (5.5% [SD=0.3] vs 5.5% [SD=0.3], p>0.05). Significant improvements in quality of life were reported in parents (64.6 [SD=15.8] to 71.0 [SD=13.7],p=0.001) and children (69.7 [SD=15.8] to 72.6 [SD=13.7],p=0.05). Conclusions: These findings support the preliminary efficacy of an integrated research–practice partnership to meet the diabetes prevention needs of high-risk Latino families within a vulnerable community.

Community-based educational interventions for prevention of type II diabetes: a global systematic review and meta-analysis

“…A theoretical framework was applied in only eight out of 19 studies. The frameworks used in the studies were social cognitive theory in four studies [27][28][29]38], t5 instructional design in two studies [37,39], and health belief [22] and social marketing [24] theories in one study each. In terms of educational interventions, 12 studies were aimed at improving lifestyle and increasing physical activity.…”

“…The majority ( n = 12, 63.1%) of the 19 studies were conducted in high-income countries [ 23 – 30 , 33 , 34 , 36 , 38 , 39 ], but more importantly, in merely three of them including nine studies in the USA, two in the UK, and one in Canada. The remaining seven studies were conducted in upper- and lower-middle-income countries [ 22 , 32 ], including three in India and one each in China, Thailand, Iran, and Malaysia (Suppl file 2 ).…”

“…These studies had a total of 16,106 participants (7391 cases and 9715 controls). Of 19 studies, 13 studies were conducted in urban and suburban areas [ 22 – 27 , 29 , 32 – 34 , 36 , 38 , 39 ], four in rural areas [ 21 , 28 , 30 , 35 ], and two in both kinds [ 37 ].…”

“…Ten studies were randomized [ 25 – 28 , 32 – 35 , 37 , 38 ], five had a pre–post design, [ 21 , 23 , 24 , 30 , 38 ], while two studies were non-randomized [ 22 , 29 ] (Supplementary file 2 ). Thirteen studies had adults alone [ 22 – 27 , 30 , 32 – 37 ], one had both children and adults [ 21 ], while two studies had children alone [ 29 , 38 ]. The additional descriptive data of these studies are provided in Supplementary file 2 .…”

Bridging Gaps and Understanding Disparities in Gestational Diabetes Mellitus to Improve Perinatal Outcomes

“…GDM programs focusing on education, patient engagement, and improving patients' experience positively influence maternal and fetal outcomes and future disease prevention (48,58). Possible interventions include online dietary trackers (44), smartphone applications for glucose management (59), Web-based education resources to promote healthy behavioral modifications (47), and family-and community-based programs (60). A comprehensive GDM program would ideally be woman-centric, focused on the unique social, financial, and medical concerns and situation of individual patients (Table 3).…”