Abstract
Aim
To evaluate the effects of a randomized education program for community health care workers (CHCWs) on the knowledge, awareness and understanding of key messages related to healthy eating among community members at risk for diabetes (at-risk-DM) identified through community diabetes screening.
Subjects and methods
Sixty-nine health centers from five districts in Chiang Mai Province, Thailand, were randomized into the intervention (CHCWs-IG, n = 35) and control group (CHCWs-CG, n = 34). CHCWs-IG participated in a diabetes prevention education program (DPEP) over 4 months. No training/support materials were provided to the CHCWs-CG. The knowledge of all CHCWs was assessed at baseline and the 4- and 8-month follow-ups. To test knowledge dissemination from CHCWs to at-risk-DM, awareness of key messages and other risk factors was tested between at-risk-DM in the CHCW intervention group (at-risk-DM-IG, n = 511) compared with controls (at-risk-DM -CG, n = 405) at baseline and 8 months.
Results
CHCWs-IG knowledge scores improved from baseline [mean (SD), 56.5% (6.26)] after 4-month training [75.5% (6.01), p < 0.001] and 8-month follow-up [71.3%(7.36), p < 0.001) while those of CHCW-CG remained unchanged. Body weight, body mass index, waist circumference and systolic blood pressure within at-risk-DM-IG and at-risk-DM-CG at baseline and 8 months were not significantly different. Knowledge test scores of both groups after 8 months had increased from baseline (p = 0.001) but were not different from each other.
Conclusion
DPEP for CHCWs was effective in improving knowledge. However, it was likely that multiple influences resulted in improvements in community member knowledge. As expected, no difference between groups in physical measures was observed at 8 months. Long-term lifestyle changes towards the health outcome of diabetes prevention are suggested for future study.
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References
Aekplakorn W, Bunnag P, Woodward M, Sritara P, Cheepudomwit S, Yamwong S, Yipintsoi T, Rajatanavin R (2006) A risk score for predicting incident diabetes in the Thai population. Diabetes Care 29(8):1872–1877
Aekplakorn W, Chongsuvivatwong V, Abbott KJ, Suwanprapisa T, Premgamone B, Tiptarado S, Chaikittipon C, Lim SS (2007) Prevalence and management of diabetes and associated risk factors by regions of Thailand. Diabetes Care 30(8):2007–2012
Amend A, Melkus GD, Chyun DA, Galasso P, Wylie-Rosett J (2007) Validation of dietary intake data in black women with type 2 diabetes. J Am Diet Assoc 107:112–117
Armstrong SJ, Bryce J, de Savigny D, Lambrechts T, Mbuya C, Mgalula L, Wilczynska K, Tanzania IMCI Multi-Country Evaluation Health Facility Survey Study Group (2004) The effect of integrated management of childhood illness on observed quality of care of under-fives in rural Tanzania. Health Policy Plan 19:1–10
Baker EA, Kreuter M, Homan SM, Starkloff-Morgan S, Schonhoff R, Francioni A (2002) Using community-based participatory processes to bring health education technology to communities. Health Promot Pract 3(1):83–94
Baumgartner TA, Chung H (2001) Confidence limits for intraclass reliability coefficients. Meas Phys Educ Exerc Sci 5:179–188
Briggs FH, Turner MB, Gary TL, Brancati FL, Hill MN, Levine DM, Bone LR (2006) Training community health workers as diabetes educators for urban African Americans: value added using participatory methods. Prog Community Health Partnersh 1(2):185–193
Bryant CA, McCormack Brown KR, McDermott RJ, Forthofer MS, Bumpus EC, Calkins SA, Zapata LB (2007) Community-based prevention marketing: organizing a community for health behavior intervention. Health Promot Pract 8(2):154–163
Eriksson J, Lindstrom J, Valle T, Aunola S, Hamalainen H, Parikka-Ilanne P, Keinänen-Kiukaanniemi S, Laakso M, Lauhkonen M, Lehto P, Lehtonen A, Louheranta A, Mannelin M, Martikkala V, Rastas M, Sundvall J, Turpeinen A, Viljanen T, Uusitupa M, Tuomilehto J (1999) Prevention of type II diabetes in subjects with impaired glucose tolerance: the diabetes prevention study (DPS) in Finland. Study design and 1-year interim report on the feasibility of the lifestyle intervention programme. Diabetologia 42(7):793–801
Flynn MAT, McNeil DA, Maloff B, Mutasingwa D, Wu M, Ford C, Tough SC (2006) Reducing obesity and related chronic disease risk in children and youth: a synthesis of evidence with ‘best practice’ recommendations. Obes Rev 7(suppl 1):7–66
French SA, Story M, Jeffery RW (2001) Environmental influences on eating and physical activity. Annu Rev Public Health 22:309–335
Hair JF, Anderson RE, Tatham RL, Black WC (1998) Multivariate data analysis, 5 edition. Prentice Hall Inc., London
Keeratiyutawong P, Hanucharurnkul S, Melkus GD, Vorapongsathon OPT (2006) Effectiveness of a self-management program for Thai with type 2 diabetes. Thai J Nurs Res 10:85–97
Knowler WC, Barrett-Connor E, Fowler SE, Hamman RF, Lachin JM, Walker EA, Nathan DM, Diabetes Prevention Program Research Group (2002) Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med 346:393–403
Lindstrom J, Louheranta A, Mannelin M, Rastas M, Salminen V, Eriksson J, Uusitupa M, Tuomilehto J (2003) The Finnish diabetes prevention study (DPS): lifestyle intervention and 3-year results on diet and physical activity. Diabetes Care 26:3230–3236
Mochari H, Gao Q, Mosca L (2008) Validation of the MEDFICTS dietary assessment questionnaire in a diverse population. J Am Diet Assoc 108:817–822
Raine KD (2004) Overweight and obesity in Canada: A population health perspective. CIHI/CPHI
Richard L, O’Loughlin J, Masson P, Devost S (1999) Healthy menu intervention in restaurants in low-income neighbourhood: a field experience. J Nutr Educ Behav 31:54–59
Salter D, Richards L, Carey T (2004) The ‘T5’ design model: An instructional model and learning environment to support the integration of online and campus-based course. EMI Educ Media Int 207–217
Satterfield DW, Burd C, Valdez HG, Eagle SJ (2002) The in-between people: participation of community health representatives in diabetes prevention and care in American Indian and Alaskan Native communities. Health Promot Pract 3(2):166–175
Schulz AJ, Zenk S, Odoms-Young A, Hollis-Neely T, Nwankwo R, Lockett M, Ridella W, Kannan S (2005) Healthy eating and exercising to reduce diabetes: exploring the potential of social determinants of health frameworks with the context of community-based participatory diabetes prevention. Am J Public Health 95(4):645–651
Segal-Isaacson C, Wylie-Rosett J, Gans KM (2004) Validation of a short dietary assessment questionnaire: the rapid eating and activity assessment for participants short version (REAP-S). Diabetes Educ 30:774–781
Sirichakwal PP, Sranacharoenpong K (2008) Practical experience in development and promotion of food-based dietary guidelines in Thailand. Asia Pac J Clin Nutr 17(Suppl 1):63–65
Sranacharoenpong K, Hanning RM, Sirichakwal PP (2009) Chittchang U (2009) process and outcome evaluation of a diabetes prevention education program for community healthcare workers in Thailand. Educ Health (Abingdon) 22(3):335–346
Sranacharoenpong K, Hanning RM (2011) Developing a diabetes prevention education programme for community health care workers in Thailand: formative findings. Prim Health Care Res Dev 12:357–369
Sranacharoenpong K, Hanning RM (2012) Diabetes prevention education program for community health care workers in Thailand. J Community Health 37:610–618
Story M, Kaphingst KM, Robinson-O’Brien R, Glanz K (2008) Creating healthy food and eating environments: policy and environmental approaches. Annu Rev Public Health 29:253–272
Wibulpolprasert S (ed) (2002) Thailand health profile 2001–2004. Express Transportation Organization Printing Press, Bangkok
Wibulpolprasert S (Editor) (2007) Thailand health profile 2005–2007. Bangkok: Express Transportation Organization. http://www.hiso.or.th/hiso/picture/reportHealth/report/ThaihealthProfileE2007.pdf. Accessed 26 March 2016
Witmer A, Seifer SD, Finocchio L, Leslie J, O’Neil EH (1995) Community health workers: integral members of the health care work force. Am J Public Health 85:1055–1058
World Health Organization (2002) Globalization, Diets and Noncommunicable Diseases. WHA55.23. Geneva, Switzerland. http://whqlibdoc.who.int/publications/9241590416.pdf. Accessed 5 Jan 2016
World Health Organization (2005) IMCI Integrated Management of Childhood Illness. (NLM classification: WS 200). Geneva, Switzerland. http://apps.who.int/iris/bitstream/10665/42939/1/9241546441.pdf. Accessed 12 Feb 2016
Acknowledgements
This research was supported by grants from the Nestlé Foundation, Switzerland. The authors acknowledge the team staff of the health care offices in Chiang Mai Province, Thailand, and particularly thank the staff of The Office of Disease Prevention and Control 10 Chiang Mai Province, Ministry of Public Health, for their facilities and hospitality. The authors thank Ms. Julia Verhaeghe for editing the English grammar.
Funding
This research was supported by the Nestlé Foundation in Switzerland.
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Ethical consideration of this study was sent for approval by the Chiang Mai Public Health Office Institutional Review Board, Ministry of Public Health, Thailand. All the respondents signed an informed consent form.
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Sranacharoenpong, K., Praditsorn, P. & Churak, P. Developing a diabetes prevention education program for community health care workers in Thailand: translation of the knowledge to at-risk people. J Public Health (Berl.) 26, 515–522 (2018). https://doi.org/10.1007/s10389-018-0897-5
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DOI: https://doi.org/10.1007/s10389-018-0897-5