Reducing Health Disparities Related to Diabetes: Lessons Learned Through the Canadian Diabetes Strategy Community-Based Program

Case Study 5: Addressing Childhood Obesity Through a Community-Based Strategy to Screen and Engage High-Risk Migrant Families - Families in Action: A Global Village Pediatric Diabetes Prevention Resource

Lead Organization

• Middlesex-London Health Unit

Key Partners

• Brescia University College
• Children's Hospital of Western Ontario
• London Health Sciences Centre
• Schulich School of Medicine and Dentistry
• St. Joseph's Health Care Primary Care Diabetes Support Program
• The University of Western Ontario
• The YMCA of London

Funders

• Canadian Diabetes Association
• Public Health Agency of Canada
• Lawson Foundation

Target Group

• Latin American children and their families

Communities

• London, Ontario (expanded to sites in Toronto and Ottawa)

Background

London is home to one of the fastest-growing Latin American communities in Ontario. It is estimated that 35% of Latin American children in London are overweight and 24% are obese—more than double the proportions of children from the general population in London. The prevention of obesity is recognized as a critical step in the prevention of type 2 diabetes. Compared with the general population's rate of type 2 diabetes, the rate for Latin American adults is three to four times higher. It is estimated that children with parents who have diabetes are twice as likely to get diabetes as those whose parents do not have the disease.

The Families in Action (FIA) Program was designed to address the needs of the Latino population in London by identifying those children at greatest risk of developing obesity-related health consequences, such as diabetes.

Implementation

The program included both a screening component and a six-month intervention component for children and families identified as high risk.

Screening

Recruitment and diabetes screening events were held in local community centres and churches. Children's height and weight were measured and used to calculate body mass index (BMI). Those with a BMI above the 85th percentile for their age and gender were invited to participate in the intervention. Information was collected on family history, nutrition and physical activity habits, breastfeeding history and birth weight.

• A total of 178 children between the ages of 6 and 12 were screened.
• Of these, 71 (40%) were identified as overweight or obese.
• All 71 children enrolled in the program.

Intensive Six-Month Intervention

Children and their families attended hour-long intervention sessions monthly for six months. They were asked to fill out a survey about basic information such as level of physical activity and screen time. Children were measured for weight, height and waist circumference, and participated in a fitness shuttle run.

Children and their families met with the case manager to develop one or two main goals for the family that month (e.g. reduce the number of sugary drinks consumed). Case managers provided coaching and support to help the families meet their goals. Subsequently, the children were invited to participate in a nutrition program. Children were taught to make a healthy snack and were provided with the recipe for the snack. Parents had the opportunity to ask questions of the dietitians.

Evaluation

The evaluation of the project was a partnership between the public health unit, the community and academic institutions. Participant measurements (e.g. weight, height, physical fitness, eating habits) were taken prior to entry in the program and changes were tracked over a 12 month time period. Information on sociodemographics and food security was collected prior to entry in the program through in person interviews. Focus groups were also conducted to examine the utility of the training resource and the adaptability of the FIA model.

Results

After the six-month intervention, the following improvements were noted:

• Physical activity had increased by 46 minutes a day;*
• Screen time was reduced by 55 minutes a day;*
• Fruit and vegetable intake had increased by 1.1 servings a day;*
• Junk food consumption was reduced by 3.3 times a week;* and
• BMI had declined.*

(*Statistically significant P<0.05)

Reaching the Population

• FIA presentations were conducted at community meetings, churches and community health forums, in local Spanish newsletters and in radio interviews in Spanish.
• Caseworkers were respected members of the community, which helped with acceptance of the program.
• In order to overcome barriers to completing the program, families were provided with a complimentary YMCA pass for the first three months of the program and a subsidized rate thereafter ($35/family/month). In addition, the families received free public transit tickets to attend sessions and vouchers to purchase fruits and vegetables.
• These incentives (e.g. YMCA membership, grocery vouchers, transit costs) encouraged both participation and healthy behaviours.

Lessons Learned

• The barriers to healthy behaviours in the target population went beyond the health sector. They included settlement, housing and employment issues. Information was provided in the Resource Manual developed for caseworkers in order to help address these barriers.
• Lessons learned from this pilot program in London were used to adapt the program to three new sites: elsewhere in London, in Ottawa and in Toronto. These sites served South Asian, Latin American and African populations. Using the FIA Resource Manual and a small operating grant, each site adapted the program to meet the needs of its target population. The adaptability and effectiveness of the FIA model is being evaluated in these new sites for use with other ethnocultural communities and in other urban settings.

"There is a need to approach the issue of childhood obesity from a family perspective in order to have the greatest impact."

FIA Program Coordinator

Resources

A Families in Action Resource Manual was created with step-by-step instructions to introduce a culturally appropriate diabetes prevention program in the community. The manual is designed for use by community agencies that serve newcomers to communities or by those who are mandated to address diabetes prevention.

Download the complete manual and additional resources at
www.gvfia.com

For additional information:
Gillian Mandich, Project Co-ordinator
E-mail: gmandich@uwo.ca