| Summary: | In response to the increasing prevalence and impact of non-insulin-dependent diabetes mellitus
(NIDDM) in Canadian Aboriginal populations, a community-based diabetes prevention and control
project of 24 months duration was implemented in the interior of British Columbia. A participatory
approach was used to plan strategies by which diabetes could be addressed in ways acceptable
and meaningful to the intervention community. The strategies emphasised a combination of
changing behaviours and changing environments. Project workers implemented programme
initiatives. Researchers served as facilitators and advocates for community change processes.
The project was quasi-experimental. The intervention community was matched to two
comparison communities. Workers in the intervention community conducted interviews of
individuals with or at risk for diabetes during a seven-month pre-intervention phase (n = 59).
Qualitative analyses were conducted to elucidate strategies for intervention. Baseline measures
were obtained in each community, and implementation began in the eighth month of the project.
A population approach was taken to diabetes prevention and control.
Trend measurements of diabetes risk factors were obtained in each community for "high-risk"
cohorts (persons with or at familial risk for NIDDM) (n = 105). Cohorts were tracked over the
16-month intervention phase, with measurements at baseline, the midpoint and completion of the
study. Cross-sectional surveys of diabetes risk factors were conducted in each community at
baseline and the end of the intervention phase (n = 295). Surveys of community systems were
conducted during the pre-intervention and early and late intervention phases.
The project yielded few changes in quantifiable outcomes. Activation of the intervention
community was insufficient to enable individual and collective change through dissemination of
quality interventions for diabetes prevention and control. Theory and previous research were not
sufficiently integrated with information from pre-intervention interviews, nor were qualitative
results brought to bear on activation and intervention planning. Interacting with these limitations
were the short planning and intervention phases, just eight and sixteen months, respectively.
The level of penetration of the interventions mounted was too limited to be effective. Attention to
process is warranted, as is the feasibility of achieving effects within 24 months.
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