The feasibility of diabetes prevention in real life settings

Developing tools for community-based health promotion

Rationale and aim
Several studies have shown that the onset of type 2 diabetes (T2D) among people with pre-diabetes can be postponed or prevented by resource-intensive interventions targeting lifestyle changes. This is relevant not only for high-income countries such as Denmark, but also for low and middle-income countries (LMIC) throughout the world.

The existence of health inequity based on social determinants of health is well documented in Denmark (Diderichsen et al. 2012) as well as globally (CSDH 2008). One of the many aspects of this inequity is caused by differences in access to health care services including preventive services. In Denmark, prevention has been the responsibility of the municipalities since 2007.

The projects explore how feasible interventions can be implemented in “real life” settings with a particular focus on reaching marginalised population segments. Rose’s (2001) discussion of a “population” versus a “high risk” prevention strategy, and Frohlich & Potvin’s (2008) notion of vulnerable populations constitute key reference points to prevent T2D and other NCDs. Thus, instead of applying general structural interventions at the population level (which may potentially increase health inequities), we emphasize a prevention strategy focusing on selected marginalised population segments with known high prevalence rates and reduced access to health care services. The projects will identify population segments with reduced access to preventive services and identify potential health change agents and networks through which the health centres of the municipalities may implement tailored interventions.

Objectives
General objective:

To develop community-based health promotion approaches that utilize population resources such as local networks and health change agents, with the view to prevent T2D and other NCDs among marginalised population segments thereby reducing inequity in health.

Specific objectives:

To assess health inequity in coverage and recruitment pathways of existing preventive services at health centres in Danish municipalities.

To explore the potential of social networks and central opinion leaders in health promotion programmes in marginalised Danish communities.

To develop innovative, feasible, community–based prevention strategies and pedagogic tools targeting T2D and other NCDs.

Design, method and theory
Christakis and Fowler (2007) have demonstrated how risk factors (e.g. overweight) spread in social networks over time and this may serve as a potential entry point for health-promoting interventions. It is possible to identify centrally placed health change agents that may serve as an entry point to utilizing existing social networks for health promotion thereby reaching more marginalized segments of the population. We base our work on social science methods such as social network analysis (Scott 2000) and community capacity mapping (Valente & Pumpuang 2007) as well as the “health lifestyle theory” concept by Cockerham (2005). The research methodology is based on action research approaches (Greenwood and Levin 2007), GIS (Geographic Information Systems) analysis and mixed methods (Cresswell 2003).

Interventions will among others be guided by the World Health Organization (WHO)'s “2008-2013 Action plan for the global strategy for the prevention and control of non-communicable diseases” (including T2D) which addresses the four shared risk factors: tobacco use, physical inactivity, unhealthy diets and the harmful use of alcohol.

Target groups
Adults in marginalized population segments where the prevalence rates of prediabetes, T2D and other NCDs are known to be higher than in the general population.

Professionals working with prevention of T2D and other NCDs in institutions such as municipal health centers or NGOs.

Expected outcomes
Innovative tools for community-based prevention of T2D and other NCDs among marginalised population segments.

Funding and collaborators

Our collaborators include:
City of Copenhagen
Municipality of Vejle 
BolivVejle (tenant association)
- Epicenter (University of Aarhus) 
Clinical Epidemiology Group at Steno Diabetes Center 

Presentations
2011 Aagaard-Hansen Jens & Bonde Ane Høstgaard & Jensen Bjarne Bruun & Terkildsen Maindal, Helle: A feasible, lifestyle-based prevention of diabetes in general practice – identification of new educational key concepts. Poster presentation at World Diabetes Congress, 4-8 December 2011, Dubai.

2011 Aagaard-Hansen, Jens & Andersen, Louise Buhl & Bonde Ane & Jensen, Bjarne Bruun & Terkildsen Maindal, Helle: A review of resource utilization of lifestyle interventions for type 2 diabetes prevention among persons with pre-diabetes. Poster presentation at 4th European Public Health Conference, 10-12 November 2011, Copenhagen.

2013 Hindhede, Anette Lykke & Thygesen, Vikki: The mediating role of social networks in health promotion in a Danish vulnerable urban neighbourhood. Poster presentation at IUHPE 21st world conference, 25-29 August 2013, Pattaya.

Hindhede, AL. (2013). The mediating Role of Social Networks in a Danish Vulnerable Urban Neighbourhood. Oral presentation at BSA Medical Sociology Group 45th Annual Conference 2013, York, UK

Sidst opdateret 24-07-2015

Jens Aagaard-Hansen
Senior Researcher
Prevention Research