# Presentation: 155438

## Partners Reducing the Effects of Diabetes: Initiatives through Collaboration and Teamwork P.R.E.D.I.C.T

- David L. Katz, MD, MPH, FACPM, FAAC
- Georgia Jennings, MPH
- Margot Zaharek, MS
- Ann Agro, MPH
- Lindsey Greene, BA
- Valentine Yanchou Njike, MD, MPH
- Zubaida Faridi, MBBS, MPH

**Yale Prevention Research Center**
**Yale University School of Medicine**

## Centers for Disease Control and Prevention (CDC)
Connecticut Health Foundation (CHF)

- Connecticut Health Foundation (CHF)

**Sponsors**

## Proposed Project

- Diabetes prevention and management among African Americans
- Highly participatory, 3-phase intervention

## Background and Significance

- 7th leading cause of death in CT
- Disproportionate burden: African Americans are 2 times as likely as whites to get diabetes
- Hospitalization is 3.5 times in African Americans as compared to the whites
- 27% more likely to die of complications

## Methods

- Consisted of 3 Phases
- I.    Formative Research
- II.   Design and implement intervention
- III.  Evaluation

## Phase I. Formative Research

- Literature Search of Best Practices
- Formation of Community Partnership Team
- Focus Groups
- Environmental Audit

## Phase II. Intervention Description

- Purpose
- Demonstrate the efficacy of using a Community Health Advisor (CHA) model
- Improve diabetes **prevention** and management behaviors in an urban African American community

## Church Based Component

- Setting:
- 13 churches in New Haven (intervention site)
- 6 churches in Bridgeport (control site)
- Participants:
- 21 CHAs in New Haven
- 17 CHAs in Bridgeport
- 134 congregation members in New Haven
- 125 congregation members in Bridgeport

## Church Based Component, Con’t

- CHA Training
- 10-week training session on diabetes prevention and management
- Each session lasted  2 hours and was conducted by a Certified Diabetes Educator
- About the disease, healthy dietary patterns, increased physical activity

## Church Based Component, Con’t

## Quantitative
CHA training: Pre/post diabetes knowledge survey
Church based component: 
         7 Day Physical Activity Recall
         Harvard Food Frequency Questionnaire  
         Nutrition Self Efficacy
         Physical activity self efficacy
         Medical Outcomes Social Support Survey

- CHA training: Pre/post diabetes knowledge survey
- Church based component:
-          7 Day Physical Activity Recall
-          Harvard Food Frequency Questionnaire
-          Nutrition Self Efficacy
-          Physical activity self efficacy
-          Medical Outcomes Social Support Survey

**Phase III.  Evaluation**

## Demographic Characteristics and Baseline values

| Variable | New Haven (N=121) | Bridgeport (N=125) | p-value |
| --- | --- | --- | --- |
| Gender |  |  |  |
| Female, n (%)  | 101 ( 84.87) | 95 ( 77.87) | 0.1630 |
| Male, n (%) | 18 ( 15.13) | 27 ( 22.13) |  |
| Education Level |  |  |  |
| Some High School or High School Diploma, n (%) | 56 (47.46) | 35 (28.46) | 0.0098 |
| Some College, n (%) | 38 (32.20) | 54 (43.90) |  |
| Associate or Bachelor Degree, n (%) | 24 (20.34) | 34 (27.64) |  |
| Household Income |  |  |  |
| Less than $29.999, n (%) | 55 ( 51.89) | 37 ( 32.17) | 0.0105 |
| $30.000- $49.000, n (%) | 23 ( 21.70) | 39 ( 33.91) |  |
| More than $50.000, n (%) | 28 ( 26.42) | 39 ( 33.91) |  |
| Body Weight (lbs) | 204.63 ± 52.40 | 193.92 ± 43.74 | 0.0939 |
| Body Mass Index (kg/m2) | 33.86 ±  8.4 | 31.90 ± 7.15 | 0.0603 |
| Social Support |  |  |  |
| Emotional/Information Support | 31.79 ± 7.58 | 30.62 ± 7.91  | 0.2395 |
| Tangible Support | 15.97  ± 3.89 | 14.79 ± 4.45 | 0.0283 |
| Affectionate Support | 12.91 ± 2.67 | 12.06 ± 3.42 | 0.0313 |
| Positive Social Interaction | 12.59 ± 2.88 | 11.75 ± 3.19 | 0.0316 |
| Overall Support Index | 76.97 ± 15.16 | 72.41 ± 18.08 | 0.0329 |
| Diabetic Knowledge (%) | 65.99 ± 9.93 | 68.12 ± 10.27 | 0.1004 |
| Physical Activity self-efficacy | 13.42 ± 4.02 | 14.02 ± 3.73 | 0.2315 |
| Energy Expenditure (kcal/kg/wk) | 124.87 ± 109.92 | 134.35 ± 110.47 | 0.5051 |
| Nutrition self Efficacy | 14.99 ± 3.92 | 15.54 ± 3.62 | 0.1648 |

**Demographic Characteristics and Baseline values**

**Baseline values of selected nutrients**

| 
Variable | Bridgeport (n=124) | New Haven (n=122) | p-value |
| --- | --- | --- | --- |
| Total calories  | 2232.1 ± 2029.6 | 2656.2 ± 2802.6 | 0.1760 |
| Total Protein | 101.4 ± 90.2 | 114.0 ± 112.1 | 0.3322 |
| Total Carbohydrates | 278.9 ± 298.2 | 348.2 ± 402.6 | 0.1269 |
| Fats |  |  |  |
| Trans fats | 81.2 ± 67.9 | 93.3 ± 96.2 | 0.2571 |
| Saturated fatty acid | 25.9 ± 19.8 | 30.7 ± 32.8 | 0.1665 |
| Mono-unsaturated fatty acid | 30.5 ± 26.5 | 34.9 ± 34.9 | 0.2889 |
| Poly-unsaturated fatty acid | 16.4 ± 17.1 | 17.8 ± 18.6 | 0.5378 |
| Total Cholesterol | 334.7 ± 262.6 | 385.5 ± 425.1 | 0.2619 |

## Change in Outcome measures

| 
Variable | New Haven (N=83) | Bridgeport (N=78) | p-value |
| --- | --- | --- | --- |
| Body Weight (lbs) | 0.32 ± 25.92 | 0.82 ± 19.30 | 0.8974 |
| Body Mass Index (kg/m2) | -0.63 ± 6.72 | 0.13 ± 3.18 | 0.4191 |
| Social Support |  |  |  |
|      Emotional/Information Support | 0.99 ± 7.74 | 0.32 ± 7.48 | 0.5757 |
|      Tangible Support | -0.52 ± 4.49 | 0.09 ± 3.38 | 0.3312 |
|      Affectionate Support | -0.33 ± 3.09 | -0.17 ± 3.55 | 0.7648 |
|      Positive Social Interaction | -0.33 ± 3.18 | -0.49 ± 3.77 | 0.7743 |
| Overall Support Index | 0.14 ± 15.45 | 0.20 ± 16.40 | 0.9816 |
| Diabetic Knowledge (%) | 2.45 ± 11.22* | 1.76 ± 0.87 | 0.6896 |
| Physical Activity self-efficacy | 0.23 ± 5.46 | 0.38 ± 3.49 | 0.8400 |
| Physical Activity Level, past 3 months |  |  |  |
|      Increased, n (%) | 20 (25.64) | 25 (32.05) | 0.6652 |
|      Decreased, n (%) | 14 (17.95) | 12 (15.38) |  |
|      About the same, n (%) | 44 (56.41) | 41 (52.56) |  |
| Nutrition self Efficacy | 0.31 ± 4.66 | 0.64 ± 2.82* | 0.5858 |

**Table 2.** Change in outcome measures from baseline of selected nutrients

**Change in outcome measures from baseline of selected nutrients **

| 
Variable | Bridgeport (n=78) | New Haven (n=83) | p-value†  |
| --- | --- | --- | --- |
| Total calories  | -198.2 ± 1263.3 | -375.5 ± 1553.1 | 0.3287 |
| p-value‡ | 0.0832 | 0.0089 |  |
| Total Protein | -9.0 ± 60.1  | -11.3 ± 63.9   | 0.7691 |
| p-value‡ | 0.0982 | 0.0537 |  |
| Total Carbohydrates | -28.2 ± 180.1  | -64.1 ± 248.1  | 0.1970 |
| p-value‡ | 0.0843 | 0.0053 |  |
| Fats |  |  |  |
| Trans fats | -6.1 ± 48.3   |    -9.0 ± 47.0  | 0.6358 |
| p-value‡ |  0.1592  | 0.0365 |  |
| Saturated fatty acid | -1.5 ± 14.2  | -2.2 ± 14.0 | 0.6940 |
| p-value‡ | 0.2445 | 0.0868 |  |
| Mono-unsaturated fats | -2.2 ± 18.7 | -3.4 ± 19.5  | 0.6255 |
| p-value‡ | 0.1980 | 0.0600 |  |
| Poly-unsaturated fats | -1.8 ± 12.5  | -2.3 ± 11.2   | 0.7375 |
| p-value‡ | 0.1054 | 0.0227 |  |
| Total Cholesterol | -12.6 ± 194.9   | -16.4 ± 219.3 | 0.8862 |
| p-value‡ | 0.4732 | 0.4127 |  |

## Challenges

- Re-engaging disengaged CHAs
- CHAs lack of education

## Thank you

- New Haven Churches
- Bridgeport Churches
- Survey Participants
- Bridgeport and New Haven Community Partnership Teams