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Helping neighbors: Addressing diabetes as a community

Taking a community-based approach to diabetes could help curb high rates of the disease in less wealthy nations, new research suggests.

Diabetes is traditionally managed with medications and lifestyle changes. But as diabetes rates climb in lower income countries, community-based interventions are of growing importance, argues Stanford population health specialist Abby King, PhD.

That's because diabetes rates are driven by factors such as exercise and diet -- both of which can be strongly influenced by community-level approaches. Is there healthy food available? Safe routes for walking or culturally accepted forms of exercise?

An issue in Translational Behavioral Medicine examines the issue. To learn more, I spoke with King recently.

What is a community- based participatory approach?

Community-based participatory research (CBPR) approaches typically begin with researchers partnering with community members throughout the entire research process to ensure that programs being developed and tested are relevant, feasible to deliver, and sustainable beyond the life of the formal research project. This "partners in research" approach is at the heart of CBPR. 

Such approaches are particularly important when working with communities that have less collective experience and familiarity with science, which can lead to distrust and suspicion of the research enterprise. They are also particularly important for communities with less resources to bring to bear on what are often complex health problem areas, such as diabetes.

Why take this type of community-based approach with diabetes, especially in lower income countries?

Among the reasons are the fact that diabetes falls within the 10 top leading causes of death worldwide, and the alarming estimates that 4 out of 5 people with diabetes now live in lower income countries. The many health complications from diabetes also can create significant economic impacts not only for individuals and their families, but also for the health care system more generally, as well as nations' economies.  

Tell me more about some programs that have been successful.

One of the exciting advances in this field is the successful implementation of peer-led approaches in helping to prevent and manage diabetes. Such peer support groups and programs have been shown to improve diabetes and the outcomes associated with it, in both higher income and lower to mid-income nations, including India and China.

For example, in the Kerala Diabetes Prevention Program in India, trained peer leaders were able to successfully deliver culturally adapted behavioral education and health promotion groups aimed at improving behavioral risk factors associated with diabetes onset, including physical inactivity, unhealthy food choices, and other health behaviors.

At two-year follow-up, individuals assigned to receive this peer-led lifestyle intervention had significant improvements in cardiometabolic, clinical, and behavioral risk factors for diabetes relative to a control group. Current efforts are now focusing on scaling up this program to a wider population in India.

Similarly, recent evidence from Shanghai, China, this time with people already diagnosed with diabetes, has shown that peer support groups can be effective in helping people control their hemoglobin A1c levels ---an important marker of people's average blood sugar levels over several months. This program is now being expanded, and shows that community-based, as well as clinical-based, peer support can be a valuable approach for diabetes management.  

One approach that you recommend involves citizen science -- can you describe that?

Community-engaged citizen science approaches can provide a systematic yet practical method for fully engaging community members in the research endeavor in ways that can build their individual and collective skills and feelings of competence. These skill sets and knowledge can in turn provide the catalyst for actually changing things for the better in their own neighborhoods and communities. 

The example of the citizen science approach that I described in my commentary, called Our Voice, is an evidence-supported example that is now being implemented in over 20 countries, typically in underresourced communities. It can be used to address a variety of challenges, such as making a community friendly for older adults.

The Our Voice process has shown how providing community members with simple yet effective tools for capturing aspects of their local environments that either help or hinder their health and then teaching them how to communicate their findings in compelling ways, can lead to meaningful local changes.

These local changes (e.g., improving local infrastructures for walking; increasing access to healthy foods; facilitating social connectivity and support through making places and programs more accessible) can positively impact their own community engagement and health as well as the health and well-being of their neighbors.

Photo by Melissa Viiron

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