A Journey behind the program! By: Heba Sadek and Neil Stephens
Introductions
Who we are: <ul><li>Heba Sadek  Manager, Health Promotion </li></ul><ul><ul><ul><li>Program Manager, SADPP </li></ul></ul>...
Who are you? 1. Name 2. Organization 3. Role
EXPECTATIONS
All about SADP <ul><li>Funded by the Toronto Central Local Health Integration Network ( TCLHIN) </li></ul><ul><li>Started ...
Program Overview
Our   Mission <ul><li>The overall goal of the program is to provide the SA communities with equitable access to services b...
Our Vision <ul><li>To prevent diabetes among the South Asian Communities by outreaching and providing culturally relevant ...
SADP Team   <ul><li>A multidisciplinary team part of the Health Promotion Department at FHC: </li></ul><ul><li>Registered ...
What we do <ul><li>We reach out to the SA communities and; </li></ul><ul><li>Conduct group screening sessions  for prediab...
Outreach
FHC’s Catchment Area Demographic Source: FHC Catchment Area Census Study 2006
Demographics within a demographic
Bangladeshi Bengali East Indian Goan Gujarati Hindu Ismaili Kashmiri Nepali Tibetan Pakistani Punjabi Sikh Sinhalese Tamil...
How we outreach to the SA community
But, why focus on the South Asian population?
The South Asians are at High Risk! Genetic predisposition lifestyle risk factors   stresses associated with migration  The...
Stat and Fact <ul><li>South Asians migrants are 4-6 times more likely to develop diabetes </li></ul><ul><li>Ontario Diabet...
 
Secondary Triad: Environmental
Program Delivery
<ul><li>FIRST SESSION </li></ul><ul><li>Initial Screening and Pre-diabetes workshop </li></ul><ul><li>SECOND SESSION </li>...
First Session:  Screening and workshop
 
 
 
 
SECOND SESSION:  Diabetes Prevention  Workshop Question:  How to Prevent Diabetes?
Healthy Eating Physical Activity Mental Health Diabetes Prevention Answer:   Healthy Lifestyle Modifications
Why focus on lifestyle modifications?   <ul><li>A recent systematic review looking at interventions for people with predia...
THIRD SESSION: Workshops delivered by our collaborative partners
South Asian community groups are continually looking to connect with programs and open to host services at their locations...
 
Innovation
SADP as an innovative initiative <ul><li>Filling gaps in service around  </li></ul><ul><ul><ul><li>a) Early detection and ...
1) Filling gaps in service around early detection and prevention <ul><ul><li>Why to screen? </li></ul></ul><ul><ul><li>A p...
Screening Tool  <ul><ul><li>Unique to SADPP </li></ul></ul><ul><ul><li>Modified from CANRISK;  </li></ul></ul><ul><ul><ul>...
Secondary Triad: Environmental
2) SADP; a community- based approach <ul><li>Culturally relevant and language specific program = connection with the commu...
3) Evidence-Based Programming <ul><li>The guidelines used to determine if the program was evidence-based were taken from t...
<ul><li>Role of Research:  thorough needs assessment, in depth focus groups, literature review and key informant interview...
 
SADPP’s Database Registration Screen
SADPP’s Database Toolkit: Questionnaire
SADPP’s Database Toolkit: Clinical
SADPP’s Database Toolkit: Anonymous Data
Evaluation
Participants screened for since February 2009 Participants determined to be at risk of prediabetes 880  660 132 Screening ...
Performance indicator Measure Baseline Target Results Prevent onset of diabetes Number of people screened 88 by March 31, ...
 
Tool Revision
SADPP as a best practice <ul><li>The criteria used to determine if the program was a best practice in health promotion was...
Our report card: highlights of evaluation <ul><li>An excellent program; achieving intended outcomes, exceeded its performa...
Highlights of evaluation, Cont… <ul><li>Broad trends that emerged in the data collected included rich program content, str...
New Developments
What have we been up to lately? <ul><li>We have been busy filling in other gaps:   </li></ul><ul><li>Developing a resource...
 
The Prediabetes Care Kit: <ul><li>Booklet </li></ul><ul><li>DVD </li></ul><ul><li>Measuring spoons </li></ul><ul><li>Pedom...
Future developments <ul><li>Heart Health Workshop </li></ul>
Our Challenges… <ul><li>Operating under a project concept versus an established core program, a funding sustainability que...
Wrap up Final thoughts and questions
Thank you!
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The Successes of the SADPP Program

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Presented at the Association of Ontario Health Centres' conference on June 10 2010 in Niagara Falls, Ontario - Canada.

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  • Heba
  • Heba
  • Neil
  • South asian profile
  • This works best in slideshow mode – try it out.
  • Can you change the box of Community Events to Community Centres?
  • Neil
  • Genetic predisposition to insulin resistance Lifestyle risk factors; calorie dense foods and decreased physical activity Stress associated with migration We learnt from the literature that the risk increases for the South Asian populations when they migrate from rural to urban areas – the risk becomes more evident when they migrate across continents. They have greater access to calorie dense foods and they lifestyles change where their physical activity decreases and stress increases
  • Healthy Immigrant Effect (mention) – Sobia/Doris.
  • Neil
  • Need to change to Prediabetes Information Session - title
  • Talk about the encounters
  • Please insert the logos of our collaborative agencies
  • Neil
  • Heba
  • The tool was developed by clinicians. I did literature research from credible sources such as the CDA, WHO, Health Canada and peer reviewed journals to develop our tool. The tool has 3 components: Questionnaire which ask about the risk factors, such as family history. The second part is the Anthropometric section (which calculates BMI and waist measurements) and the third part id the blood glucose testing (fasting and/or Random). We are very proud of the development of this tool and it’s comprehensive design
  • Heba
  • Please update the numbers with our targets
  • Neil
  • Please insert the tool box clip here and or another clip to show people adding a block/ filling a gap/ or any clip inspired by our wonderful experience with the kit- just do not put dead bodies ;)
  • To address cholesterol, Diabetes and Heart Disease
  • Heba
  • Heba
  • Intro Heba Prog Overview Heba Outreach Neil Why focus on SA Neil Program deliver Neil Logi model Neil Innovation Heba Evaluation Heba New Development Neil Challenges and wrap up Heba
  • The Successes of the SADPP Program

    1. 2. A Journey behind the program! By: Heba Sadek and Neil Stephens
    2. 3. Introductions
    3. 4. Who we are: <ul><li>Heba Sadek Manager, Health Promotion </li></ul><ul><ul><ul><li>Program Manager, SADPP </li></ul></ul></ul><ul><li>Neil Stephens Program Coordinator, SADPP </li></ul>
    4. 5. Who are you? 1. Name 2. Organization 3. Role
    5. 6. EXPECTATIONS
    6. 7. All about SADP <ul><li>Funded by the Toronto Central Local Health Integration Network ( TCLHIN) </li></ul><ul><li>Started in January 2009 to March 2010 </li></ul><ul><li>Developed by Flemingdon Health Centre </li></ul><ul><li>Social Services Network- Pilot Phase partnership around outreach </li></ul><ul><li>Focuses on the South Asian communities within Flemingdon Health Centre’s catchment area </li></ul>
    7. 8. Program Overview
    8. 9. Our Mission <ul><li>The overall goal of the program is to provide the SA communities with equitable access to services by offering language specific and culturally sensitive diabetes prevention services. </li></ul>
    9. 10. Our Vision <ul><li>To prevent diabetes among the South Asian Communities by outreaching and providing culturally relevant services at the community level. </li></ul>
    10. 11. SADP Team <ul><li>A multidisciplinary team part of the Health Promotion Department at FHC: </li></ul><ul><li>Registered Nurse </li></ul><ul><li>Registered Dietician </li></ul><ul><li>Two Outreach Workers </li></ul><ul><li>A pool of Outreach Animators with various language skills </li></ul><ul><li>A pool of dedicated Volunteers </li></ul><ul><li>Project Coordinator </li></ul>
    11. 12. What we do <ul><li>We reach out to the SA communities and; </li></ul><ul><li>Conduct group screening sessions for prediabetes using an evidence- based tool tailored for the SA population </li></ul><ul><li>Offer workshops: initial and follow up that focus on diabetes prevention and lifestyle changes </li></ul><ul><li>Connect people and make referrals to different services </li></ul>
    12. 13. Outreach
    13. 14. FHC’s Catchment Area Demographic Source: FHC Catchment Area Census Study 2006
    14. 15. Demographics within a demographic
    15. 16. Bangladeshi Bengali East Indian Goan Gujarati Hindu Ismaili Kashmiri Nepali Tibetan Pakistani Punjabi Sikh Sinhalese Tamil Sunni Shia Zoroastrian So, who makes up the South Asian demographic? And, many, many more language and cultural groups!...
    16. 17. How we outreach to the SA community
    17. 18. But, why focus on the South Asian population?
    18. 19. The South Asians are at High Risk! Genetic predisposition lifestyle risk factors stresses associated with migration The literature on diabetes in the South Asian population clearly states the high-risk status of this group
    19. 20. Stat and Fact <ul><li>South Asians migrants are 4-6 times more likely to develop diabetes </li></ul><ul><li>Ontario Diabetes (2005) estimates that 14% of the South Asian population living in Canada is living with Type 2 Diabetes, compared to 5.2% of Canada’s general population. </li></ul><ul><li>BUT </li></ul><ul><li>South Asians are generally healthy when they get here!- Toronto Star </li></ul>
    20. 22. Secondary Triad: Environmental
    21. 23. Program Delivery
    22. 24. <ul><li>FIRST SESSION </li></ul><ul><li>Initial Screening and Pre-diabetes workshop </li></ul><ul><li>SECOND SESSION </li></ul><ul><li>Diabetes Prevention Workshop </li></ul><ul><li>THIRD SESSION </li></ul><ul><li>Workshops delivered by collaborative partners </li></ul>
    23. 25. First Session: Screening and workshop
    24. 30. SECOND SESSION: Diabetes Prevention Workshop Question: How to Prevent Diabetes?
    25. 31. Healthy Eating Physical Activity Mental Health Diabetes Prevention Answer: Healthy Lifestyle Modifications
    26. 32. Why focus on lifestyle modifications? <ul><li>A recent systematic review looking at interventions for people with prediabetes found that although both lifestyle and pharmacological interventions were effective, lifestyle interventions were generally more effective ( Gillies, Abrams, Lambert,et al, 2007) </li></ul>
    27. 33. THIRD SESSION: Workshops delivered by our collaborative partners
    28. 34. South Asian community groups are continually looking to connect with programs and open to host services at their locations Programs are facing challenges gaining access to South Asian communities Final Encounter with any screened group THE SOLUTION!
    29. 36. Innovation
    30. 37. SADP as an innovative initiative <ul><li>Filling gaps in service around </li></ul><ul><ul><ul><li>a) Early detection and prevention </li></ul></ul></ul><ul><ul><ul><li>b) A tailored Screening Tool for the SA population </li></ul></ul></ul><ul><li>Community based approach; we bridge access barriers; transportation, culture and language </li></ul><ul><li>Evidence-based program design based on research and community needs assessment </li></ul><ul><li>SADPP Database </li></ul>
    31. 38. 1) Filling gaps in service around early detection and prevention <ul><ul><li>Why to screen? </li></ul></ul><ul><ul><li>A proven effective practice in high- risk populations </li></ul></ul><ul><ul><li>The detection of prediabetes is seen as a viable way to prevent the development of diabetes (Waugh, Scotland, McNamee et al., 2007). </li></ul></ul><ul><ul><li>Diabetes can be a silent condition for a long time before it presents itself for the first time- sometimes with complications! </li></ul></ul><ul><ul><li>Individuals with additional risk factors and impaired FG or GT have 2-3 times the risk of developing Diabetes </li></ul></ul>
    32. 39. Screening Tool <ul><ul><li>Unique to SADPP </li></ul></ul><ul><ul><li>Modified from CANRISK; </li></ul></ul><ul><ul><ul><li>Risk factors questionnaire: </li></ul></ul></ul><ul><ul><ul><li>Anthropometric measurements by RD </li></ul></ul></ul><ul><ul><ul><li>Blood sugar level – finger prick test by RN </li></ul></ul></ul><ul><ul><li>Tailored to South Asians; BMI and risk factors </li></ul></ul><ul><ul><li>An effective public health strategy; combines risk factor assessment with simple clinical testing </li></ul></ul><ul><ul><li>A first step to identify those who are at risk to be followed by the second step; laboratory testing </li></ul></ul>
    33. 40. Secondary Triad: Environmental
    34. 41. 2) SADP; a community- based approach <ul><li>Culturally relevant and language specific program = connection with the community, effective messages and a better chance for lifestyle modifications </li></ul><ul><li>Delivered in a community setting; we go where people are </li></ul><ul><li>We connect the dots between communities and services; the referral system and third session. </li></ul>
    35. 42. 3) Evidence-Based Programming <ul><li>The guidelines used to determine if the program was evidence-based were taken from the criteria for Evidence-Based Public Health (Posavac & Carey, 2007). </li></ul><ul><li>This includes: </li></ul><ul><li>Making decisions on the basis of the best available scientific evidence </li></ul><ul><li>Using data and information systems systematically </li></ul><ul><li>Applying planning frameworks to the development of programs </li></ul><ul><li>Engaging the community in decision-making </li></ul><ul><li>Sound evaluation </li></ul><ul><li>Disseminating results </li></ul>
    36. 43. <ul><li>Role of Research: thorough needs assessment, in depth focus groups, literature review and key informant interviews to: </li></ul><ul><ul><li>Validate project assumptions and direction </li></ul></ul><ul><ul><li>Develop the screening tool </li></ul></ul><ul><ul><li>Understand the risk factors associated with the South Asian communities </li></ul></ul><ul><ul><li>Understand the barriers to participation, prevention and management of diabetes </li></ul></ul><ul><ul><li>Program design and workshops content development </li></ul></ul><ul><ul><li>Program evaluation; process and outcome </li></ul></ul>
    37. 45. SADPP’s Database Registration Screen
    38. 46. SADPP’s Database Toolkit: Questionnaire
    39. 47. SADPP’s Database Toolkit: Clinical
    40. 48. SADPP’s Database Toolkit: Anonymous Data
    41. 49. Evaluation
    42. 50. Participants screened for since February 2009 Participants determined to be at risk of prediabetes 880 660 132 Screening sessions conducted 37 Follow Up workshops conducted 28 Groups/ centers to which SADP has been introduced 41 Our Successes so far...
    43. 51. Performance indicator Measure Baseline Target Results Prevent onset of diabetes Number of people screened 88 by March 31, 2009 660 by March 2010 880 (33.3%) Number of workshop attendees 70 by March 31, 2009 660 by March 31 2010 774 (17.27%) Number of identified pre-diabetics 25 by March 31, 2009 145 by March 31, 2010 132 (Incidence of prediabetes among SA: 12-15%) Reduce incidence of diabetes related complications Number of referrals and intake to the Mid Toronto Diabetes Education Program 41 by March 31, 2009 220 by March 31, 2010 369 (67.73%) Number of referrals to primary care doctor 7 by March 31, 2009 66 by March 31, 2010 67 (1.52%)
    44. 53. Tool Revision
    45. 54. SADPP as a best practice <ul><li>The criteria used to determine if the program was a best practice in health promotion was obtained through two different sources (Freudenberg et al, 1995, Goodstadt and Kahan, 2006). The combined guidelines suggests programs should do the following: </li></ul><ul><li>Be tailored to specific populations and settings </li></ul><ul><li>Involve participants in all aspects of the program life cycle (including planning, implementation, and evaluation) </li></ul><ul><li>Integrate a variety of efforts targeted at changing individuals, social and physical environments, communities, and policies </li></ul><ul><li>Use resources within the environment </li></ul><ul><li>Build on existing strengths within participants and communities </li></ul><ul><li>Advocate for resources and policy changes needed to achieve the desired health outcomes </li></ul>
    46. 55. Our report card: highlights of evaluation <ul><li>An excellent program; achieving intended outcomes, exceeded its performance targets </li></ul><ul><li>A program design and delivery highly reflective of current evidence, both in academia and current practice </li></ul><ul><li>Screening tool to be revised and validated </li></ul><ul><li>Has a potential to develop into a best practice </li></ul>
    47. 56. Highlights of evaluation, Cont… <ul><li>Broad trends that emerged in the data collected included rich program content, strong program functionality, and challenges related to resource scarcity. </li></ul><ul><li>Participants highlighted how informative the sessions were and also highlighted the way the program raised their awareness of diabetes. </li></ul><ul><li>Participants felt the one-time screening and information session was excellent, but insufficient to meet ongoing needs. </li></ul>
    48. 57. New Developments
    49. 58. What have we been up to lately? <ul><li>We have been busy filling in other gaps: </li></ul><ul><li>Developing a resource kit around Diabetes Prevention with culturally relevant and translated content for the SA community </li></ul><ul><li>Heart Health Workshop to address the strong association between diabetes and heart disease </li></ul>
    50. 60. The Prediabetes Care Kit: <ul><li>Booklet </li></ul><ul><li>DVD </li></ul><ul><li>Measuring spoons </li></ul><ul><li>Pedometer </li></ul><ul><li>Stress ball </li></ul><ul><li>Measuring tape (Heart and Stroke Foundation) </li></ul><ul><li>Additional translated resources </li></ul>
    51. 61. Future developments <ul><li>Heart Health Workshop </li></ul>
    52. 62. Our Challenges… <ul><li>Operating under a project concept versus an established core program, a funding sustainability question and staff insecurity </li></ul><ul><li>Difficulty in obtaining and retaining capacities </li></ul><ul><li>Unbelievable tight timelines; the start up of the initiative including meeting service targets took place over 3 months! </li></ul><ul><li>Lack of resources- a part time team achieved all this- can we imagine a full time team capacity? </li></ul><ul><li>Where is SADP on the Ministry’s Diabetes Strategy map? Educational campaigns to prevent diabetes in Aboriginal and South Asian communities and increase access to diabetes team based care- a key element. </li></ul>
    53. 63. Wrap up Final thoughts and questions
    54. 64. Thank you!

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