Power to Prevent Diabetes Prevention Program

State: MD Type: Model Practice Year: 2011

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In November of 2009, the Frederick County Health Department launched its new Power to Prevent diabetes prevention program. The overall goal of this program is to reduce the burden of chronic disease by preventing or delaying type 2 diabetes onset and preventing or delaying health complications associated with type 2 diabetes. Those with and at risk for type 2 diabetes are eligible to join the program. However, the program targets the un/underinsured and African American and Hispanic populations.

This grant project also includes an environmental change component called the “Frederick Restaurant Challenge.” Participating restaurants agree to offer a healthy meal option which meets dietary parameters suitable for people with diabetes or for anyone wishing to eat healthier. Diners rate their dishes and the restaurant with the highest rating wins the Challenge and an award. The Power to Prevent program has currently completed three 12-week cycles and enrolled 106 participants. Of these, 75% identified as White and 25% responded as “African American,” “Other” or did not answer. 13% reported having neither private nor public health insurance. 10% affirmed there was a time in the past 12 months when they needed to see a doctor but did not due to costs.

In order to achieve the overall goal, the Power to Prevent program has two primary objectives: (1) Overweight participants lose 5-7% of their weight. Normal weight participants maintain their weight and (2) Participants are moderately physically active for at least 30 minutes a day, 5 days a week. A third objective is that participants who have not seen a healthcare provider in the past year report follow-up with a healthcare provider, and participants without a medical home are connected with a healthcare provider.

The program uses the curriculum, Power to Prevent: A Family Lifestyle Approach to Diabetes Prevention, which was developed by the National Diabetes Education Program (NDEP). The curriculum educates about diabetes while promoting healthy eating, physical activity, and making changes one step at a time. Power to Prevent is based upon the Diabetes Prevention Program (DPP) study, which showed that people at high risk for diabetes can prevent or delay the onset of the disease by losing 5-7 percent of their body weight. The DPP study participants were able to lose this weight by eating lower fat, lower calorie foods and getting 30 minutes of physical activity 5 days a week. Many of the tools used in the Power to Prevent curriculum were adapted from tools used in the DPP study. Funding for this program has been made possible through a 3-year grant received from the Office of Chronic Disease Prevention of the Maryland Department of Health and Mental Hygiene. The Frederick County Diabetes Coalition serves as the Advisory Committee for this project.

Support and in-kind services are provided by more than 10 different community organizations/groups. Each 12-week cycle is preceded by promotional efforts, which includes specific marketing to our target populations. Participants attend a registration/informational session and obtain physician clearance forms (if needed) in order to participate in the physical activity portion of the program. Participants attend one 2-hour class per week for the 12-week period. Thirty minutes of class are dedicated to doing low impact physical activity. Each participant also receives two individual sessions with the Registered Dietician and is contacted by our Health Access Coordinator to ensure all participants have seen their healthcare provider in the past year or are connected with a provider if they do not have one. Regarding progress in meeting our two primary objectives, based upon data that is available at this time, participants engaging in 30 minutes or more of moderate physical activity or 20 minutes or more of vigorous physical activity per day, at least 5 days per week improved from 36% (pre-program) to 62% (post-program). 

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Frederick County Health Department
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Power to Prevent Diabetes Prevention Program
In November of 2009, the Frederick County Health Department launched its new Power to Prevent diabetes prevention program. The overall goal of this program is to reduce the burden of chronic disease by preventing or delaying type 2 diabetes onset and preventing or delaying health complications associated with type 2 diabetes. Those with and at risk for type 2 diabetes are eligible to join the program. However, the program targets the un/underinsured and African American and Hispanic populations. This grant project also includes an environmental change component called the “Frederick Restaurant Challenge.” Participating restaurants agree to offer a healthy meal option which meets dietary parameters suitable for people with diabetes or for anyone wishing to eat healthier. Diners rate their dishes and the restaurant with the highest rating wins the Challenge and an award. The Power to Prevent program has currently completed three 12-week cycles and enrolled 106 participants. Of these, 75% identified as White and 25% responded as “African American,” “Other” or did not answer. 13% reported having neither private nor public health insurance. 10% affirmed there was a time in the past 12 months when they needed to see a doctor but did not due to costs. In order to achieve the overall goal, the Power to Prevent program has two primary objectives: (1) Overweight participants lose 5-7% of their weight. Normal weight participants maintain their weight and (2) Participants are moderately physically active for at least 30 minutes a day, 5 days a week. A third objective is that participants who have not seen a healthcare provider in the past year report follow-up with a healthcare provider, and participants without a medical home are connected with a healthcare provider. The program uses the curriculum, Power to Prevent: A Family Lifestyle Approach to Diabetes Prevention, which was developed by the National Diabetes Education Program (NDEP). The curriculum educates about diabetes while promoting healthy eating, physical activity, and making changes one step at a time. Power to Prevent is based upon the Diabetes Prevention Program (DPP) study, which showed that people at high risk for diabetes can prevent or delay the onset of the disease by losing 5-7 percent of their body weight. The DPP study participants were able to lose this weight by eating lower fat, lower calorie foods and getting 30 minutes of physical activity 5 days a week. Many of the tools used in the Power to Prevent curriculum were adapted from tools used in the DPP study. Funding for this program has been made possible through a 3-year grant received from the Office of Chronic Disease Prevention of the Maryland Department of Health and Mental Hygiene. The Frederick County Diabetes Coalition serves as the Advisory Committee for this project. Support and in-kind services are provided by more than 10 different community organizations/groups. Each 12-week cycle is preceded by promotional efforts, which includes specific marketing to our target populations. Participants attend a registration/informational session and obtain physician clearance forms (if needed) in order to participate in the physical activity portion of the program. Participants attend one 2-hour class per week for the 12-week period. Thirty minutes of class are dedicated to doing low impact physical activity. Each participant also receives two individual sessions with the Registered Dietician and is contacted by our Health Access Coordinator to ensure all participants have seen their healthcare provider in the past year or are connected with a provider if they do not have one. Regarding progress in meeting our two primary objectives, based upon data that is available at this time, participants engaging in 30 minutes or more of moderate physical activity or 20 minutes or more of vigorous physical activity per day, at least 5 days per week improved from 36% (pre-program) to 62% (post-program). 
Our Power to Prevent program addresses the public health issue of diabetes. In Maryland, in 2008, an estimated 373,346 (8.7%) adults were diagnosed with Type 2 diabetes. The curriculum we use also indirectly addresses obesity by encouraging healthy eating habits and increased physical activity. Diabetes and obesity are major causes of morbidity and mortality in the United States. Evidence from several studies indicates that obesity and weight gain are associated with an increased risk of diabetes. Each year an estimated 300,000 US adults die of causes related to obesity. Over half (68%) of US adults with diabetes die of heart disease or stroke. Obesity also substantially increases morbidity and impairs quality of life. Overall, the direct costs of obesity and physical inactivity account for approximately 9.4 percent of US health care expenditures. The total estimated cost of diabetes (direct and indirect) in the U.S. in 2007 was $174 billion.
Agency Community RolesThe Health Department is the lead agency in the implementation of the Power to Prevent program and provides in kind group meeting space. Staff within the division are educated about the program and refer clients from other Community Health division programs to Power to Prevent. The Power to Prevent Coordinator also attends staff meetings of other divisions within the Health Department to provide information about the program and encourage referrals. The Hillcrest School-Based Health Center, which is a program of the Health Department, identifies and refers parents who may be at high risk for type 2 diabetes. The community, in which the School-Based Health Center is located, is predominantly of low socio-economic means and largely populated by Hispanic and African American residents. Costs and ExpendituresIn November of 2009, the Frederick County Health Department launched its new Power to Prevent diabetes prevention program. The overall goal of this program is to reduce the burden of chronic disease by preventing or delaying type 2 diabetes onset and preventing or delaying health complications associated with type 2 diabetes. Those with and at risk for type 2 diabetes are eligible to join the program. However, the program targets the un/underinsured and African American and Hispanic populations. This grant project also includes an environmental change component called the “Frederick Restaurant Challenge.” Participating restaurants agree to offer a healthy meal option which meets dietary parameters suitable for people with diabetes or for anyone wishing to eat healthier. Diners rate their dishes and the restaurant with the highest rating wins the Challenge and an award. The Power to Prevent program has currently completed three 12-week cycles and enrolled 106 participants. Of these, 75% identified as White and 25% responded as “African American,” “Other” or did not answer. 13% reported having neither private nor public health insurance. 10% affirmed there was a time in the past 12 months when they needed to see a doctor but did not due to costs. In order to achieve the overall goal, the Power to Prevent program has two primary objectives: (1) Overweight participants lose 5-7% of their weight. Normal weight participants maintain their weight and (2) Participants are moderately physically active for at least 30 minutes a day, 5 days a week. A third objective is that participants who have not seen a healthcare provider in the past year report follow-up with a healthcare provider, and participants without a medical home are connected with a healthcare provider. The program uses the curriculum, Power to Prevent: A Family Lifestyle Approach to Diabetes Prevention, which was developed by the National Diabetes Education Program (NDEP). The curriculum educates about diabetes while promoting healthy eating, physical activity, and making changes one step at a time. Power to Prevent is based upon the Diabetes Prevention Program (DPP) study, which showed that people at high risk for diabetes can prevent or delay the onset of the disease by losing 5-7 percent of their body weight. The DPP study participants were able to lose this weight by eating lower fat, lower calorie foods and getting 30 minutes of physical activity 5 days a week. Many of the tools used in the Power to Prevent curriculum were adapted from tools used in the DPP study. The Frederick County Diabetes Coalition serves as the Advisory Committee for this project. Support and in-kind services are provided by more than 10 different community organizations/groups. Each 12-week cycle is preceded by promotional efforts, which includes specific marketing to our target populations. Participants attend a registration/informational session and obtain physician clearance forms (if needed) in order to participate in the physical activity portion of the program. Participants attend one 2-hour class per week for the 12-week period. Thirty minutes of class are dedicated to doing low impact physical activity. Each participant also receives two individual sessions with the Registered Dietician and is contacted by our Health Access Coordinator to ensure all participants have seen their healthcare provider in the past year or are connected with a provider if they do not have one. Regarding progress in meeting our two primary objectives, based upon data that is available at this time, participants engaging in 30 minutes or more of moderate physical activity or 20 minutes or more of vigorous physical activity per day, at least 5 days per week improved from 36% (pre-program) to 62% (post-program). 18% of graduates have lost 5% or more of their weight or maintained a normal weight. The number of graduates who have lost any amount of weight is 84%.  ImplementationThe Power to Prevent (PTP) program has two primary objectives: (1) Overweight participants lose 5-7% of their weight. Normal weight participants maintain their weight and (2) Participants are moderately physically active for at least 30 minutes a day, 5 days a week. These are achieved through the PTP program, which involves carrying out the following key tasks: 1- Start-Up Tasks (Timeframe: 4-5 months)- these were tasks that took place as part of writing the 3-year grant and then, subsequently, in planning for implementation of the program: • Determine overall goal and objectives. • Identify an evidenced-based curriculum/model which matches the project goal and that can be easily replicated. The NDEP curriculum, Power to Prevent: A Family Lifestyle Approach to Diabetes Prevention, met this criteria. • Identify an Advisory Committee for the project. The Frederick County Diabetes Coalition was already in place and a good fit. • Identify supplemental program activities/features to support objectives. • Identify and secure community partners to volunteer their services and/or space for the program. • Hire and train Community Lay Educator, Interpreter, Health Access Coordinator. • Identify and order appropriate class handouts and incentives for participant progress. • Develop registration procedures/forms. • Have all handouts/forms translated into Spanish. • Develop evaluation measures and a pre/post survey tool to track progress. • Determine program frequency, meeting days and times. • Secure meeting locations. • Develop and implement marketing plan.   2- On-Going Tasks • Select cycle and registration dates for upcoming year. • Meet regularly with staff to review/improve program policies and procedures, review participant feedback, and discuss ideas for program enhancements. • Seek on-going training for staff. Coordinate volunteer appreciation events as able. • Conduct community education and outreach regarding PTP. • For each program cycle, market and conduct registration, secure expert guest speakers, confirm/reserve venues, ensure adequate supply of handouts and incentives. • Collect and analyze all program data and complete quarterly reports. • Conduct three 12-week cycles per year. (Two groups run consecutively per cycle). Ensure implementation of program’s key features: a grocery field trip, ½ hour of low impact physical activity at each class, 2 individual nutritional counseling sessions with the Registered Dietician, contact by a Health Access Coordinator to ensure connection with a healthcare provider. • Modify budget, as needed, each year and maintain list of additional funding opportunities/options.
One of our primary objectives is that overweight participants lose 5-7% of their weight, and normal weight participants maintain their weight. Performance measures used to evaluate the practice: The Registered Dietician (RD) measures change in participant’s weight based on data collected pre-program, post-program and 3-months post program. Data collection: Using a scale, the Registered Dietician collects weights and heights from each participant. This data was gathered during participant’s one on one counseling sessions with the RD. Evaluation results: Based upon results from the 55 participants who completed pre/post weight measurements, 18% of graduates lost 5% or more of their weight or maintained a normal weight. Among those who lost weight, the average weight loss was 3.2%. The number of graduates who lost any amount of weight was 84%. Among the 33 graduates who completed the 3-month follow-up, using their pre-session weight as a bench mark, 79% have maintained their weight loss. The activities which supported this objective were fully implemented and included: the 12-week Power to Prevent classes, the sessions with the RD, the 30 minutes of physical activity that took place during class and the food and activity tracker tools. These results highlight that achieving a weight loss of 5% or greater is difficult to accomplish within a 3-month period. The Healthy Living Partnerships to Prevent Diabetes Project, a program similar to ours that is also based on the DPP, recently published that participants in their program achieved an average weight loss of 7.3% after a full year. Feedback: The Maryland Department of Health and Mental Hygiene, as the grantor, receives all evaluation results. One of the lessons learned applies to taking weight measurements. Weights had previously been taken during individual sessions with the RD (once at the beginning and again at the end of the program). However, as class size has grown, it now takes several weeks after the program has begun and ended before participants see the RD for their first and second appointment. As a result, weights are now privately taken during the first and final class in order to obtain the most accurate picture of how weight has changed pre and post program. Participants are moderately physically active for at least 30 minutes a day, 5 days a week. Performance measures used to evaluate the practice: Participants complete a pre/post survey, which measures time and level of physical activity. Participants use a food and activity tracker to record what they eat and their daily level of activity. Data collection: A pre/post survey is administered at registration and on the last day of class. One of the questions asks: Do you do 30 minutes or more of moderate physical activity OR 20 minutes or more of vigorous physical activity per day, at least 5 days per week? Answers to this and the other survey questions are tabulated for quarterly data reports by the Program Coordinator. Evaluation results: Based upon data that is available at this time, participants engaging in 30 minutes or more of moderate physical activity or 20 minutes or more of vigorous physical activity per day, at least 5 days per week improved from 36% (pre-program) to 62% (post-program). The activities which supported this objective were fully implemented and included: the 12-week Power to Prevent classes, the sessions with the RD, the 30 minutes of physical activity that took place during class and the food and activity tracker tools. One of the lessons learned is that while participants report dislike for completing the physical activity, and particularly, the food trackers, they acknowledge that doing so has raised awareness and helped them make desired changes. Additionally, we have received numerous requests for a post program support group to help them stay on track. Feedback: The Maryland Department of Health and Mental Hygiene, as the gra
The Power to Prevent (PTP) program has excellent stakeholder commitment, which we believe has contributed in large part to the program’s success. This commitment begins with the Frederick County Health Department, where the leadership recognized some time ago that diabetes (and its related health conditions) is a major public health issue and that preventive resources in our community for those at risk is limited. The state of Maryland, the grantor of this project, has indicated that they are committed to this practice because of the program’s results and due to the Centers for Disease Control and Prevention who is promoting replication of the Diabetes Prevention Program (the study for which the PTP curriculum is based). In fact, one of the proposed vision areas of Maryland’s State Health Improvement Plan is to prevent and control chronic disease, and several of the objectives coincide with the objectives of the PTP program. Also, since the program’s inception, we have been in communication with the National Diabetes Education Program (NDEP) for guidance and to make them aware of our success in using their curriculum. In March 2011, the PTP program was featured on the NDEP’s Partner Spotlight website. Additionally, the program has strong support from the community. The Frederick County Diabetes Coalition serves as the advisory committee, and several members of the coalition volunteer their time as expert guest speakers for some of the classes. The coalition, programs within the Health Department and numerous community agencies help to market PTP. The program increasingly receives referrals from doctor’s practices. Most importantly, there is great interest from those in the community who are eligible for the program. In some instances, it has been necessary to create a waiting list at registration as we have had more people than slots available. The PTP program plans to sustain itself by, first and foremost, attending and responding to the feedback provided by the participants, our partners and the community in order to ensure that the program is adequately meeting the need and that program objectives are being met. Adaptability and flexibility is very important so that the program continues to meet its objectives and remains aligned with public health priorities identified at the federal level. Currently, policy and environmental strategies are being promoted as a means to increase reach. In response to this, we are expanding PTP next year by taking the program to a worksite. We will also collaborate with this worksite to institute other environmental or policy changes which promote/support healthy behaviors. The State has indicated that future funding opportunities will likely emphasize this approach and, therefore, we are positioning the program accordingly. Other possibilities for broadening our funding eligibility include emphasizing how a lifestyle program such as PTP not only helps to reduce risk for type 2 diabetes but other related conditions such as heart disease and stroke as well. A final development we are monitoring with regards to future sustainability is the health care reform act and the potential for billing insurance for the preventive services the program provides.
 
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