Effectiveness of the Diabetes Prevention Program in Urban Bamako, Mali: Small Steps, Big Rewards

项目摘要 随着非洲国家迅速城市化，它们面临着新的服务提供挑战，以解决非政府组织的迅速增加， 在城市中，妇女承担了特别大部分的这一负担。虽然获得 这些疾病的医疗管理正在受到关注，需要采取文化上适当的方法， 解决包括改变饮食和体育活动习惯在内的行为问题。我们提出了一个 创新适应疾病控制和预防中心的糖尿病预防计划“权力” 预防”计划，我们将在巴马科的低收入城郊社区开发和试点该计划， 马里.这个项目非常适合由已经在为家庭提供支持的城市社区卫生工作者提供 改善妇幼保健成果。首先，我们将采用参与式研究方法， 他们和社区居民适应社区卫生工作者的指导方针和工具， 建议的活动，使它们在语言和文化上是适当的，包括食品准则， 使用当地可获得的食物。这些改编将使用更多的图形和照片，所以他们 适合低文化程度的参与者。其次，另一个关键创新是明确的方向， 夫妇，其中只有一个可能有诊断的心血管疾病。我们的适应将提供工具 妇女们可以用来谈判改变家庭的膳食和她的日常生活。第三，我们将开展 在6个心血管疾病发病率高的社区卫生中心进行的一项比较有效性研究，招募成年人 最近被诊断患有糖尿病或高血压。根据他们社区健康的随机分配 中心，参与者将被分配到三个组之一，每组150人：夫妇，至少有一次会议， 合格标准;个人，男性和女性，均合格;比较，男性和女性CVD。训练 社区卫生工作者和糖尿病同伴教育者将使用经过改编的DPP材料， 在12个月的时间里，个人和团体。在该试点结束时，我们将评估 采用推荐的降低心血管风险的行为和改变肥胖， 高血压和糖尿病控制，比较三组之间的结果差异。我们 这项工作将使马里能够将降低糖尿病和高血压风险纳入其已部署的网络 社区卫生工作者。试点成功后，将进行更大规模的研究， 马里的医疗保健系统，然后有可能惠及妇女及其家庭。马里民进党改编 也将适用于讲法语的西非，那里数百万人的习俗和生活方式相似 面对心血管疾病负担的家庭。

Project Abstract As African countries rapidly urbanize, they face new service delivery challenges to address the rapid rise of non- communicable diseases in cities, where women bear an exceptional portion of this burden. While access to medical management of these conditions is receiving attention, culturally appropriate approaches are needed to address the behavioral components including changes to diet and physical activity habits. We propose an innovative adaptation of the Centers for Disease Control and Prevention’s Diabetes Prevention Program “Power to Prevent” program, which we will develop and pilot in the low-income peri-urban neighborhoods of Bamako, Mali. This program is well-suited to delivery by the city’s community health workers already supporting families in improving maternal and child health outcomes. First, we will use participatory research methods to engage them and community residents in making adaptations to the community health worker’s guidelines and tools for recommended activities so that they are linguistically and culturally appropriate, including guidelines for food consumption using locally available foods. These adaptations will use more graphics and photographs, so they are appropriate for low-literacy participants. Second, another key innovation is the explicit orientation to couples, where only one may have a diagnosed cardiovascular disease. Our adaptation will provide tools the women can use in negotiating for changes to the family’s meals and her daily routine. Third, we will conduct a comparative effectiveness study at 6 community health centers with high rates of CVD, recruiting adults recently diagnosed with diabetes or hypertension. Based on the random allocation of their community health center, participants will be assigned to one of three groups of 150 each: Couples, with at least one meeting the eligibility criteria; Individuals, men and women, both eligible; Comparison, men and women with CVD. Trained community health workers and diabetic peer educators will use the adapted DPP materials with the Couples and Individuals groups over a period of 12 months. At the conclusion of this pilot we will assess the levels of adoption of recommended cardiovascular risk reduction behaviors and changes in obesity, hypertension, and diabetes control, comparing differences in outcomes between the three groups. Our work will enable Mali to incorporate diabetes and hypertension risk reduction into their already deployed networks of community health workers. A successful pilot will be followed by a larger scale study with full integration into the Malian health care system, potentially then reaching women and their families. The Malian DPP adaptation will also be suitable for Francophone West Africa, where customs and lifestyles are similar among the millions of families confronting the burdens of cardiovascular disease.