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，以应对非 在城市中，妇女承担着这一负担的特殊部分，这是一种传染性疾病。在访问时 这些疾病的医疗管理正在受到关注，需要采取文化上合适的方法来 解决行为因素，包括饮食和体力活动习惯的改变。我们提出了一个 美国疾病控制和预防中心糖尿病预防计划“POWER”的创新调整 “预防”计划，我们将在巴马科的低收入城市周边社区开发和试点， 马里。这项计划非常适合已经在支持家庭的城市社区卫生工作者提供服务 在改善孕产妇和儿童健康成果方面取得的进展。首先，我们将采用参与式研究方法， 他们和社区居民对社区卫生工作者的指导方针和工具进行调整 建议的活动，使其在语言和文化上适当，包括关于食物的准则 使用当地可获得的食物进行消费。这些改编将使用更多的图形和照片，所以他们 适用于低识字率的参与者。第二，另一个关键创新是明确定位 夫妇，其中只有一人可能有被诊断为心血管疾病。我们的适应将提供工具 这些女性可以用来谈判改变家庭用餐和她的日常生活。第三，我们将进行 6个心血管病发病率高的社区卫生中心招募成人的效果比较研究 最近被诊断出患有糖尿病或高血压。基于对其社区卫生的随机分配 参赛者将被分配到三组中的一组，每组150人：情侣，至少有一人在 资格标准；个人，男性和女性，均符合条件；比较，患有心血管疾病的男性和女性。训练有素 社区卫生工作者和糖尿病同伴教育工作者将与夫妇和糖尿病同伴一起使用经过修改的DPP材料 个人团体，为期12个月。在试验结束时，我们将评估 采用推荐的减少心血管风险的行为和肥胖的变化， 高血压和糖尿病控制，比较三组结果的差异。我们的 这项工作将使马里能够将减少糖尿病和高血压风险纳入其已经部署的网络 社区卫生工作者。在成功的试点之后，将进行更大规模的研究，全面整合到 马里卫生保健系统，然后有可能惠及妇女及其家人。马里民进党的改编 也适用于讲法语的西非，那里的习俗和生活方式在数百万人中相似 面临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.