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While previous health research with Aboriginal populations focused almost exclusively on Aboriginal Peoples of First Nations descent living on reserves or in isolated rural communities in Canada, this study focusing on diabetes aimed to engage Aboriginal Peoples of First Nations and Métis descent living in an urban Ontario setting. Type 2 diabetes mellitus is a progressive metabolic disorder that affects Aboriginal Peoples of Métis and First Nations descent disproportionately compared to the rest of the Canadian population. To understand this disparity in diabetes incidence and to address issues with existing diabetes prevention and management strategies, this study: a) explores the perceptions surrounding Type 2 diabetes and its prevention from First Nations and Métis community people and health service providers and policy makers; and b) informs the existing diabetes prevention, management and care strategies in light of these perceived understandings. Primary data was collected through 40 in-depth one-on-one narrative interviews with First Nations and Métis people, health service providers and policy makers. Thematic codes that emerged through the narrative analysis of this data revealed that to fully understand the social determinants of diabetes in an urban First Nations and Métis people’s context required the application of intersectionality theory, since production of First Nations and Métis diabetes is socially determined and deeply intersectional. By combining the concepts of the social determinants of health and intersectional approaches, narrative analysis of the primary data revealed that diversities in socio-economic, cultural, legal and spatial contexts determine First Nations and Métis people’s life choices and have a strong bearing on their health outcomes. First Nations and Métis participants’ narratives revealed that dimensions of marginalization were reflected not only through inadequate material resources, but also through intersections of multiple factors such as colonial legacies, stereotyping, legal statuses, and the pan-Aboriginal nature of government policies and services. First Nations and Métis community members indicated that preventive programming aimed at avoiding or managing diabetes should be grounded in balancing and restoring the positive aspects of physical, mental, spiritual and emotional health and should also balance their diverse needs, lived realities, and social circumstances. The views of health service providers and policy makers captured in this thesis tended to reflect an understanding of diabetes causation grounded in both biomedical and intersecting social determinants of health. At the pragmatic level, however, the solution to this health issue presented by health service providers and policy makers addresses only the measurable individualistic biomedical risk factors of diabetes. Policy makers also discussed the need for developing qualitative indicators of the success of presently implemented health programs. Overall, the results of this study indicated that effective diabetes prevention and management strategies for urban First Nations and Métis people must recognize and address the diversities in their historical, socio-economic, spatial and legal contexts as well as their related entitlement to health services. A comprehensive diabetes prevention strategy should target the social determinants of health that are specific to urban First Nations and Métis people and must build on community strengths.

While previous health research with Aboriginal populations focused almost exclusively on Aboriginal Peoples of First Nations descent living on reserves or in isolated rural communities in Canada, this study focusing on diabetes aimed to engage Aboriginal Peoples of First Nations and Métis descent living in an urban Ontario setting. Type 2 diabetes mellitus is a progressive metabolic disorder that affects Aboriginal Peoples of Métis and First Nations descent disproportionately compared to the rest of the Canadian population. To understand this disparity in diabetes incidence and to address issues with existing diabetes prevention and management strategies, this study: a) explores the perceptions surrounding Type 2 diabetes and its prevention from First Nations and Métis community people and health service providers and policy makers; and b) informs the existing diabetes prevention, management and care strategies in light of these perceived understandings. Primary data was collected through 40 in-depth one-on-one narrative interviews with First Nations and Métis people, health service providers and policy makers. Thematic codes that emerged through the narrative analysis of this data revealed that to fully understand the social determinants of diabetes in an urban First Nations and Métis people’s context required the application of intersectionality theory, since production of First Nations and Métis diabetes is socially determined and deeply intersectional. By combining the concepts of the social determinants of health and intersectional approaches, narrative analysis of the primary data revealed that diversities in socio-economic, cultural, legal and spatial contexts determine First Nations and Métis people’s life choices and have a strong bearing on their health outcomes. First Nations and Métis participants’ narratives revealed that dimensions of marginalization were reflected not only through inadequate material resources, but also through intersections of multiple factors such as colonial legacies, stereotyping, legal statuses, and the pan-Aboriginal nature of government policies and services. First Nations and Métis community members indicated that preventive programming aimed at avoiding or managing diabetes should be grounded in balancing and restoring the positive aspects of physical, mental, spiritual and emotional health and should also balance their diverse needs, lived realities, and social circumstances. The views of health service providers and policy makers captured in this thesis tended to reflect an understanding of diabetes causation grounded in both biomedical and intersecting social determinants of health. At the pragmatic level, however, the solution to this health issue presented by health service providers and policy makers addresses only the measurable individualistic biomedical risk factors of diabetes. Policy makers also discussed the need for developing qualitative indicators of the success of presently implemented health programs. Overall, the results of this study indicated that effective diabetes prevention and management strategies for urban First Nations and Métis people must recognize and address the diversities in their historical, socio-economic, spatial and legal contexts as well as their related entitlement to health services. A comprehensive diabetes prevention strategy should target the social determinants of health that are specific to urban First Nations and Métis people and must build on community strengths.

Thesis (M. A. Medicine (Family Medicine)) -- University of Limpopo, 2021 / Diabetes is a rising problem globally. The World Health Organization (WHO) has classified diabetes as an epidemic. The major impact of the disease is felt in low- and middle-income countries. The literature has emphasised the fact that most patients living with diabetes are undiagnosed, and those who are diagnosed are poorly controlled. The complications associated with diabetes usually occur over a long period of time and are mainly influenced by poor glycaemic control. In South Africa, diabetes is a major cause of morbidity and mortality and a burden to the already overstretched health system in the country. In this study, factors that impair a patient’s ability to achieve good glycaemic control are investigated. ' Methods In this cross-sectional, descriptive study was conducted at the general outpatients department (GOPD) of the Mankweng hospital in the Capricorn District of the Limpopo Province. A total number of 97 participants formed part of the study. An HbA1c test was used to classify patients into a well-controlled glycaemic group (HbA1c ≤ 7%) or a poorly controlled group (HbA1c > 7%). Factors for poor glycaemic control were investigated. The following factors were investigated to identify characteristics of poorly controlled diabetes patients: demographic data; adherence to treatment; and, clinical measurements characteristics. Frequency tables, univariate logistic regression models and chi-square tests were used to determine factors influencing glycaemic control. Results Of the 97 patients, only 63 (64.9%) had an HbA1C measurement done (measurable outcome). Of these patients, only 13 (15.7%) had well controlled diabetes, while diabetes in 50 patients was poorly controlled. Patients on oral treatment only comprised the bulk of the patients who were well controlled. Following multivariate analysis, being male was found to be a significant predictor of good glycaemic control. Conclusions Most patients who had an HbA1C done were poorly controlled. As a secondary observation, management of diabetes was suboptimal. Male patients treated with oral medication alone were more likely to have good glycaemic control. Key concepts Diabetes mellitus, HbA1C, glycaemic, hospital, general out-patient department, Limpopo

Cheng, Suosuo. / Thesis (Ph.D.)--Chinese University of Hong Kong, 2013. / Includes bibliographical references (leaves 159-173). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Abstracts aslo in English.

<p>In this study a process evaluation of the action planning process of the HealthKick programme in disadvantaged primary school settings in the Western Cape was conducted. A qualitative methodology was adopted to best determine the experiences of the participants and the underlying factors involved. Four schools were randomly selected to participate. Four focus group discussions were conducted with educators, and four in-depth interviews were conducted with principals and champions at schools, (champions are either an educator or school governing body member selected to be the driver of the project at each school, as well as the liaison person between the school and the HealthKick project team). Semi-structured interview guides were used to steer the discussions. Interviews and focus groups were audio taped and transcribed verbatim. The data was thematically analysed with the assistance of Atlas ti computer software. The results of this study indicated that the action planning process did not take place as designed by the project team. Several challenges were identified and experienced by participants. The results further indicated that the challenges of time, workload and competing priorities were intrinsically linked. Positive experiences were also reported and various enablers to the process were identified, such as the facilitation process, the receipt of the resource toolkit as well as the complementary nature of the HealthKick curriculum to the normal academic curriculum.</p>

Thailand has faced under-nutrition and yet, paradoxically, the prevalence of diseases of over-nutrition, such as obesity and diabetes, has escalated. Since access to diabetes prevention programs is limited in Thailand, especially in rural areas, it becomes critical to develop a health information delivery system that is relevant, cost-effective and sustainable. Therefore, the main objective of this program is to build capacity for chronic disease prevention in Thailand through application of learning technologies in the education, support and accreditation of community health care workers (CHCWs). This program stems from established partnerships among: The University of Waterloo (UW), Department of Health Studies and Gerontology; Institute of Nutrition, Mahidol University (INMU); The Office of Disease Prevention and Control 10 Chiang Mai province; Ministry of Public Health (MOPH), Thailand and UW, Centre for Teaching Excellence (CTE) . The development of the community-based diabetes prevention education program in Chiang Mai, Thailand was informed by in-depth interviews with health care professionals (n=12) and interviews (n=8) and focus groups (n = 4 groups, 23 participants) with community volunteers, screened as at-risk for diabetes. Coded transcripts from audio-taped interviews or focus groups underwent qualitative analysis by hand and using NVivo software. Health care professionals identified opportunities to integrate health promotion/ disease prevention into CHCWs’ duties. However, they also identified potential barriers to program success as motivation for regular participation, and lack of health policy support for program sustainability. Health care professionals supported an education program for CHCWs and recommended small-group workshops, hands-on learning activities, case studies and video presentations that bring knowledge to practice within their cultural context; CHCWs should receive a credit for continuing study. Community volunteers lacked knowledge of nutrition, diabetes risk factors and resources to access health information. They desired two-way communication with CHCWs. A tailored diabetes prevention education program was designed based on this formative research. Learning modules were delivered over eight group classes (n=5/class) and eight self-directed E-learning sessions (www.FitThai.org). The program incorporated problem-based learning, discussion, reflection, community-based application, self-evaluation and on-line support. The frequency that students accessed on-line materials, including video-taped lectures, readings, monthly newsletters, and community resources, was documented. Participant satisfaction was assessed through three questionnaires. Knowledge was assessed through pre-post testing based on an exam that was pilot tested with 32 CHCWs from a district outside of the 5 districts in semi-urban Chiang Mai province from which the 69 participating CHCWs (35 intervention, 34 control) were randomly selected. The program was implemented over four months. Three quarters of participants attended all eight classes and no participant attended fewer than six. Online support and materials were accessed 3 – 38 times (median 13). Participants reported that program information and activities were fun, useful, culturally relevant, and applicable to diabetes prevention in their specific communities. Participants also appreciated the innovative technology support for their work. Comfort with E-learning varied among participants. Scores on pre-post knowledge test increased from a mean (SD) of 56.5% (6.26) to 75.5% (6.01) (P < .001). The effect of the program on knowledge of CHCWs was compared between intervention and control communities at baseline and the end of the program. Overall, the knowledge at baseline of both groups was not significantly different (56.5% (6.26) intervention versus 54.9% (6.98) control) and all CHCWs scored lower than 70%. The lowest scores were found in the “understanding of nutritional recommendations” section (mean score = 28% in intervention and 30% in control CHCWs). After 4 months, CHCWs in the intervention group demonstrated improvement relative to the control group (75.5% (6.01) versus 57.4% (5.59), respectively, p <.001, n=69). The percent of CHCWs achieving a total score of 70% was 77% (27/35) in intervention and 0% in control groups. The diabetes prevention education program was effective in improving CHCWs’ health knowledge relevant diabetes prevention. The innovative learning model has potential to expand chronic disease prevention training of CHCWs to other parts of Thailand. Ultimately, prevention of chronic diseases and associated risk factors should be enhanced.

Thailand has faced under-nutrition and yet, paradoxically, the prevalence of diseases of over-nutrition, such as obesity and diabetes, has escalated. Since access to diabetes prevention programs is limited in Thailand, especially in rural areas, it becomes critical to develop a health information delivery system that is relevant, cost-effective and sustainable. Therefore, the main objective of this program is to build capacity for chronic disease prevention in Thailand through application of learning technologies in the education, support and accreditation of community health care workers (CHCWs). This program stems from established partnerships among: The University of Waterloo (UW), Department of Health Studies and Gerontology; Institute of Nutrition, Mahidol University (INMU); The Office of Disease Prevention and Control 10 Chiang Mai province; Ministry of Public Health (MOPH), Thailand and UW, Centre for Teaching Excellence (CTE) . The development of the community-based diabetes prevention education program in Chiang Mai, Thailand was informed by in-depth interviews with health care professionals (n=12) and interviews (n=8) and focus groups (n = 4 groups, 23 participants) with community volunteers, screened as at-risk for diabetes. Coded transcripts from audio-taped interviews or focus groups underwent qualitative analysis by hand and using NVivo software. Health care professionals identified opportunities to integrate health promotion/ disease prevention into CHCWs’ duties. However, they also identified potential barriers to program success as motivation for regular participation, and lack of health policy support for program sustainability. Health care professionals supported an education program for CHCWs and recommended small-group workshops, hands-on learning activities, case studies and video presentations that bring knowledge to practice within their cultural context; CHCWs should receive a credit for continuing study. Community volunteers lacked knowledge of nutrition, diabetes risk factors and resources to access health information. They desired two-way communication with CHCWs. A tailored diabetes prevention education program was designed based on this formative research. Learning modules were delivered over eight group classes (n=5/class) and eight self-directed E-learning sessions (www.FitThai.org). The program incorporated problem-based learning, discussion, reflection, community-based application, self-evaluation and on-line support. The frequency that students accessed on-line materials, including video-taped lectures, readings, monthly newsletters, and community resources, was documented. Participant satisfaction was assessed through three questionnaires. Knowledge was assessed through pre-post testing based on an exam that was pilot tested with 32 CHCWs from a district outside of the 5 districts in semi-urban Chiang Mai province from which the 69 participating CHCWs (35 intervention, 34 control) were randomly selected. The program was implemented over four months. Three quarters of participants attended all eight classes and no participant attended fewer than six. Online support and materials were accessed 3 – 38 times (median 13). Participants reported that program information and activities were fun, useful, culturally relevant, and applicable to diabetes prevention in their specific communities. Participants also appreciated the innovative technology support for their work. Comfort with E-learning varied among participants. Scores on pre-post knowledge test increased from a mean (SD) of 56.5% (6.26) to 75.5% (6.01) (P < .001). The effect of the program on knowledge of CHCWs was compared between intervention and control communities at baseline and the end of the program. Overall, the knowledge at baseline of both groups was not significantly different (56.5% (6.26) intervention versus 54.9% (6.98) control) and all CHCWs scored lower than 70%. The lowest scores were found in the “understanding of nutritional recommendations” section (mean score = 28% in intervention and 30% in control CHCWs). After 4 months, CHCWs in the intervention group demonstrated improvement relative to the control group (75.5% (6.01) versus 57.4% (5.59), respectively, p <.001, n=69). The percent of CHCWs achieving a total score of 70% was 77% (27/35) in intervention and 0% in control groups. The diabetes prevention education program was effective in improving CHCWs’ health knowledge relevant diabetes prevention. The innovative learning model has potential to expand chronic disease prevention training of CHCWs to other parts of Thailand. Ultimately, prevention of chronic diseases and associated risk factors should be enhanced.

<p>In this study a process evaluation of the action planning process of the HealthKick programme in disadvantaged primary school settings in the Western Cape was conducted. A qualitative methodology was adopted to best determine the experiences of the participants and the underlying factors involved. Four schools were randomly selected to participate. Four focus group discussions were conducted with educators, and four in-depth interviews were conducted with principals and champions at schools, (champions are either an educator or school governing body member selected to be the driver of the project at each school, as well as the liaison person between the school and the HealthKick project team). Semi-structured interview guides were used to steer the discussions. Interviews and focus groups were audio taped and transcribed verbatim. The data was thematically analysed with the assistance of Atlas ti computer software. The results of this study indicated that the action planning process did not take place as designed by the project team. Several challenges were identified and experienced by participants. The results further indicated that the challenges of time, workload and competing priorities were intrinsically linked. Positive experiences were also reported and various enablers to the process were identified, such as the facilitation process, the receipt of the resource toolkit as well as the complementary nature of the HealthKick curriculum to the normal academic curriculum.</p>