Login Event Calendar Careers About NACCHO Contact Us Site Map
 
Search  
Programs & Activities
»
»
»
»
Cross-cutting Topics
»
»
»
»
»
»
»
»
»
Print this page Print This Page

Email this page E-Mail This Page

Bookmark and Share

Program Details


Back to main page.

Practice Type: Model
Program Name: Power to Prevent Diabetes Prevention Program
Organization: Frederick County Health Department/Nursing Division
Web site: www.frederickhealth.org
Overview: Power to Prevent Diabetes Prevention Program
Year Submitted: 2011
Responsiveness and Innovation: 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 and Community Roles: The 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 Expenditures: 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. 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%. Participant feedback indicates that one of the factors to our success is the fact that the program is offered for free. Many have stated they simply would not have taken the class if there was a fee. Participants have also reported that the group support and accountability (discussion of food and physical activity trackers) influenced their behavior in positive ways. Other features that we believe make the difference include our use of expert guest speakers from the community, the incorporation of physical activity during class time and the individualized meetings with the Registered Dietician.
Implementation: 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.
Sustainability: 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.
Lessons Learned:

 

Back to main page.