World Diabetes Day Manual

World Diabetes Day Manual

November 14th

Table of Contents

1. Welcome Message 2. What is World Diabetes Day? 3. Information about Diabetes a. What is Diabetes (from a Public Health perspective) b. Causes c. The Public Health Perspective 4. Activities, a brief “How To Start” a. Before starting any Activity, on any topic b. Start giving your Activity a skeleton c. Now you are ready to get your Activity going! d. What you can do 5. Experiences a. SloMSIC - Slovenia b. AMSB – Bulgaria 6. Evaluate your work, a brief “How To End” a. Feedback b. Data gathering c. Measuring the change in participants' Knowledge or Behaviour d. Measuring Impact on a higher level: how we measure impact as a Federation 7. Externals a. International Diabetes Federation b. NCD Alliance

Welcome Message Dear SCOPHians worldwide, World Diabetes Day (WDD) is coming up again!

As Public Health activists, we are aware that many National Public Health Officers (NPOs) are working hard at organizing activities for this event. With this Manual, we would like to provide you with a little support that aims first and foremost to help you improve your activities, and then to possibly also give you some new ideas!

In line with this year’s Standing Committee On Public Health (SCOPH) Plan of Action, we are strongly focusing our work on improving quality throughout the work of the Federation.

We invite you to join our mission!

In (2016) WDD theme was: “Eyes on Diabetes”.

In (2017) the WDD theme is: “Women and Diabetes”. You can find a lot of information about this on the International Diabetes Federation (IDF) website.

Please let us know if we can support your work in any other way!!!

Blue-Orange Hugs, Ella (SCOPH-Director) for the SCOPH International Team 2016-17.

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Link: http://www.idf.org/wdd-index/

1. What is World Diabetes Day? “The World Diabetes Day campaign was created in 1991 by the IDF and the World Health Organization in response to the growing concerns about the escalating health threats posed

by Diabetes”.

World Diabetes Day is a day during which a large number of interested parties make an effort to raise awareness about Diabetes. Each year there is particular focus on a different aspect of the disease (healthy lifestyles, early diagnosis, treatment, ...). The WDD is celebrated annually on November 14.

The theme of WDD 2017 is “Women and Diabetes.” This year’s activities and materials will focus on promoting the awareness of the disproportionate impact on of diabetes on women and on bringing focus to gestational diabetes. According to the IDF Over 200 million women are currently living with diabetes and many face multiple barriers in accessing cost-effective diabetes prevention, early detection, diagnosis, treatment and care, particularly in developing countries. Women with diabetes are more likely to be poor and have less resources, face discrimination and have to survive in hostile social environments.* Throughout this document, you will be introduced to the actions being taken, important tips, and other tools to help you increase the impact of your work.

2. Information about Diabetes a. What is Diabetes?

This year, the SCOPH International Team has created a “Basics of Diabetes” document, which can be found by clicking here. The following paragraph is a short summary: Diabetes is a chronic disease that occurs when a person has high blood glucose either because their insulin production (Type 1) or insulin response (Type 2) has decreased.

Produced in the pancreas, the hormone insulin allows glucose from food to enter the body’s cells. In a diabetic person, glucose is not delivered to the cells properly, and it remains circulating in the blood (a condition known as hyperglycaemia), damaging body tissues over time. Inside cells, glucose is needed to be converted into energy, essential for muscle and tissue function. Therefore the role of insulin is crucial in the balance and efficiency of our energy metabolism. Any damage in the insulin balance can lead to disabling and lifethreatening health complications.

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Source: http://www.idf.org/WDD15-guide/pdf/WDD_2015_Guide.pdf Definition of Target Group: Who are the people, specifically, who will be affected by the activity/intervention? Examples of target groups can be: Adults between 25 and 60 years, adults from 75 years of age, individuals who have been smoking at least 2 years,...(it is important to ensure that the choice of a target group is as specific as possible, to ensure more ease in the evaluation of the intervention). *IDF Website: https://goo.gl/Hn4BhG 4 Link: https://drive.google.com/file/d/0BxQ0f5zaC3e_MXV6c1F0d0pkelU/view?usp=sharing 3

b. Causes According to recent data and research published by the WHO, diabetes is caused by the interaction of preventable (such as: smoking, unhealthy diet, physical inactivity and irresponsible alcohol consumption) as well as non-preventable risk factors (such as: genetics and age). What matters the most to our work in the Public Health sector are the preventable factors, as there are multiple ways of influencing each one of them.

c. The Public Health perspective The International Diabetes Federation (IDF) estimates that 9.0 % of adults worldwide (415 million people) have Diabetes, and that the number of people with the disease is set to rise beyond 642 million in less than 25 years. There are already 318 million adults with impaired glucose tolerance, which puts them at high risk of developing the disease in the future.

These numbers are steadily increasing. With an estimate of 193 million Diabetes cases as currently undiagnosed, a vast amount of people with Diabetes are progressing, unawares, towards complications. Worth noticing is also that 4-5 times more deaths are caused by diabetes (5.0 million) than by AIDS (1.5 million), Tuberculosis (1.5 million) or Malaria (0.6 million) every year. Undoubtedly, the IDF Diabetes Atlas’ latest figures provide a worrying indication of the future impact of diabetes as a major threat to global development. Diabetes in all its forms imposes unacceptably high human, social and economic costs on countries at all income levels.

The investment in tackling Diabetes is both medically and financially profitable. Although Type 1 diabetes is not preventable, Type 2 diabetes, gestational diabetes and pre-Diabetes are all preventable by modifying one’s lifestyles, such as: adopting a healthy diet, exercising, losing weight, and smoking cessation.

3. Activities, a brief “How To Start” Dear National or Local Public Health Officer, Dear SCOPHero, There are many different ways that a National Member Organization (NMO) or Public Health team can be active and celebrate World Diabetes Day! In the following few pages we will outline the essentials of how to build a successful Activity.

a. Before starting any Activity, on any topic: 1) First of all, we have to ask ourselves: “Is the “issue” you are about to tackle, really an issue?”. Before starting any Activity, we want to make sure we are not going to waste our energy for nothing. Therefore, in this case specifically, it is important to determine: Is Diabetes really a problem? It it a Public Health issue (in my country/city)?

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Source: http://www.idf.org/about-diabetes/facts-figures Source: http://www.who.int/ncdnet/risk_factors_20090930.jpg?ua=1 7 Source: http://www.diabetesatlas.org/, IDF Diabetes Atlas 7th edition 6

- If the answer is YES, then you know you are off to a good start, and that your efforts will not be meaningless! We have already briefly outlined the entity of the Diabetes issue earlier in the Manual, but remember that much more information can be found on the WHO website (and the IDF website). This can help you to further prove that Diabetes truly is a Global Public Health issue. Further research can also help you prove how Diabetes is an issue for your country or community.

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If the answer is NO, maybe you need to broaden your search, find more sources, reconsider the topic you are working on altogether.

2) Identify the reasons why you are addressing the issue. Why Diabetes? Why are we tackling Diabetes? Why are we organizing it during World Diabetes Day and not some other time?

Answering the “Why” questions can be one of the hardest parts of your Activity, but once you have, you will have a clearer perspective on the Activity you want to organize!

Example of answers to ‘Why’ questions: Why Diabetes: Because it is a major Public Health concern in my country and worldwide.

Why we are tackling it as Medical Students: Because we are following a vision to make this world a healthier place (e.g. IFMSA Vision/Mission). Another answer could be: Because we are health leaders of tomorrow and we care about the health of the societies we will work in as doctors.

Why organize an Activity during World Diabetes Day: Because on this day multiple other stakeholders as well as colleagues are also celebrating the event, and by organizing the event together, we have a louder voice and stronger impact.

Any more “why” questions before you start? Take a little while to think about some!

3) Define a “Vision” for your Activity. A vision is a seemingly idealistic statement, which constitutes the core of why you are doing something. The question you are answering is, what is the ideal situation that you would like to be in, about the topic you are tackling? Sometimes you will already identify your vision by asking the ‘why’ questions, sometimes you will not.

Example of a Vision: We believe in a world in which nobody is ever affected by Diabetes.

Want to make it more specific? Here is another example: We believe in a world in which each individual is aware about the risk factors and means of prevention of Diabetes Type 2.

b. Start giving your Activity a skeleton: Define Goals and Objectives.

Goals and Objectives are the “What” and “How” of your Activity. They will help you know exactly what is going to happen, and they will be of major help when you will evaluate your Activity.

A Goal embodies “How” you will follow your vision. You have already previously defined (for example) that Diabetes is an issue, that as a medical student you believe in making the world healthier and Diabetes free, and that you are tackling Diabetes because it is a Global Health issue. Now you have to define how you are going to tackle it.

Your Goals could be endless and span from: -

Raising awareness about Diabetes risk factors Teaching children about healthy lifestyles Encouraging the general population to do Physical Activity

Try to choose a series of Goals which have unity between them, because now you are giving shape to your Activity. You have to keep in mind the resources (human, financial,...) you have for your Activity so you do not shoot way higher than you can reach.

Objectives are the specific list of “What” you are going to do to achieve your Goals. Carefully defining a list of Objectives related to each Goal is one of the most crucial points of Activity planning, and can make all the difference between complete success and failure! Objectives have to be based on what your resources are and how much time you have to achieve your goals. To define your objectives, you can keep in mind the SMART acronym; objectives have to be: S: Specific (TIP: try to answer the questions “who”, “what”, “when”, “where”, “how”)

→ WRONG: Encourage adults to do physical activity [unclear exactly what we want these people to do!] → RIGHT: Get at least 60 adults aged between 35-55 to run through the official WDD obstacle course within 12 hours [Here it is very clear what is going to happen!]

M: Measurable (TIP: already start thinking about how you are going to be measuring these)

→ Get at least 60 adults aged between 35-55 to run through the official WDD obstacle course within 12 hours. [Easily measurable - we just have to count!]

A: Attainable → WRONG: Get at least 3000 adults aged between 90-95 to run through the official WDD obstacle course within 2 hours. [Define an objective that you will be able to obtain within the time you have and the resources you have] → RIGHT: Get at least 60 adults aged between 35-55 to run through the official WDD obstacle course within 12 hours. [Does this sound more realistic than the previous objective? I think so too!]

R: Relevant → WRONG: Get at least 60 adults aged between 35-55 to draw 1 picture of a fish during WDD day. [This has nothing to do with tackling our issue!] → RIGHT: Get at least 60 adults aged between 35-55 to run through the official WDD obstacle course within 12 hours. [Physical activity helps lower blood sugar, and prevent Diabetes. Teaching people about it can help them develop this habit! → this is relevant!]

T: Time Bound → WRONG: Get at least 60 adults aged between 35-55 to run through the official WDD obstacle course. [When? In how long? Will this Activity last a month? A decade? 12 hours?] → RIGHT: Get at least 60 adults aged between 35-55 to run through the official WDD obstacle course within 12 hours. [Knowing by when you have to be done will aid you in effectively organizing your activity as well as measuring your results at the end] Objectives can vary a lot (e.g.: from making sure someone acquires a certain amount of knowledge, to gathering measurements like blood sugar, to exposing the general public to a certain message, or asking people from a specific target group to participate in a survey).

Make sure your objectives are SMART, so at the end of your Activity you will be able to know if you met your Goals!

Take Home Message: - Identify the issue [Is it really an issue?]

- Ask yourself why? [Why this? Why you?]

- Define your Vision [What do you believe in?]

- Set Goals and Objectives (following the SMART method) [How and What are you going to do to follow your vision?]

Other important preparations that can help you: - Define a specific timeline for all the elements of your Activity (including preparation time, the activity itself and the follow-up period).

- Evaluate all the risks tied to the planning and executing of your activity (do you need a sunny day? Could your colleagues get sick? Could your main sponsor pull out at the last moment? → what would the consequences be?). As a follow-up, for each risk, consider how likely it is to happen, how much damage it would make if it did happen, and what you can do to both prevent it, or handle it if it happens.

- Create a stakeholder map to identify the people/organizations that could help you or hinder you in your Activity.

You can find examples and “How To”s to all of these online.

For each objective, because it is SMART, you will swiftly be able to determine what resources you need, and make a list.

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Examples of messages: “Screening is important”, “Eyes on Diabetes!”, “Let’s raise awareness about Diabetes!”, “Beat Diabetes!”, “Eating 1 apple a day takes the Doctor away!”…

9 Who are the people who will be affected by your activity? Examples of target groups can be: Adults between 25 and 60 years, adults from 75 years of age, individuals who have been smoking at least 2 years,...(keep this specific as well!)

c. Now you are ready to get your Activity going!: Once you have defined Goals and Objectives, and you have a clear idea of why you are pursuing this Activity, you will be able to realize what you need to realize your objectives.

Will you need 2 colleagues to help you, or 20? Do you need Glucose measurement instruments? Do you need money?

Once you have your list of needed resources, you can make a plan to obtain them (if you do not already have them), and then you can start your Activity!

NOTE: Needed resources can also be less tangible things, like “obtaining permission from the City to set up a stand in the main square”, or “obtain permission from the school to not attend classes on the day of your Activity”.

d. What you can do: 1) Prevention Promoting awareness about any issue awareness can be directed towards Behavior or people’s Perception of an contribute to people developing healthier the different factors that could lead to the close synonym to Prevention.

can have a strong impact. The changing people’s Knowledge, issue. All of these domains can lifestyles, and paying attention to disease. Awareness is therefore a

Examples of these changes: - Knowledge: following your activity, a person learns about the risk factors of Diabetes - Behavior: following your activity, a person develops the habit of going running every day - Perception: following your activity, a person does not feel disgusted by the idea of a diabetic person anymore.

NOTE: it is important to keep these three domains in mind when defining objectives and when defining evaluation methods.

With a strategic Activity design, you could be able to impact people in all three domains!

Examples of Activities: a) WDD Information Stand Distribute flyers, stickers, pins and information about Diabetes, either in your University or City.

Ideas you can include: → Measure blood glucose with glucometers, and check people’s blood pressure ppii(Screening). → Inform people about healthy diet and lifestyle habits → Inform people about the risk factors and lifestyles related to Diabetes → Encourage physical activity → Encourage people at risk to see a doctor

→ Offer people an apple in exchange for their cigarette, to promote healthy lifestyles ppitwo ways → Challenge people to solve a quiz about the topic you are promoting

For this kind of an event, a solid evaluation system is essential to measure the impact you have!

NOTE: Perform a pre- and post- questionnaire to evaluate people’s knowledge before and after you talk to them, or before and after they perform an exercise or challenge at your stand! This will help you to evaluate the impact of your Activity.

TIPS!

- To create eye-catching infographics for flyers you could try using piktochart.com -

or canva.com.

Choose few messages, but very clear ones that you want to share with your target group.

Join the fight against stigma, by also about letting people know about what it means to be a person -with- diabetes, and the related social issues that can arise as consequence (eating disorders, discrimination,...).

Be sure you encourage people to take pictures! You could for example use the World Diabetes Day Selfie App (which can be downloaded both for Apple and Android) b) WDD Party Organizing a party at your university will help both raise funds and awareness about your cause. It can be the perfect prelude to the organization of a Conference or recruitment of motivated students who could help you with your project in the future.

- Make the theme of the party -

clear Give the guests something creative to promote your theme (e.g. WDD Blue circle logo body paint, “Blue Everything” party theme,...)

Make sure your theme has thematic props, such as blue balloons, and a photo corner, so you will be able to promote the success of your party also after the event, and market it in the future!

Ensure you have a solid strategy and timeline for follow-up!

c) WDD Conference A conference’s target group will be smaller compared to that of an Information Stand, but the advantage would be that more information can be transmitted to the participants.

Inviting medical students can help both increase visibility of your NMO within the student community as well as recruit motivated students to take part in other interventions you will be organizing.

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By inviting important members of your community, you can increase the visibility of the event, and make some noise for a follow-up Activity such as an Info Stand.

d) WDD Online campaign The main benefits of an Online Campaign are that the potential outreach of a single post can be gigantic, and the efforts put into it can be minimal, compared to other Activities. A Media Campaign can help have a greater impact in terms of visibility of your message, or can simply help you create an atmosphere of cohesion between you and your team, if everyone is participating. It can also aid the international work of multiple organizations, if you take part in their Media Campaign, instead of organizing your own (e.g.

WDD Selfie App to make photos with the WDD Blue Circle Logo and use them as Profile Pictures). This last Activity could be a good choice if time is limited, as well as other resources.

What you can post on Social Media, to promote your campaign: - Photos - Videos - Articles - Posts (Facebook, Twitter, Instagram,...)

- Polls Any of these can either be made by you, or you can share ones already created by someone else.

CAREFUL! - Some videos and images are protected by Copyright! Make sure you check the sources of all of your materials to make sure that uploading them yourself will not lead to problems for you. Very often you can check Copyright terms by scrolling to the very bottom of websites and clicking on “Terms Of Use�.

- There are strict rules about how IFMSA logos can be used. Please consult the IFMSA Corporate Identity Manual to make sure you are not using Federation logos the wrong way.

- Choosing to organize a Media Campaign as an Activity alone does not mean that you do not need a Vision, Goals and clear Objectives - these are always useful and crucial to a successful Campaign!

2) Advocacy Advocacy is a crucial and integral pillar in Public Health work, as it can bring to positive change, supported by decision making bodies (Commissions, Governments,...).

Often when people think about advocacy, they think about the kind of activities that an organisation or group of individuals can undertake. These could include: Press conference, Strike March, Court cases, Poster campaign, Round table, Pamphlets, Survey/Opinion Poll, Theatre Workshop, TV or radio drama, Letter writing, Petitions, Public forum, Conference, Press release, Policy research, Exposure tour, Lobbying, Flyers, Website Networking, Coalitions or networks, Newsletter.

When pursuing advocacy, it is especially important to define clear and impactful answers to the “why” questions (i.e.: “Why is this an issue?”). The entities or individuals you approach will want to know why you are pursuing a certain goal.

In addition to this, it is also important to know which factors determine or influence the issue, which ones can be changed, and which ones cannot. It is important to define who your potential allies can be (e.g. producers of sports gear might be on your side if you are promoting physical activity), as well as who the potential “enemies” could be (e.g. a Fast Food company, if you are promoting Healthy Diets).

To have a clear overview of your potential supporters you can create a Stakeholder Map. Plenty of How To guides and Stakeholder Map models can be found online.

When it comes to Advocacy, there are many different people you can spread your message to. Of all the ones who support you though, probably not all of them will be able to help you in the way you expect. This is why it is important to define who the key players are in every situation, especially in situations you are attempting to influence. Accordingly, you will have set your priorities of how to meet them, talk to them, and present your case in the hopes of convincing them of the change you seek.

There are five key questions to ask when thinking about advocacy and developing an advocacy strategy: A. What do you want to change?

B. How will change happen?

C. What is your core argument/message?

D. How are you going to win the argument or deliver the message?

E. How will you know if you are making progress or have succeeded?

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Source:https://docs.google.com/document/d/1CCBADJk517KS1qXXBaY_0M0kiGMRkiyiT0slMuke6 n4/edit

Proposing solutions: In general, when engaging in advocacy it is difficult to meaningfully engage in influencing change by just pointing out what is wrong with the current situation (the problem). It is helpful to have a proposal for change – a solution or recommendations.

If you are going to engage in discussions with decision makers around your solution it can be important to ‘test’ it for any weaknesses.

Key questions it can be useful to ask are: - Is your solution/recommendation realistic?

- Can it be implemented without much expense?

- Is your solution simple and easy to understand?

- Could your solution/recommendation achieve tangible results in a short period of time?

- Who will oppose your solution/recommendation or be sceptical about it?

Why? - Will decision-makers like your solution/recommendation? Why? Why not?

- Are there other solutions to the problem that are more practical than your initial idea, and that will be more appealing to the decision makers? What are these solutions?

How will change happen?

How change happens is context (and issue) specific so it is important to think about what you know about the context for change (whether at the international, national or local level). Key to understanding how change will happen is knowing who has the power to make decisions in relation to your issue and who influences them. It is also important to reflect on the role that your individual organisation can play in influencing change. a) Understanding the context for change A very simple way to think through your context and make sure you are taking it into consideration in relation to your advocacy strategy is to use the PESTLE framework. This is often used in strategic planning processes.

PESTLE stands for the (P)olitical, (E)conomic, (S)ocial, (T)echnological, (L)egal and (E)nvironmental context. It can also be useful to add in an extra ‘I’ (PESTLEI) which covers the (I)nternational context – the involvement of international donors or agencies in your context.

In turn think about each element of the context (the political, then the economic…) and think about how it affects your issue.

For example, there may be elections coming up (political context) or there may be a high rate of inflation which affects the price of food (economic context). Once you have been through each of the elements (PESTLEI), sit back and reflect on what it tells you about your context and what you need to consider in relation to your advocacy strategy. For example, election time can potentially be a good time to advocate as political parties may want to include your ideas in their manifestos but also on the other hand there may be greater instability, politicians may be distracted and civil society space may be constrained.

b) Understanding who will be involved in change First list all of the potential stakeholders that are involved your issue currently and would need to be involved in the change you want to see.

The kinds of organisations/institutions you may want to include are: - National Government - Local Government - Business and the private sector - Non-governmental (Civil society) organisations - That is you! Think about which other NGOs focus on this issue.

- Professional bodies such as physicians, veterinarians, etc.

- Religious or community leaders - Media - International donors and international organisations You will probably need to do some research in order to identify individuals within organisations as we influence people not institutions.

For example, if you identify that the Daily National Newspaper is an important media stakeholder, you may need to think about who at the Daily Nation Newspaper you need to influence – is it the Editor, the health columnist or the opinion page editor? Once you have identified the individuals, you may want to gather other information which helps you to understand their interests so that you can better target your advocacy and understand whether they are allies or opponents of your ideas.

Having the stakeholder analysis can be useful but it is difficult to visualise and understand how the various stakeholders relate to each other and also how your organisation or you as an individual can actually influence the decisionmaker either directly or indirectly. For example, there could be a range of different ways to influence the decision-maker. c) Understanding multiple paths to influence - You could request a meeting with the public health minister directly.

- You could focus on increasing press coverage that will influence the Minister.

- You could engage with the parliamentary committee on health who would produce a report that would be sent to the Minister.

- You could engage religious leaders within the Catholic Church who may be able to influence the Minister.

- You could form an alliance with the professional association (midwives, nurses and obstetricians and gynaecologists).

The most effective advocacy strategy might be to use a combination of all the above approaches in order to develop momentum and pressure for change.

Why you might be interested in pursuing Advocacy, when it comes to Diabetes: - Is the health care system in your country treatment oriented rather than prevention oriented?

- Is there a policy in your country which could be modified in regards to Diabetes prevention?

- Is screening for Diabetes free or affordable for all citizens in your country?

- Do diabetic patients have access to affordable medications? Is there access for everyone affected, or is it limited to specific conditions (e.g under a certain age, only for patients affected by Type 1 Diabetes,...)?

Advocacy can be performed on many different levels, and not only on a National level. Here are some examples: - University Does your school cafeteria serve many high-sugar products?

Are there too few physical activity programs offered?

Taking advantage of the celebration of the WDD can be a good starting point to open a conversation with various departments in your university and start provoking change for your student colleagues.

- Community Each community has weak spots, some which you could impact as future health professionals! Start a conversation with local officials to have a stronger influence on health where you live.

Keep in mind that often your first attempt might seem ineffective to you, but this is completely normal! Revise your strategy, your approach to the different stakeholders, and keep trying. Often, it will not be enough to explain the Why of the issue to the parties you approach. It is also very important to be able to explain Why changing the issue in your favor could also be beneficial and practical for them (e.g. prevention is less expensive than treatment, therefore the Government would save expenses if they invested more in prevention).

Advocacy Take Home Message: - Be well informed about the issue you are fighting to change - Define a Stakeholder map - Create a clear, evidence-based message that will support your cause - Find support from relevant parties - Keep your interests in mind, but also evaluate what interests others may have in your action, to improve your chances of finding support - Never forget to define your Vision, Goals, Objectives.

5. Experiences a. SloMSIC Slovenia: #LOWersugar On World Diabetes Day 2015 SloMSIC Slovenia prepared a compilation of events and activities for citizens of the capital city of Slovenia, Ljubljana. Diabetes is becoming ever more a large problem in the country. There are many undiscovered/undiagnosed patients with diabetes and the complications of the disease are a large burden. This is why as SloMSIC, we decided to target people of all age groups and tackle the issue by raising awareness about Diabetes and help increase people's knowledge about the disease, as well as help them decrease the risk of getting Diabetes themselves by promoting healthy lifestyles.

A few days before the actual WDD, SloMSIC organized a short workshop, in which medical students got a chance to increase their own knowledge on the topic of Diabetes, preventive measures and tactics. After the workshop, students and lecturers were invited to participate in a round-table debate to discuss different approaches on how to tackle diabetes in the future and the effectiveness of screening practices.

SloMSIC celebrated the WDD itself on the 14th of November, performing screening for Diabetes by conducting free blood sugar and blood pressure measurements, as well as distributing informative flyers about diabetes. Risk calculators in printed form were used to determine which participants did not need screening for diabetes. Participants were invited to try the HypoKit: a simulator of hypoglycemia symptoms: the kit includes goggles similar to alcohol impairment simulation goggles, gloves for electrical simulation of hand tremors and heavy-weight shoes to simulate difficulty while walking.

Medical Students discussed preventive measures, signs and symptoms of Diabetes with almost 2000 people in only a few short hours. We conducted more than 1200 measurements and discovered less than 20 alarming results, meaning that the situation and the state of awareness about Diabetes in the country is improving and more and more people are seeking and obtaining appropriate follow-up testing.

This finding was further reinforced with our survey, measuring participants’ knowledge about Diabetes, the early signs and symptoms, preventive measure and the importance of good Diabetes management. The average grade of 634 surveys completed was 92%!

For all participants in the #LOWersugar events (screening participants, interested individuals, medical students) we also organized a short hike on a nearby hill, where the castle of Ljubljana is situated. The event was well covered by media and was much loved by participants. More than 600 hikers enjoyed the event.

Following last year’s success, the event for WDD 2016 is in preparation, hoping for it to be even bigger and better than last year.

b. ASMB Bulgaria: World Diabetes Day 2015 in Bulgaria - we can change the face of Public Health!

Every year the Bulgarian Medical Students’ Association (ASMB) puts a lot of effort into celebrating the World Diabetes Day (WDD) and into trying to raise awareness about this socially significant disease. The WDD 2015 was very special for us as we were able to conduct a variety of activities to promote healthy lifestyles and also to show the union of medical students from different countries against Diabetes.

Starting in early October during the Balkan SCOPH Weekend that took place in Sofia, Bulgaria, we organized special SCOPH sessions on the topic of Non-Communicable Diseases and also filmed a short promo video with all participants. The video aimed to help us raise awareness among the general public about the health issues caused by Diabetes, and it also helped us show that in fact medical students from the Balkans are united in the fight against this disease.

Moving on to November, we celebrated the WDD 2015 in all medical universities in the country. The medical universities organized the events, which were then conducted in open areas and public centres in the cities. In the 5 major cities in Bulgaria, measurements of blood glucose levels, blood pressure and fats were conducted in order to perform an early screening for Diabetes among the citizens, and to raise awareness about its symptoms and causes. Over 1500 polls about the general lifestyle of participants (concerning their diet, amount of physical activity, work environment and stress levels, etc.) and measurements were performed throughout the country. The data analysis is still in progress, but we are very proud that just in one of the major cities we were able to detect 29 cases of diabetes which the patients were not aware of.

As the promotion of physical activity is essential for the prevention of diabetes, ASMB also organized a 5 kilometer run in the capital of Bulgaria in which more than 500 people from all different age groups took part. At the end of our campaign we performed the WDD 2015 flashmob in one of the most popular shopping centers in Sofia. For all these activities, AMSB partnered with many institutions in the healthcare system and with the private sector as well.

We consider last year’s celebrations very successful as we received very positive feedback from all medical students, citizens and partners and we truly hope that our work has influenced Public Health in Bulgaria!

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ASMB promo video: https://www.youtube.com/watch?v=qIX78WWYwcY&feature=youtu.be

Please note: There are only examples of Activities from Europe in this manual, because we were unable to receive articles on time from coordinators from other Regions. We are however hoping for an updated version of this document to be published, once we have a couple more articles from non-European Regions.

6. Evaluate your work, a brief »How to End«

Evaluating your projects is a crucial step in order to compare the results with the initial objectives of your campaign and measure the impact that was created at the end. It is useful to know the things that have worked, and the things to be improved or changed for the next time you organize an Activity.

It is important to include the members who took part in preparing your project or campaign in the evaluation process, because the lessons learnt from this project will serve as a basis for future ones.

In 3 key points, it is important to perform an evaluation about your Activity: ⇒ So you know if it is working (having an impact) ⇒ So you are aware of unintended outcomes ⇒ To build organizational resilience (strength) within the members who took part in the project → So you can improve your Activity in the future Every organization must provide evidence of impact if it wants to be successful. This can be done by gathering, analyzing and presenting scientific data which will prove that work was performed, Activities implemented and that a difference was made in society through the Activity.

Proof of Impact can be achieved in multiple ways:

a. Feedback Feedback is a subjective way of gaining important information about the design, implementation and impact of your Activity from the population’s perspective, from the organizers, the collaborators and others. When gathering feedback from the public, they generally feel comfortable with medical students as a model for health promotion and do not have difficulties in sharing their thoughts and engaging in campaigns!

Also consider adding an open question to your feedback survey, giving participants space to share anything they might feel they want to add and let you know about what they think.

TIPS! -

-

When you create feedback surveys, make sure they are adapted to the people you are presenting them to (a survey for your colleagues might have to be different than a survey for participants!).

Do not include too many questions in your survey, and keep the questions short (also ask questions that can have short answer)! People do not like to spend more than 1-3 minutes on a survey. Limit the number of questions to the strict essential, less is more!

A few examples of questions you can use: - Do you feel like you learned valuable information about Diabetes? Yes / No - Do you feel like you have learned about the principal risk factors for Diabetes?

Yes/No - Do you think you will change something in your lifestyle after experiencing this Activity? Yes/No - Please rate from 1 to 10 how important you thought awareness about Diabetes was before experiencing this Activity - Please rate from 1 to 10 how important you think awareness about Diabetes is after experiencing this Activity - Do you have any comments you would like to share with us?

To add ‘qualitative’ rather than ‘quantitative’ evaluation information about your Activity, you can also randomly organize slightly longer interviews with certain members of your Target Group. This will allow you to explore the opinions of your participants or collaborators more in-depth, and can result in very useful information to improve your Activity in the future.

b. Data gathering Data gathering is an objective method of evaluating your Activity. It will give you a clear idea about the magnitude of your Activity, and help you realize whether you have met your objectives or not.

A very few examples of data you can gather can be: - Number of people who participated in your Activity - Number of people who answered your surveys - Number of screening tests performed - Screening values - Number of flyers distributed If you are to organize massive outreach campaigns targeting the general population (e.g screening campaigns), you can analyze the data collected in a form of a retrospective study that will show correlations in the results found, but also provide recommendations for further campaigns in the methodology used.

c. Measuring Behaviour

the

change

in

participants'

Knowledge

or

Measuring the aforementioned change is also an objective method of evaluating your Activity. Often evaluating knowledge can be easier than analyzing behavioural changes.

There are however multiple difficulties tied to both types of this evaluation.

Here is an example of how you can gain data about Knowledge and Behavior changes: “Pre-” and ”post-” surveys: For any Activity you conduct, you can perform this type of evaluation. If you are to conduct workshops or conferences, it would be good to share pre-surveys to assess the preliminary knowledge of participants on issues related to the topic of the event. At the end, assess if their opinion and responses have changed following the event, to evaluate the level of comprehension and whether the take-home messages were impactful.

The questions included in the Pre- survey, have to be the same as in the Post- survey, so you can evaluate the difference in response, and therefore the difference in knowledge. To include behavior in this type of evaluation you can include questions like: - Describe your dietary habits and your physical activity routine - From 1 to 10, how much attention do you pay to buying healthy food?

- How many times a week do you perform sports?

The distance between a Pre- and Post- survey can vary between a few minutes and months. They can be delivered right at the start and then the end of your Activity, or can be sent to your participants 1 month before, and then again 1 month after the Activity. How this happens will depend on the number of participants, your contact with them, and the objectives of your Activity.

Clearly, to truly evaluate both changes in knowledge and behavior, it would be ideal to plan a considerable distance between your Pre- and Post- survey.

Answering a knowledge survey 5 minutes after hearing information is not the same as having to answer the same survey 2 weeks later. Similarly, it takes time to modify habits, and evaluating behaviour changes can be a lot more meaningful if it is done a few weeks after the Activity.

It is very important to define an evaluation strategy before you start your Activity. You have to make sure it is clear how you will measure whether your objectives have been reached or not.

For example, if your objective is “Get at least 60 adults aged between 35-55 to run through the official WDD obstacle course within 12 hours”, you will have to make sure to put someone in charge of counting participants, asking them their age, and someone keeping track of time. You will also have to make sure there is a way for you to easily access this information after the Activity. For each objective, analyze what evaluation tools you can and will use, and make sure to prepare for them carefully!

Remember to plan a timeline also for the evaluation and follow-up of your Activity - do not forget that quality evaluation can take time!

Once your evaluation is complete, make sure you can use the analysis of your data to improve your Activity in the future, as well as approach other parties with the proof of your impact, to increase the support you will have in the future.

Be sure to plan a solid evaluation strategy! If you need help with this, feel free to contact any member of the SCOPH International Team, or the Program Coordinator on NCDs (ncd@ifmsa.org)

Take Home Message: - Plan your evaluation strategy before the start of the Activity - Consider multiple types of evaluation methods, to gain a full picture of the impact of your activity - Carefully analyze all the data you have gathered so you can present it to future collaborators, colleagues, external organizations,...

- Use your data analysis to also improve the Activity design for the future.

d. Measuring Impact on a higher level: how we measure impact as a Federation

Centralizing activities: The NCDs and Healthy Lifestyles IFMSA Program You have probably all heard about Programs - after all, we have been talking about them a lot during past year. They exist in order to help you set the basics for your Activity in terms of project management, to help you measure the impact you make when conducting your Activity and to show the world how good your Activity is.

As of this year, more efforts of the IFMSA will be put into IFMSA Programs. Programs represent a series of platforms, each gathering all the Activities related to specific topics.

What to do when you do not know how to start your Activity?

We have an answer to that, too!

In this context, the World Diabetes Day falls under the Healthy Lifestyles and NonCommunicable Diseases Program whose Program Coordinator is appointed to gather all the Activities, projects and actions regarding that specific day, as well as analyzing the data collected. The Program Coordinator can also provide you with best examples of Activities performed in this domain as well as give advice on project management.

How to enroll your Activity in the Program?

To enroll your activity you have to send the Candidature Form, signed and stamped by your NMO president and complete the Enrollment Form with basic information about your Activity. You can contact the Program Coordinator or visit ifmsa.org to get the Enrollment and Candidature Forms in order to allow your NMO to include all their Activities into the Program.

After your Activity, and this is the most important part, you have to submit the Report Form (also supplied by the Program Coordinator) to show how your activity was conducted, and

supply IFMSA with data about its impact. This is how we can review your Activity and measure the impact of it, of your NMO and adding up the single impacts of all the enrolled Activities, we can finally evaluate the impact we have as a Federation.

If you want to know more about Programs consult the Programs Toolkit!

Receiving support from the Program Coordinators One of the most important things Programs are here for, is to teach coordinators how to evaluate Activities. More specific details about evaluation will be shared with members when the new Project Management Manual is published. Program Coordinators can support members both with Activity enrollment as well as with the content of the Activity itself, the starting resources, structure, etc.

IFMSA Programs will be effective and gain more visibility only when all the IFMSA members are well introduced to the work of Programs and are aware about how to participate in them.

Fortunately, it is not complicated and we look forward to gathering all the events being done for World Diabetes Day in our Program.

For any support feel free to send an e-mail to the NCDs and Healthy Lifestyles Program Coordinator (ncd@ifmsa.org)!

7. Externals

a. International Diabetes Federation & National members:

The International Diabetes Federation (IDF) is a worldwide alliance of over 230 national diabetes associations in more than 170 countries who have come together to enhance the lives of people with diabetes everywhere. The Federation is divided into 7 regions (Africa, Europe, Middle East and North Africa, North America and Caribbean, South and Central America, South East Asia and Western Pacific), in order to enhance the collaboration between the different regions and to strengthen the more local effects of their work. For over 60 years, the IDF has been at the vanguard of global Diabetes advocacy.

The Federation is committed to raising global awareness of Diabetes, promoting appropriate Diabetes care and prevention, and encouraging activities towards finding a cure for the different types of Diabetes. It is the mission of the IDF to promote Diabetes care, prevention and a cure worldwide - both globally and locally.

In 2006, the IDF led the “Unite for Diabetes” campaign, which secured a United Nations Resolution on Diabetes. Currently, the Federation continues to lead the global effort to implement Resolution 61/225: It encourages UN Member States to develop national policies for the prevention, treatment and care of Diabetes concordant not only with the sustainable development of their health-care systems but also with the internationally agreed development goals, including the Millennium Development Goals.

The World Diabetes Day – November 14th was introduced in 1991 by IDF and WHO in response to the alarming rise in Diabetes around the world.

IFMSA has actively been participating in the Campaign since November 2007.

⇒ If interested, you can have a look at IDF national members to find organizations you may collaborate with. You can also join their campaigns, or get support from them in your advocacy efforts.

Meet IDF Members here.

b. NCD Alliance: The NCDA is an alliance, founded by four NGOs: the International Union against Cancer (UICC), the International Diabetes Federation (IDF), the World Heart Federation (WHF) and the International Union against Lung Disease and Tuberculosis (The Union), and it was created in May 2009.

The NCDA tackles the four main NCDs outlined in the World Health Organization’s 2008-2013 Action Plan for NCDs: - Cardiovascular Diseases (CVDs) - Cancer - Chronic Respiratory Diseases and - Diabetes.

They also represent the four shared risk factors, namely, tobacco use, harmful use of alcohol, physical inactivity and unhealthy diets. The NCDA works towards the recognition of NCDs as a major cause of poverty, a barrier to economic development and as a global emergency. ⇒ NCDA also has national and regional branches you are welcome to collaborate with. You can also join their campaigns.

You can find them here.

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Link: http://www.idf.org/membership/meet-our-members Link: https://ncdalliance.org/who-we-are/the-ncd-alliance-network/national-and-regional-alliances

Algeria (Le Souk)

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Serbia (IFMSA-Serbia)

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Lesotho (LEMSA)

Sierra Leone (SLEMSA)

Australia (AMSA)

Ethiopia (EMSA)

Libya (LMSA)

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Austria (AMSA)

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Lithuania (LiMSA)

Slovakia (SloMSA)

Azerbaijan (AzerMDS)

Finland (FiMSIC)

Luxembourg (ALEM)

Slovenia (SloMSIC)

Bangladesh (BMSS)

France (ANEMF)

Malawi (UMMSA)

South Africa (SAMSA)

Belgium (BeMSA)

Gambia (UniGaMSA)

Mali (APS)

Spain (IFMSA-Spain)

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Georgia (GMSA)

Malta (MMSA)

Sudan (MedSIN)

Bosnia & Herzegovina (BoHeMSA)

Germany (bvmd)

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Sweden (IFMSA-Sweden)

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Morocco (IFMSA-Morocco)

Taiwan (FMS-Taiwan)

Namibia (MESANA)

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The Former Yugoslav Republic of Macedonia (MMSA)

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Tanzania (TaMSA)

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Togo (AEMP)

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Trinidad and Tobago (TTMSA)

Oman (MedSCo)

Tunisia (Associa-Med)

Bosnia & Herzegovina – Republic of Srpska (SaMSIC) Brazil (DENEM)

Ghana (FGMSA) Greece (HelMSIC) Grenada (IFMSA-Grenada)

Brazil (IFMSA-Brazil)

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Guinea (AEM)

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Hungary (HuMSIRC)

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Costa Rica (ACEM)

Israel (FIMS)

Poland (IFMSA-Poland)

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Italy (SISM)

Portugal (ANEM)

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Qatar (QMSA)

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United States of America (AMSA-USA)

Democratic Republic of the Congo (MSA-DRC)

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Romania (FASMR)

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Russian Federation (HCCM)

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Denmark (IMCC)

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Venezuela (FEVESOCEM)

Dominican Republic (ODEM)

Korea (KMSA)

Russian Federation – Republic of Tatarstan (TaMSA)

Ecuador (AEMPPI)

Kosovo (KOMS)

Rwanda (MEDSAR)

Zambia (ZaMSA)

Egypt (IFMSA-Egypt)

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Zimbabwe (ZiMSA)

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Yemen (NAMS)