Preventing Diabetes
Together, Focusing on Healthy South Asian Communities
Program Profile Objectives: Enhance equitable access to diabetes prevention services and resources for the South Asian communities in the North East region of Toronto, by offering language-specific and culturally-relevant services. Objectives: Identify South Asians who are at risk of developing Diabetes through Early Detection Clinics Raise awareness about diabetes in the South Asian communities Enhance knowledge and skills around healthy lifestyle modifications and diabetes prevention Connecting communities to health providers, programs and organizations 1st Encounter: Early Detection Clinics The program outreaches and conducts Diabetes Early-Detection for the South Asian communities using an evidence-based screening tool tailored for South Asians risk factors: A First-Step check-up to identify those who are at risk of developing diabetes. The same day a Prediabetes Awareness workshop is delivered. 2nd Encounter: Diabetes Prevention Workshops South Asian Participants learn how to build skills around the three pillars of diabetes prevention i.e. Healthy Eating, Physical Activity and Mental Health, especially as it relates to resettlement in Canada. They receive a practical and relevant set of tools to enhance the quality of life for themselves and their families. 3rd Encounter: Chat and Chai Workshops Here we invite back participants at the highest risk,1 to 2 months after the second encounter. Referral Services: Those South Asian participants identified through our screening process to be at high-risk of developing diabetes are referred to their family physician to complete the Second-Step check up and confirm if they are at high risk (prediabetes diagnosis). Those already living with diabetes are referred to management programs.
Model of Care 1st Step Screening Diabetes Early Detection Clinic
CANRISK screening tool
- Evidence-based - Tailored to South Asians - Individual Risk Assessment - Body measurements - Blood Glucose testing
Assessment
At Risk At Increased Risk At High Risk Living with Diabetes
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Referral and Attachment Enrolled in culturally-relevant and language-specific diabetes prevention workshop to support lifestyle modifications around healthy eating, physical activity and mental health. 2nd Step Screening: Referred to Physician for lab testing. Referred to Diabetes Education Program near home and support participant with enrolment and attachment
A Typical Diabetes Early-Detection Clinic Time required for this first session: 3 hours The team can effectively screen between 30-35 South Asian participants during this time.
PART 1: Pre-Diabetes Awareness Workshop (Fun and engaging workshop!) Duration: (40 minute workshop, 10 minutes questions and answers) The Registered Dietitian and Nurse engage in an interactive, evidence-based, language-specific and culturally relevant workshop tailored specifically for the South Asian population, where pre-diabetes and diabetes prevention are explained. Here participants are encouraged to join the discussion and bring their questions. They often share their beliefs around diabetes and in exchange learn how to debunk many common myths around diabetes in the South Asian communities. Finally, participants learn about what uniquely puts South Asians at risk, as well at helps them understand the difference between modifiable and non-modifiable risk factors.
PART 2: Clinic Duration: (2 hours and 15 minutes for a group of 30-35 participants) Station 1: Individual Risk Assessment Each participant meets an outreach worker who facilitates an initial risk-assessment using the SADPP screening tool. This is an evidence-based tool developed by the SADPP team that is tailored for the South Asian population. This tool also serves as a risk calculator and includes an in-depth questionnaire designed primarily to identify those at risk of diabetes. Station 2: Body Measurements Participants individually visit the Registered Dietitian (RD) for one-on-one assessments. The RD measures the waist-circumference, height and weight, calculates the Body Mass Index (BMI) and assesses the physical activity level. The personal significance of these findings related to prediabetes and diabetes risks, are described to each participant.
Station 3: Glucose Testing (Finger-Prick Test) Here the Registered Nurse (RN) reviews the assessment tool and administers a simple finger prick -test to test the blood sugar level with a glucometer - a test that is extremely important for both people at high-risk of diabetes and those who have already been diagnosed. After the participant visits all three stations, the nurse can provide a comprehensive assessment and conclude whether participant is at-risk for Pre-diabetes. At-risk patients are referred to the diabetes education services at no charge, while those patients without a family physician are provided resources to connect them to primary care. After the participants have attended the relevant clinic stations, they are each handed a copy of their assessment. They are encouraged to set two goals at least, from their risk-factors that would serve as their own individual road map for diabetes prevention.
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A Typical Diabetes Prevention Workshop Time required for this second session: 3 hours This workshop involves an interactive session focusing on the three pillars of diabetes prevention based on evidence and current best-practice, as described below:
Part 1: Recap of Session 1 and Goal Setting
The group profile is shared with the participants and organizers giving insight on their risk-profile as a group and a shared sense of purpose around diabetes prevention. Participants are also encouraged to share their individual goals around diabetes prevention with the group. This is an effective capacity-building exercise that results in the group forming their own self-help group to take charge of their individual health!
PART 2: Healthy Eating after resettling in Canada The Registered Dietitian engages participants in an interactive information session on Healthy Eating. It encompasses the food guide based on cultural relevance, portion sizes, relevance of simple changes as related to fibre, sugar, sodium, cooking methods, how to interpret information on nutrition labels, shopping on a budget, healthy weight and waist management.
PART 3: Physical Activity throughout the year This component focuses on the benefits of physical activity to improve overall health and its role in reducing the risk of pre-diabetes and diabetes. We discuss the different types of physical activity, myths around physical activity, recommendations and practical tips to overcome barriers. This component is followed by a demonstration of exercises and ideas for individual or group physical activities.
PART 4: Mental Health (The link between resettlement and diabetes) This component emphasizes what is mental health; highlighting stress and depression as related to the resettlement process of immigrants. It draws attention to the physiological implications of unresolved chronic stress and depression and the role they play in increasing the risk of developing prediabetes and diabetes. We engage the participants in a dialogue around some of the barriers that prevent South Asians from accessing professional mental health services. We discuss the importance of seeking professional services to take care of mental health concerns along with strategies to cope with stress.
PART 4: Salad Demonstration (Eating South Asian and Eating Healthy are compatible!) Here we focus on the principle that eating healthy and eating traditional are not incompatible. Participants look forward to the salad demonstration with great eagerness. They are surprised that traditional foods can be used to prepare a high-nutrition, low cost dish which may be eaten by itself or as part of a healthy meal. Each participant receives a set of practical and relevant resources around the three cornerstones of Healthy Eating, Physical Activity and Mental Health to support diabetes prevention.
A Typical Chat and Chai Time required for this second session: 90 minutes This workshop is tailored specifically to support the participants identified at high and very risk of developing diabetes.
What is the Chat and Chai Workshop?
This third encounter includes a workshop for only the highest risk participants roughly one to two month after the second encounter, which revisits important prediabetes awareness and prevention concepts from the EDC and the DPW. At this session, participants are asked about lifestyle changes they have been attempting since attending the program and the clinicians help brainstorm tailored and practical solutions that respond to their personal barriers. Participants are then further referred to health centres and providers such as physical activity programs, social workers and dietitians as needed.
Program participants learning how to use the Care Kit
What’s so special about this session?
In response to requests from participants, SADPP developed Canada’s first-of-it’s-kind Diabetes Prevention Care Kit for South Asian individuals during 2010-11. Each valued at $120 each, the Care Kits contain an evidence-based handbook and DVD (in English/Urdu and English/Tamil) that reflect the content of the EDC and DPW (diabetes awareness, healthy eating, physical activity, and mental health), a healthy plate tool, a pedometer, measuring spoons, and a waist-measuring tape. Currently these innovative Care Kit are given out to highest risk participants at SADPP at these Chat and Chai sessions to reinforce key diabetes prevention messages delivered in the program. Ongoing requests continue by SADPP to the Ministry of Health and Long-Term Care to support translation into other South Asian languages.
What’s in the Diabetes Prevention Care Kit for South Asians?
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Impact of the Program on Participants
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EDC: Flyers, Posters & Postcards 1st Encounter Languages This Flyer is available 11 South Asian languages, including 1. Urdu, 2. Tamil, 3. Gujarati, 4. Dari, 5. Hindi, 6. Bengali, 7. Telugu, 8. Punjabi, 9. Sinhalese, 10. Tibetan and 11. Nepal Sizes and formats Letter (8.5 in x 11 in) Tabloid (17 in x 22 in) Postcard (4.25 in x 5.5 in) Note: After the logistical details have been finalized with the Community Outreach team, these outreach and promotional materials can be available within 3-4 business days.
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DPW: Flyers, Posters & Postcards 2nd encounter
This Flyer is provided to participants to attend the 1st encounter. This is also available in the South Asian languages mentioned on the previous page.
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Chat and Chai: Flyers, Posters & Postcards 3rd encounter
This Flyer is mailed to the participants directly. This is also available in the South Asian languages mentioned on the previous page.
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Frequently Asked Questions (FAQ) What is the minimum number of participants needed to run the program? Great question! The program team is well equipped to screen up to a maximum of 35 South Asian participants. We do require a confirmation of a minimum of 25 participants before conducting the clinic. There is a lot of planning involved leading up to the screening session and many resources that go into bringing this program to your group, place of worship, community or centre.
How are we going to register participants? We are very interested in screening South Asians who are either not traditionally accessing services or because of resettlement. We will work with you to first outreach and engage the communities you work with and then, register and recruit participant to the program. Additionally, participants will be registered through groups they are in already and come on regular basis to the centre. We will also register participants by outreaching in the community by holding information sessions and individually speaking with them about the program. Together we are confident we can respond to the needs of all South Asians.
What role do I or my organization play in outreaching and promoting the program? How will you support us? You play one of the most important roles of raising awareness about preventing diabetes by promoting this program to South Asians you work with! This can include posting the flyers on your bulletin boards and websites, providing a signup desk for participants and individually speaking with those who you think can gain from this program. Here too, we will support you all along the way! From information sessions, where Community Outreach Workers from the program come to your location to hold brief (15-30 mins) sessions, and with groups to answer questions and prepare them for the experience. Tip: The registration lists should be made a week earlier than the clinic to help with planning and logistics of the session.
Why do you need a participant list? What does this list need to include?
SADPP is a truly culturally-relevant and language-specific diabetes prevention program that is tailored to the South Asian communities in Toronto. We find the lists very helpful with the following: 1. Tailoring the content of the workshop to the participants’ needs 2. Preparing the risk-screening tools for participants 3. Planning the pre—post assessment questions for the participants 4. Organizing logistics like translations, referrals and child-minding 5. Confirming that the minimum threshold for holding the clinic has been met (20 South Asians) This list simply needs to capture for us 1. Full Name 2. Language Spoken 3. Ethnicity 4. Phone number 5. Age and number of children (if child-minding is needed)
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Frequently Asked Questions (FAQ) How will you be setting up the space you will be using at our location? We invest heavily in the planning of any clinic in the community and planning the space with you is something we spend a lot of time and effort on! During the first meeting, the Community Outreach Worker will do a walk-through with you the review the space to ensure enough space to safely conduct a community clinic like this. We keep participant safety, privacy and confidentiality at the centre of all this planning. We will provide you with a VenueChecklist, which will helps us in planning the different stations for the Early Detection Clinic. The stations include: Risk-Assessment, Body Measurement, Blood Glucose testing and Referrals. Due to confidentiality we require a minimum of three rooms. One large room is used for the workshop and risk assessment while the other rooms are used for clinicians. This maintains confidentiality among the participants. (Additional recommendations and requirements can be found on the Venue Checklist)
Is this a Drop in clinic? Can Participants come in anytime? Short answer is unfortunately, No. Since the program is three hours, we encourage the participants to infect come in a little early. These sessions fill up quickly and we are able to administer pre-post assessments to these participants. We are respectful of the effort and time participants invest in attending our programs, as such, we begin on time and end on time. To help with this, we call participants who have signed up for the program 2-3 days prior to the session to remind them about the date and time of the session. Because we start the program with the Pre-diabetes Awareness workshop, we unfortunately cannot take in participants who are more than 15 minutes late. We can however add them to our waiting list.
Can Non South Asians register in the program? As a program that is working hard on enhancing equitable access to healthcare, we welcome all participants. While non-South Asians can certainly sit in on the workshop portion of the program, we are not equipped to screen non South Asian participants. This is due to risk-assessment screening tool , which is tailored to risk-factors associated with the South Asian population. However we do connect the individual to resources or services that can look after their needs.
What languages do you conduct the program in? As language is a barrier to access for many resettled participants, we provide the program in a number of South Asian languages based on the census data such as Urdu, Tamil, Hindi, Punjabi, Gujarati, and Farsi (with advance notice we can plan for other South Asian languages as well). Here too, the pre-registration list a week before to the session is very helpful. This helps us with planning to see which language the majority of registered participants speak and we can then arrange the interpreter according to the language need. Note: With 3-4 weeks advance notice. SADPP can deliver the program in 11 South Asian languages, including Urdu, Tamil, Gujarati, Dari, Hindi, Bengali, Telugu, Punjabi, Sinhalese, Tibetan and Nepali
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Frequently Asked Questions (FAQ) Is there food provided to the participants? We provide light healthy snacks (platter of fruits and vegetables with dips) to the participant at the Early Detection Clinic and there will be salad demo at the Diabetes Prevention Workshop. Tip: Participants have to be reminded that if they are not living with diabetes they cannot eat for two hours as that can affect the blood glucose levels.
What kinds of referrals are made for participants? We provide referrals to diabetes education and management programs to participants living with diabetes, based on the participant’s needs and requirements (Example: close to home, male/female, language etc). For those identified as at very high risk of developing diabetes, a referral is sent to their primary care practitioner (family doctor or nurse practitioner) for further examination and diagnosis.
If participants have been through the program already, can they register again for both workshops? We are always happy to see our past participants come back to refresh their learning or share their learnings with the groups during the workshop component! Such participants do not need to register, but we request them to simply let us know that they have been to the program already. Note: We do not re-screen past participants. But will be happy to provide a cue card where time is available.
Is there any other criteria that we should be aware of?
Age of participant- Participants should be the age of 19 and over.
Ethnicity of participants- participants that are registering should be South Asian (this includes participants from India, Pakistan, Sri Lanka, Bangladesh, Tibet, Nepal, Afghanistan; as well as South Asians from Tanzania, Kenya etc).
The clinic is especially for those that are not living with diabetes
Focus should also be on family members that are over the age of 19 years.
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