What to know
Bringing health promotion activities to members of the community often requires mobilizing the community’s existing assets, both people and institutional resources, as described in Principle 7.
Background
The YMCA is a capable community partner. It has exceptional reach into diverse U.S. communities and a long history of implementing successful health promotion programs. Over a period of four years, the YMCA of Greater Indianapolis participated with researchers at Indiana University School of Medicine (IUSM). Together they designed, implemented, and evaluated a group-based adaptation of the highly successful Diabetes Prevention Program (DPP) lifestyle intervention.
This project was called the Diabetes Education & Prevention with a Lifestyle Intervention Offered at the YMCA (DEPLOY). It was conducted to test the hypotheses that YMCA wellness instructors could be trained to implement a group-based lifestyle intervention. This intervention would also need to have fidelity to the DPP model. DEPLOY was also to help adults at high risk for developing diabetes. The hope was that those who received this intervention could achieve changes in body weight comparable to those in the DPP.
Methods
DEPLOY compared the delivery of a group-based DPP lifestyle intervention by the YMCA with brief counseling alone (control). DEPLOY is a matched-pair, group-randomized pilot comparative effectiveness trial involving two YMCA facilities in greater Indianapolis.
The YMCA, which was engaged before the development of the research grant proposal, collaborated with researchers at IUSM throughout the study. Research participants were adults who attended a diabetes risk-screening event at one of two semi-urban YMCA facilities. They had a BMI (kg/m2) greater than 24 and two or more risk factors for diabetes. Participants also had a random capillary blood glucose concentration of 110–199 mg/dL. Multivariate regression was used to compare between-group differences in:
- Changes in body weight
- Blood pressures
- Hemoglobin A1c (glycosylated hemoglobin)
- Total cholesterol, and
- HDL (high-density lipoprotein) cholesterol after six and 12 months
Results
Among 92 participants after six months, body weight decreased by 6.0% in intervention participants and 2.0% in controls. Intervention participants also had greater changes in total cholesterol. These significant differences were sustained after 12 months, and adjustment for differences in race and sex did not alter the findings.
Comments
More than 2,500 facilities nationwide participate with their YMCA. This makes the YMCA a promising channel for wide-scale dissemination of a low-cost model for preventing diabetes by changing lifestyles.
Applications of Principles of Community Engagement
Bringing health promotion activities to members of the community often requires mobilizing the community's existing assets. This includes both people and institutional resources, as described in Principle 7. In line with Principles 3, 4, 5, and 7, the YMCA was engaged before the development of the research grant proposal.
The YMCA collaborated on
- The study design
- Approach to recruiting,
- Delivery of the intervention
- Development of measures,
- Interpretation of results, and
- Dissemination of findings
DEPLOY demonstrates how intensive lifestyle-change programs can be more sustainable when health care centers engage established social institutions like the YMCA.