Preventing Chronic Disease in Primary Care: NRC Webinar Series Recap

November 27, 2017

On November 2^nd, 2017 the Nutrition Resource Centre (NRC) co-presented a webinar with the Physical Activity Resource Centre (PARC) on Ontario’s Primary Care Diabetes Prevention Program (PCDPP).

During the webinar, participants learned about an internationally recognized, best practice program repeatedly shown to be effective in reducing risk for diabetes and chronic disease and the results of Ontario’s demonstration project to pilot the program in Family Health Teams across Ontario.  Stories and practical considerations from Ontario’s PCDPP Lifestyle Coaches and Master Trainers, who have firsthand knowledge and experience running the program since inception at Family Healthy Team sites across Ontario, were also shared. To wrap up the webinar, the implementation manual to support organizations in planning, implementation and evaluation of this program was highlighted.

An Interview with Sarah Pink and Diane Horrigan

Q: What adaptations were made to the Group Lifestyle Balance^TM (GLB) for the Canadian/Ontario context? 

In primary care in Ontario we focus on not only diabetes prevention, but the prevention and management of several chronic diseases. As such, many of the Ontario Sites adapted eligibility criteria to include a diverse chronic disease audience. This allowed teams to spread their resources across a broader patient population, who would benefit from lifestyle changes to improve their health. Examples of new criteria included those with high blood pressure, high cholesterol/triglycerides, lifestyle risk factors (inactive lifestyle, poor nutrition) as well as those interested and motived in making changes in their lives to improve their health. Master trainers also worked with the University of Pittsburgh Diabetes Prevention and Support Center on program adaptations to be able to run the program with participants living with diabetes.

To improve retention rates after the initial pilot program, it was decided that the post core material would be best delivered bi-weekly. This shortened the duration of the program so some sites have regular comeback /check in sessions to check in with their participants at a later date. 

Though very similar, the GLB program is based on the My Plate food guide from the USA.  The Ontario sites have adapted GLB curriculum to include Canada’s Food Guide into the teaching processes.

To include more of the food focused approach and build upon the skills taught in the GLB program, many sites have included additional hands-on teaching opportunities around nutrition and food (e.g. meal planning/cooking classes, food demonstrations, grocery store tours etc.).

In Canada/Ontario, we have seen a shift from weight loss as a treatment focus to healthy lifestyle changes as the treatment focus, with or without weight loss as an outcome. This involves setting realistic health promoting goals, which may include not having weight loss as a goal at all. As such, one of the biggest adaptions made to the program was to not emphasize calorie counting as originally done in the Diabetes Prevention Program Outcomes Study.  Some sites in the province removed this section of the program completely, while others in the pilot used it as a tool rather than as the focus of the program. In this case lifestyle coaches worked with participants to use calorie counting less and less throughout the duration of the program and used it as a learning opportunity to better understand the nutritional value of calories from different sources of foods, as well as the pros and cons of calorie counting. 

Q: What advice do you have for anyone who is looking to start a Primary Care Diabetes Prevention Program in Ontario? 

Look into using the Group Lifestyle Balance^TM program. This program is a very well rounded program for lifestyle change, is evidenced-based and continues to be reviewed by a research team to stay up-to-date with newer research in the treatment and prevention of diabetes and metabolic syndrome. 

Things that I have learned from using the GLB:

• You can’t teach lifestyle change and expect people to change their lifestyle. They need on-going support, positive feedback, positive feedback and more positive feedback.  Those who felt they were supported with kindness made the most successful lifestyle changes.
• Many benefit from a group atmosphere to share ideas, and to understand they are not alone in making changes.
• A program needs to include nutrition and physical activity resources, tools and supports.
• Collaboration with team members and community members to help get the message across.  I remember once hearing that a person needs to hear something multiple times from multiple people in order for them to really buy into the change. Collaboration helps to spread the workload amongst your team and community but also helps the participants thrive!
• Keep it simple. The GLB teaches at great number of things but does a great job of keeping the messages simple and practical and allows participants to put it into their own words.  I think this speaks a lot to its success.

Q: What are the top three take aways that you would like attendees to leave the webinar with? 

1. A better understanding of the GLB program and its benefits for chronic disease management.
2. How this program is turn-key and adaptable to many different patient populations and settings.
3. Know that there is a community in both Ontario and at the University of Pittsburgh Diabetes Prevention Support Center to help guide and support the implementation and overall process of using the GLB program. 

Q: How would you like the webinar attendees to use the information six months from now?

• Review the implementation manual.
• Contact a master trainer or PCDPP site currently using the GLB program to learn more.
• Sign up for training. 
• Propose or start using this turn-key program within their setting or find ways to adapt it to make it work best for them and their patient population.

To view the webinar recording, click here.