Approach and Key Components
The Goal of Cities for Life:
To help community groups and primary care
providers create an environment that facilitates
and encourages healthy lifestyles and diabetes
prevention and self-management.
Scope of the Problem
• 26 million people in the U.S. have type 2
diabetes:
– 19 million have received diagnosis.
– 7 million are undiagnosed at this time.
• An estimated 79 million American adults aged 20
years or older have pre-diabetes.
– Many will progress to type 2 diabetes without
substantial immediate behavioral changes in physical
activity and diet.
Source: http://www.cdc.gov/diabetes/pubs/factsheet11/fastfacts.htm
Scope of the Problem
• Without change, the Centers for Disease
Control and Prevention estimate one in three
people in the U.S. will have diabetes by 2050.
Centers for Disease Control and Prevention. Diabetes Success and Opportunities for Populationbased Prevention and Control, At A Glance [online]. Available at:
http://www.cdc.gov/chronicdisease/resources/publications/aag/pdf/2011/Diabetes-AAG-2011508.pdf Accessed August 30, 2013.
Scope of Problem
• Relatively small changes in weight can greatly
impact the chances of developing diabetes.
– 5% to 7% loss in weight can reduce chances of
developing diabetes by up to 60%.
– Small changes to physical activity and eating can
result in weight loss in this range.
• Access to local, safe places to be physically
active and to healthy foods can make a
difference.
Health Behavior Change is Needed
• Reducing the risk of diabetes and reducing the
burden for those who have diabetes requires
significant health behavior change.
• Successful behavioral change requires:
– Personal motivation
– Support from family, friends
– A community environment that makes the right
choices easier
Broad Community Support Can Help
with Behavior Change
• The critical determinant of successful health
behavior change is the range and variety of
influences, not the presence or absence of
any key influence.
• Thus, a coordinated, community wide effort is
more likely to succeed than an intensive effort
in one single area.
Cities for Life
• Cities for Life strived to help community
groups and primary care providers create an
environment that facilitates and encourages
healthy lifestyles and diabetes prevention and
self-management.
Cities for Life
• Cities for Life harnesses support and
engagement from:
•
•
•
•
Government
Business community
Medical community
Non-profits
• Resulting in better utilization of communitybased resources
Cities for Life
People with
diabetes & at
risk for diabetes
Public
Relations
Patient
Navigators
Community
Organizations &
Resources
Primary
Care
Practices
Evaluation
People
with/at risk
for diabetes
Public Relations
Patient
Navigators
Primary
Care
Practices
Community
Organizations &
Resources
Patient Navigators
• Patient navigators are community
members who provide a critical
link between primary care
clinicians, patients and
community-based organizations.
• These individuals can range from volunteers to highly
trained nurses depending on goals of the effort and the
available resources.
• Most communities utilize existing community or
organization-based personnel.
People
with/at risk
for diabetes
Patient Navigators
Public Relations
Patient
Navigators
Primary
Care
Practices
Community
Organizations &
Resources
• Cities for Life Patient navigators receive
training and have extensive knowledge
of the existing programs and services
within their community that could help
patients manage their diabetes.
• Key attributes of a patient navigator include:
-
Extensive knowledge of existing programs within the community
Focus on looking out for the best interest of patients and patients’
needs/budget/desires
Ability to successfully engage patients and link them to resources
Ability to understand the inner workings of primary care practices
and successfully interface with the team and the clinicians
People
with/at risk
for diabetes
Public Relations
Paitent
Navigators
Primary
Care
Practices
Community
Organizations &
Resources
Primary Care Practices
• Primary care clinicians play a key role in improving
diabetes management and prevention through:
– Increased recognition and screening of those at risk for
diabetes
– Increased recommendation of community-based
resources to support behavioral change for individuals
living with and at risk for type 2 diabetes
People
with/at risk
for diabetes
Primary Care Practices
Public Relations
Patient
Navigators
Primary
Care
Practices
Community
Organizations &
Resources
• Clinicians identify patients who
could benefit from health
behavior change and refer them
to patient navigators.
• Some clinicians are involved in the
Community Action Team, a group
of leaders of community
programs.
People
with/at risk
for diabetes
Public Relations
Patient
Navigators
Primary
Care
Practices
Community
Organizations &
Resources
People living with or
at risk for diabetes
• Patients of primary care
practices.
• All community residents
with/at risk for diabetes.
• Family members, friends,
coworkers, neighbors are
included, too.
People
with/at risk
for diabetes
Public Relations
Patient
Navigators
Primary
Care
Practices
Community
Organizations &
Resources
Community
Organizations &
Resources
• Community organizations are identified by a
Steering Committee, a small working group of key
individuals with extensive knowledge of
community programs.
• The Steering Committee catalogues available
programs and resources for behavior change,
wellness and efforts to reduce diabetes risk.
Community
Organizations &
Resources
People
with/at risk
for diabetes
Public Relations
Patient
Navigators
Primary
Care
Practices
Community
Organizations &
Resources
•
•
•
A Steering Committee recruits community
organizations to participate in the Cities for Life
Community Action Team
The Community Action Team is made up of members
from medical and public health organizations,
churches, voluntary organizations, and local
businesses.
The Community Action Team :
- Identifies and communicates strengths and gaps in resources for diabetes
management and living healthy lifestyles in the communities.
- Informs development of plans to (a) enhance and/or expand resources and (b)
address gaps to better meet needs of people with diabetes and those seeking to
prevent it.
- Helps guide broader messaging and media efforts related to diabetes
management and healthy lifestyles.
People
with/ at risk
for diabetes
Public Relations
Public Relations
Patient
Navigators
Primary
Care
Practices
Community
Organizations &
Resources
• Public Relations efforts can
help create a broad awareness
for diabetes in the community.
Efforts include:
- Message testing
- Surveys
- Materials development and dissemination
- Event promotion and participation
- Television/Radio interviews
- Newspaper stories
- Social media
- Promotion of mydiabetesconnect.com
Evaluation
• Evaluation is critical to demonstrating the successes of a
program and addressing deficiencies.
• Cities for Life suggests assessing:
– How effective and efficient your development and
implementation is at the practice and community level.
– The extent to which the collaborative effort helped address selfmanagement and support for people living with type 2 diabetes
or at increased risk for diabetes, and the project impact in
general.