Reducing Health Disparities Related to Diabetes: Lessons Learned Through the Canadian Diabetes Strategy Community-Based Program

Case Study 4: Putting the Breaks on Diabetes: Preventing, Detecting and Managing Diabetes in the Workplace - A Unique Joint Public Sector, Union, and Private Sector Initiative

Lead Organization:

• Windsor-Essex County Health Unit

Key Partners:

• Chrysler Canada Inc.
• Canadian Auto Worker's Union
• Sheppel-fgi

Fundraisers:

• Public Health Agency of Canada
• Chrysler Canada

Target Group:

• Autoworkers, retired autoworkers and their families

Communities:

• Windsor-Essex region and other Chrysler Canada locations across the country

Background

Diabetes onset often occurs several years before the condition is medically diagnosed. It is estimated that as many as one-third of adults living with the condition are unaware that they have diabetes. Early lifestyle or medical intervention may prevent 30-60% of type 2 diabetes.

Chrysler Canada Inc. and the Windsor-Essex County Health Unit partnered to deliver a comprehensive program to prevent, detect and manage diabetes in employees, retirees and family members. It was integrated into an existing workplace wellness program.

The diabetes program aimed to increase awareness of diabetes risk factors and prevention; to promote the adoption of healthy eating, active living and type 2 diabetes prevention behaviours; and to identify, educate, refer and support individuals at high risk for developing diabetes, as well as those living with undiagnosed and diagnosed diabetes.

Implementation

Between September 2007 and April 2008, 2,856 employees, retirees and family members participated in diabetes clinics, and an additional 3,500 received information mailed to their home. The program consisted of three main components:

Health Information:

Information was provided through Working Towards Wellness newsletters, a diabetes-specific brochure, diabetes-specific content on the Working Towards Wellness website, posters in key locations and presentations during two diabetes mini-expos.

Health Assessment, Screening and Referral:

Diabetes Screening and Wellness clinics were held at Chrysler facilities and selected community locations. Clinic participants completed a confidential diabetes risk questionnaire, had biometric screening and met with a health educator. All participants also received one of three health education packages: Healthy Living; Diabetes Prevention; or Living With Diabetes.

Diabetes Education:

Employees, retirees and family members living with diabetes who did not attend the expos or a clinic were mailed the Living With Diabetes health education package.

"So many people didn't know where they stood health wise—no clue that they're ripe for a heart attack"

Participating Health Provider

Evaluation

Chrysler Canada and the Windsor-Essex County Health Unit partnered with Sheppell-fgi to design and implement the evaluation. The evaluation strategy included the use of five data collection tools: a feedback survey for clinic participants; a follow-up survey for clinic participants; a home mail-out for recipient feedback; target audience focus groups; and a health care provider feedback survey.

Results

Program Acceptability

• 66% agreed or strongly agreed that the program provided them with information they would not have received elsewhere.
• 73% agreed or strongly agreed that the program had a positive impact on their health.

Early Detection/Screening

• 8% of participants were newly diagnosed with diabetes, 9% with high blood sugar, 16% with high cholesterol and 14.3% with high blood pressure.
• 46% of participants reported that it was unlikely or not at all likely that they would have received diabetes screening elsewhere that year.

Healthy Behaviours

• 82% reported that they ate healthier foods.
• 76% increased their level of physical activity.
• 62.5% tried to lose weight as a result of participating.

Diabetes Management

• There was a 16% increase in the number of participants who perceived their knowledge of diabetic control as good to excellent following participation.
• A lower-than-expected proportion of respondents participated in recommended diabetes management activities (e.g. formal diabetes education, having their feet checked, having a dilated eye exam) at follow-up.
• The proportion of participants taking their oral medication increased from 43% to 92% following their visit to the clinic.

"Participants reported that while getting people off the line was a major barrier to participation, many were able to get time with their supervisors help"

Summary From Employee Feedback Survey

Reaching the Target Population

The uptake for this program was greater than the organizers had anticipated. Several factors may have contributed to this, including the following:

• The convenience of attending the clinic (Chrysler staff attended the clinic during work hours or at the beginning or end of their shift);
• The incentives provided (t-shirts);
• Participant involvement in program planning and design; and
• Staff involvement in promoting the program.

Lessons Learned

• Although this program achieved many positive changes in terms of health behaviours, it did not have an impact on certain diabetes management behaviours, such as having feet checked. Information on foot care must be emphasized in future programs.
• Taking staff work time to access the clinic is an issue, especially in an assembly-line setting. Management support is critical to ensure equal access.
• It is critical to develop a flexible plan that can accommodate industry needs (e.g. plant shut-down, summer schedule).

Resources

This program relied on existing resources such as Working Towards Wellness program resources, fact sheets on diabetes, Canada's Physical Activity Guide and Diabetes for Dummies, 3rd edition.

For additional information:
Neil MacKenzie
Windsor-Essex County Health Unit
E-mail: nmackenzie@wechealthunit.org
www.wechealthunit.org