Skip to main content Accessibility help
×
Home

A school- and community-based intervention to promote healthy lifestyle and prevent type 2 diabetes in vulnerable families across Europe: design and implementation of the Feel4Diabetes-study

  • Yannis Manios (a1), Odysseas Androutsos (a1), Christina-Paulina Lambrinou (a1), Greet Cardon (a2), Jaana Lindstrom (a3), Lieven Annemans (a4), Rocio Mateo-Gallego (a5), Maria Stella de Sabata (a6), Violeta Iotova (a7), Jemina Kivela (a3), Remberto Martinez (a8), Luis A Moreno (a9), Imre Rurik (a10), Peter Schwarz (a11), Tsvetalina Tankova (a7), Stavros Liatis (a12) and Konstantinos Makrilakis (a12)...

Abstract

Objective

To describe the design of the Feel4Diabetes-intervention and the baseline characteristics of the study sample.

Design

School- and community-based intervention with cluster-randomized design, aiming to promote healthy lifestyle and tackle obesity and obesity-related metabolic risk factors for the prevention of type 2 diabetes among families from vulnerable population groups. The intervention was implemented in 2016–2018 and included: (i) the ‘all-families’ component, provided to all children and their families via a school- and community-based intervention; and (ii) an additional component, the ‘high-risk families’ component, provided to high-risk families for diabetes as identified with a discrete manner by the FINDRISC questionnaire, which comprised seven counselling sessions (2016–2017) and a text-messaging intervention (2017–2018) delivered by trained health professionals in out-of-school settings. Although the intervention was adjusted to local needs and contextual circumstances, standardized protocols and procedures were used across all countries for the process, impact, outcome and cost-effectiveness evaluation of the intervention.

Setting

Primary schools and municipalities in six European countries.

Subjects

Families (primary-school children, their parents and grandparents) were recruited from the overall population in low/middle-income countries (Bulgaria, Hungary), from low socio-economic areas in high-income countries (Belgium, Finland) and from countries under austerity measures (Greece, Spain).

Results

The Feel4Diabetes-intervention reached 30 309 families from 236 primary schools. In total, 20 442 families were screened and 12 193 ‘all families’ and 2230 ‘high-risk families’ were measured at baseline.

Conclusions

The Feel4Diabetes-intervention is expected to provide evidence-based results and key learnings that could guide the design and scaling-up of affordable and potentially cost-effective population-based interventions for the prevention of type 2 diabetes.

Copyright

Corresponding author

*Corresponding author: Email manios@hua.gr

References

Hide All
1. World Health Organization (2011) Global Status Report on Noncommunicable Diseases 2010. Geneva: WHO.
2. NCD Risk Factor Collaboration (NCD-RisC) (2016) Worldwide trends in diabetes since 1980: a pooled analysis of 751 population-based studies with 4.4 million participants. Lancet 387, 15131530.
3. International Diabetes Federation (2017) IDF Diabetes Atlas 8th Edition (2017). https://www.idf.org/e-library/epidemiology-research/diabetes-atlas.html (accessed August 2018).
4. Wandell, PE (2005) Quality of life of patients with diabetes mellitus. An overview of research in primary health care in the Nordic countries. Scand J Prim Health Care 23, 6874.
5. Baird, J, Jacob, C, Barker, M et al. (2017) Developmental origins of health and disease: a lifecourse approach to the prevention of non-communicable diseases. Healthcare (Basel) 5, E14.
6. InterAct Consortium (2014) Adherence to predefined dietary patterns and incident type 2 diabetes in European populations: EPIC-InterAct Study. Diabetologia 57, 321333.
7. Martinez-Gonzalez, MA, de la Fuente-Arrillaga, C, Nunez-Cordoba, JM et al. (2008) Adherence to Mediterranean diet and risk of developing diabetes: prospective cohort study. BMJ 336, 13481351.
8. Meisinger, C, Doring, A, Thorand, B et al. (2006) Body fat distribution and risk of type 2 diabetes in the general population: are there differences between men and women? The MONICA/KORA Augsburg cohort study. Am J Clin Nutr 84, 483489.
9. Romaguera, D, Guevara, M, Norat, T et al. (2011) Mediterranean diet and type 2 diabetes risk in the European Prospective Investigation into Cancer and Nutrition (EPIC) study: the InterAct project. Diabetes Care 34, 19131918.
10. Tobias, DK, Hu, FB, Chavarro, J et al. (2012) Healthful dietary patterns and type 2 diabetes mellitus risk among women with a history of gestational diabetes mellitus. Arch Intern Med 172, 15661572.
11. Vazquez, G, Duval, S, Jacobs, DR Jr et al. (2007) Comparison of body mass index, waist circumference, and waist/hip ratio in predicting incident diabetes: a meta-analysis. Epidemiol Rev 29, 115128.
12. Weinstein, AR, Sesso, HD, Lee, IM et al. (2004) Relationship of physical activity vs body mass index with type 2 diabetes in women. JAMA 292, 11881194.
13. World Health Organization (2013 ) Global Action Plan for the Prevention and Control of Noncommunicable Diseases 20132020. Geneva WHO
14. Agardh, E, Allebeck, P, Hallqvist, J et al. (2011) Type 2 diabetes incidence and socio-economic position: a systematic review and meta-analysis. Int J Epidemiol 40, 804818.
15. Dwyer, GM, Higgs, J, Hardy, LL et al. (2008) What do parents and preschool staff tell us about young children’s physical activity: a qualitative study. Int J Behav Nutr Phys Act 5, 66.
16. Sarti, R (2010) Who cares for me? Grandparents, nannies and babysitters caring for children in contemporary Italy. Paedagog Hist 46, 789802.
17. Brown, AF, Ettner, SL, Piette, J et al. (2004) Socioeconomic position and health among persons with diabetes mellitus: a conceptual framework and review of the literature. Epidemiol Rev 26, 6377.
18. Manios, Y, Moschonis, G, Grammatikaki, E et al. (2010) Determinants of childhood obesity and association with maternal perceptions of their children’s weight status: the ‘GENESIS’ study. J Am Diet Assoc 110, 15271531.
19. Stark, JH, Neckerman, K, Lovasi, GS et al. (2014) The impact of neighborhood park access and quality on body mass index among adults in New York City. Prev Med 64, 6368.
20. Taylor, J, Cottrell, C, Chatterton, H et al. (2013) Identifying risk and preventing progression to type 2 diabetes in vulnerable and disadvantaged adults: a pragmatic review. Diabet Med 30, 1625.
21. Foster, GD, Linder, B, Baranowski, T et al. (2010) A school-based intervention for diabetes risk reduction. N Engl J Med 363, 443453.
22. Gonzalez-Suarez, C WA, Grimmer-Somers, K & Dones, V (2009) School-based interventions on childhood obesity. A meta-analysis. Am J Prev Med 37, 418427.
23. Saraf, DS, Nongkynrih, B, Pandav, CS et al. (2012) A systematic review of school-based interventions to prevent risk factors associated with noncommunicable diseases. Asia Pac J Public Health 24, 733752.
24. Tuomilehto, J, Lindström, J, Eriksson, JG et al.; Finnish Diabetes Prevention Study Group (2001) Prevention of type 2 diabetes mellitus by changes in lifestyle among subjects with impaired glucose tolerance. N Engl J Med 344, 13431350.
25. Green, LW & Kreuter, MW (2005) Health Program Planning: An Educational and Ecological Approach, 4th ed. New York: McGraw-Hill.
26. Schwarzer, R (1992) Self-efficacy in the adoption and maintenance of health behaviors: theoretical approaches and a new model. In Self-Efficacy: Thought Control of Action, pp. 217243 [R Schwarzer, editor]. Washington, DC: Hemisphere.
27. Annemans, L (2008) Health Economics for Non-economists: An Introduction to the Concepts, Methods and Pitfalls of Health Economic Evaluation. Ghent: Academia Press.
28. Milat, AJ, King, L, Bauman, AE et al. (2013) The concept of scalability: increasing the scale and potential adoption of health promotion interventions into policy and practice. Health Promot Int 28, 285298.
29. Lindström, J & Tuomilehto, J (2003) The diabetes risk score: a practical tool to predict type 2 diabetes risk. Diabetes Care 26, 725731.
30. Diabetes Prevention Program (DPP) Research Group (2002) The Diabetes Prevention Program (DPP): description of lifestyle intervention. Diabetes Care 25, 21652171.
31. Lindstrom, J, Peltonen, M, Eriksson, JG et al.; Finnish Diabetes Prevention Study (DPS) Group (2008) Determinants for the effectiveness of lifestyle intervention in the Finnish Diabetes Prevention Study. Diabetes Care 31, 857862.
32. Heideman, WH, Nierkens, V, Stronks, K et al. (2011) DiAlert: a lifestyle education programme aimed at people with a positive family history of type 2 diabetes and overweight, study protocol of a randomised controlled trial. BMC Public Health 11, 751.
33. Uutela, A, Absetz, P, Nissinen, A et al. (2004) Health psychological theory in promoting population health in Paijat-Hame, Finland: first steps toward a type 2 diabetes prevention study. J Health Psychol 9, 7384.
34. Androutsos, O, Katsarou, C, Payr, A et al. (2014) Designing and implementing teachers’ training sessions in a kindergarten-based, family-involved intervention to prevent obesity in early childhood. The ToyBox-study. Obes Rev 15, Suppl. 3, 4852.
35. Mouratidou, T, Miguel, ML, Androutsos, O et al. (2014) Tools, harmonization and standardization procedures of the impact and outcome evaluation indices obtained during a kindergarten-based, family-involved intervention to prevent obesity in early childhood: the ToyBox-study. Obes Rev 15, Suppl. 3, 5360.
36. Pigeot, I, Baranowski, T, De Henauw, S et al. (2015) The IDEFICS intervention trial to prevent childhood obesity: design and study methods. Obes Rev 16, Suppl. 2, 415.
37. Endevelt, R, Peled, R, Azrad, A et al. (2015) Diabetes prevention program in a Mediterranean environment: individual or group therapy? An effectiveness evaluation. Prim Care Diabetes 9, 8995.

Keywords

A school- and community-based intervention to promote healthy lifestyle and prevent type 2 diabetes in vulnerable families across Europe: design and implementation of the Feel4Diabetes-study

  • Yannis Manios (a1), Odysseas Androutsos (a1), Christina-Paulina Lambrinou (a1), Greet Cardon (a2), Jaana Lindstrom (a3), Lieven Annemans (a4), Rocio Mateo-Gallego (a5), Maria Stella de Sabata (a6), Violeta Iotova (a7), Jemina Kivela (a3), Remberto Martinez (a8), Luis A Moreno (a9), Imre Rurik (a10), Peter Schwarz (a11), Tsvetalina Tankova (a7), Stavros Liatis (a12) and Konstantinos Makrilakis (a12)...

Metrics

Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed