Effectiveness of a Pasifika Women’s Diabetes Wellness Program (PWDWP)

The program content and materials were co-designed and co-developed with the Maori and Pasifika communities (2017- 2019) using participatory co-design and talanoa approach, prior to securing the fund to pilot the study. The intervention participants will be drawn from women living with diabetes in the southern section of South-east QLD (Logan, Ipswich, Gold Coast). They will be geographically separated from the control group (recruited from the northern sector of south-east QLD (Brisbane, Caboolture, Sunshine Coast) to minimise potential for cross-contamination. All intervention participants will have access to an interactive electronic journal (as well as a hardcopy program journal) via a web interface (including podcasts, a moderated discussion board and self-directed culturally co-developed resources), recipe books, passport for health checks and fact sheets as well as text messages with reinforcing positive motivational behaviours receive a program journal (interactive e journal and printed hard copy), recipe book and fact sheets which they can work through with the support of the CHWs. The participants will document their journey using the journal and with the support of the community health worker. They will share their stories during the during the Talanoa support group to identify barriers, enablers and on going maintenance support. The community health worker (CHW) will also provide coaching using the journal the women completes during the program. The CHW will work with the women to guide them with documenting the journal. Although it will be encouraged, the documentations in the journal will be at the participant's discretion. The intervention will include whanau education talanoa workshop (in-person and via zoom), individual talanoa consultations (via Zoom) and talanoa support group (in person and via zoom) over 24 weeks (12 weeks intervention and 12 weeks follow up) with Maori and Pasifika women (MPI) living with type 2 diabetes in Southeast Queensland. It will be delivered by trained MPI Health Professionals consisting of community health workers (CHWs), and a workshop facilitator (or nurse diabetes educator educators / registered nurse (RN) working with the MPI communities. The Intervention includes: 1.Whanau Talanoa Workshop ((WTW) Weeks 1 -5): 5 x 2hr session delivered in-person and via zoom over 5 weeks covering the wellness components. Whanau talanoa workshops will provide interactive knowledge-based education on targeted health knowledge and behaviours and with culturally specific tools to manage type 2 diabetes within a family, community and spiritual context (Weeks 1 -5 in person and virtual delivery will also depend on the advisory committee to run the education sessions as 2 day forum). It is anticipated that 15 participants will attend face to face session and 15 - 20 participants will attend online via zoom). Registration attendance (name, address, contact details and corresponding participant ID) will be taken for each participant at each session. Each participant who attends the workshop will also complete and evaluation at the end of the workshop. A record will also be kept for those who do not attend with face to face or online education sessions. 2. Individual Talanoa Consultation (ITC) (Weeks 6-7; 13-14; 20-21): 3 x 1hour one-to one talanoa (via zoom) with a trained Pasifika Community Health Worker (CHW). One-to-one talanoa will facilitate tailored education, goal setting and coaching with specialist advice to support individualized plan/goals on healthy weight, diet, physical activity, manage stress, sleep, medication, appropriate screening and routine check-ups (at weeks 6-7 some women will receive this in week 6 while others will receive it in week 7); review and revise goals if necessary, discuss prevention strategies and identify barriers (at weeks 13-14) and review participant progress including barriers to self-management, reinforcement of positive behaviour and setting future goals for maintenance (at weeks 20-21). (Weeks 6-7 preliminary, Weeks 13-14 follow-up and Weeks 20-21 maintenance action plan and moving forward). 3. Talanoa Support Group (TSG) (Weeks 9, 16, 19) & Text messages (8, 10-11, 15, 17-18, 22-23): Follow up with emails, text messages and virtual group talanoa to provide peer support on topics including dealing with stress, barriers, understanding family situations, mindfulness, nutrition/diet, importance of health checks, regular visits to GPs and specialists, monitoring blood sugars, medication adherence and maintenance. Individual talanoa and support group follow up by trained community health workers. Intervention component Whanau Talanoa Workshop ( Weeks 1 - 5), 2 x 2-hours workshop sessions that includes face-to-face and virtual online delivery via zoom for participants who are not able to travel or 'in line with general health recommendations during the global pandemic'. Individual talanoa consultation and coaching (via zoom 1 hour session) at Weeks 6-7, 13-14, 20-21 Text message at Weeks 8, 10-11, 15, 17-18, 22-23 Talanoa support group (via zoom 1 hour session) at Weeks 9, 16, 19 Talanoa support group (in person 1 hour session) & same time as with data collection (DC) (in-person at Weeks 12, 24)* Data collection (DC) (T0, T1 and T2) In-person at 0, 12 and 24* *DC and in-person TSG (This will be in two groups with one group of 15-20 participants in session 1 TSG and 15- 20 participants in DC 1 and then swap over for TSG session 2 and DC 2) Whanau Talanoa workshop was co-developed with the community and covers culturally specific tailored content for MPI women: Becoming Healthy- will provide practical information on type 2 diabetes, its symptoms, risk factors, diagnosis, treatment and management, medication and self-care This session will also cover practical and cultural ways to deal with issues related to the shame and stigma of developing type 2 diabetes and the impact of denial. Healthy Thinking & Feeling- Will provide information and tools to deal and cope with stress, barriers and ways to improve wellness that incorporate elements of Pasifika values, spirituality and faith. Healthy Eating -Will provide information and tools for healthy eating with a self-care healthy eating plan and strategies for managing cultural hospitality requirements without losing face. Staying Active -Will cover ways to get moving, types of exercises to do with your family, practical tips to remain motivated to stay active while managing family and community obligations. Healthy Living -Will encourage, motivate and maintain healthy living including looking after your bones, eyes, kidney and heart, sleep and menopause with spirituality, family and community wellbeing. These content are part of the program journal which all participants will receive in the study. Test SMS motivational messages will be developed in consultation with the advisory committee and will use automated Mobile SMS (recommended provider with secure data platform through QUT). This SMS software will send text bulk messaging to participants at scheduled dates/time at weeks (8, 10-11, 15, 17-18, 22-23) and will cover 'Wellness' key messages on dealing with stress, barriers, understanding family situations, mindfulness, nutrition/diet, importance of health checks, regular visits to GPs and specialists, monitoring blood sugars, medication adherence and maintenance, with particular emphasis on cultural, spiritual, family and community. SMS Software will have the capability to track data as the number of messages are sent, delivered, opened or undeliverable. The mobile number will be collected from all participants at baseline and entered into a database. A satisfaction survey for each component will collect information on uptake, satisfaction and sustainability at the three point times (T0, T1, T2).