Approach and Key Components

1. Approach and Key Components

2. 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.

3. 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

4. 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 Population-based Prevention and Control, At A Glance [online]. Available at: http://www.cdc.gov/chronicdisease/resources/publications/aag/pdf/2011/Diabetes-AAG-2011-508.pdf Accessed August 30, 2013.

5. 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.

6. 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

7. 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.

8. 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.

9. Cities for Life • Cities for Life harnesses support and engagement from: • Government • Business community • Medical community • Non-profits • Resulting in better utilization of community-based resources

10. Evaluation Cities for Life People with diabetes & at risk for diabetes Public Relations Patient Navigators CommunityOrganizations &Resources PrimaryCare Practices

11. People with/at risk for diabetes Patient Navigators Public Relations Patient Navigators • 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. • Patient navigators are community members who provide a critical link between primary care clinicians, patients and community-based organizations. PrimaryCare Practices CommunityOrganizations &Resources CommunityOrganizations &Resources

12. Patient Navigators People with/at risk for diabetes Public Relations Patient Navigators • 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. PrimaryCare Practices CommunityOrganizations &Resources • 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

13. Primary Care Practices People with/at risk for diabetes Public Relations Paitent Navigators • 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 PrimaryCare Practices CommunityOrganizations &Resources

14. Primary Care Practices People with/at risk for diabetes Public Relations Patient Navigators • 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. PrimaryCare Practices CommunityOrganizations &Resources

15. People living with or at risk for diabetes People with/at risk for diabetes Public Relations Patient Navigators • Patients of primary care practices. • All community residents with/at risk for diabetes. • Family members, friends, coworkers, neighbors are included, too. PrimaryCare Practices CommunityOrganizations &Resources

16. Community Organizations & Resources People with/at risk for diabetes Public Relations Patient Navigators • 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. PrimaryCare Practices CommunityOrganizations &Resources

17. Community Organizations & Resources People with/at risk for diabetes Public Relations Patient Navigators • 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. PrimaryCare Practices CommunityOrganizations &Resources • 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.

18. Public Relations People with/ at risk for diabetes Public Relations Patient Navigators • Public Relations efforts can help create a broad awareness for diabetes in the community. PrimaryCare Practices CommunityOrganizations &Resources • Efforts include: • Message testing • Surveys • Materials development and dissemination • Event promotion and participation • Television/Radio interviews • Newspaper stories • Social media • Promotion of mydiabetesconnect.com

19. 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 self-management and support for people living with type 2 diabetesor at increased risk for diabetes, and the project impact in general.