Barbara Frigault Bezeau, MGSS Weight management in patients living with chronic diseases: A gender-sensitive intervention Jalila Jbilou MD, PhD Barbara Frigault Bezeau, MGSS Shelley Robichaud Marie-Josée Roussel

Objectives Improve proximity and quality of preventative services and chronic diseases management through a gender-sensitive approach Adapt preventative services and chronic diseases management to gender needs Assess efficacy and potential of transferability of the implemented services

MORE THAN 1 CHRONIC DISEASE Challenges CHRONIC DISEASES COST MORE THAN 1 CHRONIC DISEASE 44% 12% 1 CHRONIC DISEASE Hospital beds utilization by patients with chronic diseases 21% 28% NO CHRONIC DISEASE 28% 68% PERSONS – with chronic diseases Canadian data on hospitalization

Miscou-Lamèque-Shippagan-Inkerman Le territoire desservit: Environ 14 000 de population Emplois saisonniers Taux de chômage plus élevé Revenu moyen plus bas Niveau d’alphabétisation plus bas Exode de nos jeunes et moins jeunes (Fort McMurry)

Hospital and Community Health Centre Lamèque En octobre 2002, le Premier Ministre de l’époque annonce un Centre de santé communautaire à l’intérieur de l’Hôpital de Lamèque En avril 2005, les 12 lits deviennent des lits de soins palliatifs et de soins de longue durée. Aujourd’hui, l’Hôpital et CSC de Lamèque continue d’offrir et met en place des services et des soins de santé primaire. Environ 130 employés. Les objectifs de notre établissement: Offrir des services en fonction des besoins de notre communauté Améliorer l’accès aux services de santé primaires Mettre l’accent sur la promotion de la santé, la prévention des maladies et des blessures ainsi que sur la gestion des maladies chroniques 3

Prevention and health promotion Challenge Prevention and health promotion Présentation de l`Hôpital et CSC de Lamèque. Nous avons un rôle de prévention et de promotion. Nous faisons des activités de cliniques de dépistage dans la communauté surtout en recherchant des milieux convoités. Ex: journée internationale d`HTA( plusieurs endroits)

Data Overweight and obesity a major health problem 46.1% among women Distribution of BMI among men 46.1% among women BMI ≥ 30 Kg/m2 BMI 25 – 30 Kg/m2

Data Physical activity: 20 minutes/Day 33% among women Less than once a week 1 to 2 times a week 3 to 4 times a week More than 4 times a week No answer

Data Nutrition: 60.4% among women Bread and cereals Milk and diary Meat, fish and poultry Vegetables Fruits and Juices (no added sugar) 60.4% among women

Intervention/Measures PairForm® Anthropometric measures in clinical/workplace/community settings 1. Screening Clinical and biological assessment 2. Assessing Addressing the problem with the patient 3. Informing Motivational interview 4. Deciding Enrollment in a 12 weeks health education program (peer facilitaed group) 5. Educating Enrollment in a 12 weeks action oriented intervention (peer facilitaed group) 6. Supporting Follow-up for a period of a total of 24 months: knowledge, motivation, behavior maintenance and emerging specific needs. 7. Maintaining healthy practices 2 Wks 12 Wks 12 Wks 12 Wks 66 Wks

Results Phase 1 Education: 108 persons Phase 2 Action: 48 persons Participants to Phase 1 Education: 23 men (4 groups) and 85 women (11 groups) 53.7% at least 1 chronic disease (diabetes, HBP, CVD, COPD) 25% treated HBP Efficacy of education : High improvement in health literacy: healthy eating, active living, stress and depression management, preventative services and tobacco Less on alcohol moderate drinking

Results Behavioral changes: Clinical efficacy: Biology: 50% tobacco cessation 52% improved physical activity (daily choices, exercising) 30% improved healthy eating (food choices, fresh cooking) Clinical efficacy: Biology: BP: T1: 26%­>140/90 while at T3: 14% >140/90 (systolic BP (M = -5.24 and SD = 14.56) diastolic BP (M = -4.06 and SD = 12.16) TGR: - .07 in average (-1.4-1.2) HBA1C1: -.01 in average (8 patients) Anthropometry : Waist circumference = (-3 cm in average) (M = -2.63 and SD = 3.97) Weight = (-5Kg in average) BMI (M = -.57 and SD = .87)

Results In New-Brunswick: In Ontario: Collaboration with Community Health Centre St. Joseph at Dalhousie (Evaluation of acceptability and feasibility among health professionals) In Ontario: Collaboration with Community Health Centre at Grand-Sudbury (1st expérimental group) Development of adapted tools for men and women in both official languages

Lessons Factors of success: Organizational support Timeliness of change ownership Social dynamic and delocalisation of sessions (outside clinical settings) Flexibility of the program Supportive research team Action-Research is a success when : 1) clarification of respective challenges 2) centration of objectives on patient’s experience and health Results form experimentation in Ontario: favorable for scaling-up and expansion

Lessons Implication of the community at all steps: Needs assessment, validation of the intervention and material, recruitment of participants and interventions delivery (community partnership) Adaptation of strategies to local realities: Social, economic and demographic dimensions Longitudinal integration of research: Participative action research