A Community-based Lifestyle Education Program Addressing Non-communicable Diseases in Low-literacy Areas of the South Pacific: A Pilot Control Cohort Study
Lifestyle interventions can effectively reduce chronic disease risk factors. This study examined the effectiveness of an established lifestyle intervention contextualized for low-literacy communities in Fiji. Ninety-six adults from four villages, with waist circumference (WC) indicative of risk of chronic disease, were randomly selected to an intervention or control group. Process evaluation indicated one intervention and one control village fulfilled the study protocol. There were no differences between intervention and control for body mass index BMI (P = 0.696), WC (P = 0.662), total cholesterol (TC) (P = 0.386), and TC:high-density lipoprotein (HDL) ratio (P = 0.485). The intervention village achieved greater reductions than the control village at 30 and 90 days for systolic blood pressure (30 days: −11.1% vs. −2.5%, P = 0.006; 90 days: −14.5% vs. −6.7%, P = 0.019); pulse rate (30 days: −7.0% vs. −1.1%, P = 0.866; 90 days: −7.1% vs. 4.3%, P = 0.027), and HDL (30 days: −13.9% vs. 1.7%, P = 0.206; 90 days: −18.9% vs. 2.2%, P = 0.001); at 90 days only for diastolic blood pressure (−14.4% vs. −0.2%, P = 0.010); at 30 days only for low-density lipoprotein (−11.6% vs. 8.0%, P = 0.009); and fasting plasma glucose (−10.2% vs. 4.3%, P = 0.032). However, for triglycerides, the control achieved greater reductions than the intervention village at 30 days (35.4% vs. −12.3%, P = 0.008; marginal at 90 days 16.4% vs. −23.5%, P = 0.054). This study provides preliminary evidence of the feasibility and potential effectiveness of the intervention to lower several risk factors for chronic disease over 30 days in rural settings in Fiji and supports consideration of larger studies.
WHO. Diabetes; 2018. Available from: https://www.who.int/news-room/fact-sheets/detail/diabetes. [Last accessed on 2019 Sep 04].
WHO. World Health Statistics 2014. In: Media Centre; 2014. Available from: http://www.who.int/mediacentre /news/releases/2014/world-health-statistics-2014/en. [Last accessed on 2014 Aug 08].
WHO. Non Communciable Diseases; 2018. Available from: https://www.who.int/news-room/fact-sheets/detail/noncommunicable-diseases. [Last Accessed 2019 Sep 04].
Omran AR. The epidemiologic transition. A theory of the epidemiology of population change. Milbank Mem Fund Q 1971;49:509-38.
International Diabetes Federation. 2017. IDF Diabetes Atlas. 8th ed. Available from: http://www.diabetesatlas.org/across-the-globe.html. [Last accessed on 2018 Oct 25].
WHO. Global Action Plan for the Prevention and Control of Noncommunicable Diseases 2013-2020. In: Noncommunicable Diseases and Mental Health; 2013. Available from: http://www.who.int/nmh/events/ncd_action_plan/en. [Last accessed on 2014 Sep 11].
Russell L. Poverty, Climate Change and Health in Pacific Island Countries. Issues to Consider in Discussion, Debate and Policy Development; 2011. Available from: http://www.hdl.handle.net/2123/9202. [Last accessed on 2019 Sep 04].
Ornish D, Brown SE, Scherwitz LW, Billings JH, Armstrong WT, Ports TA, et al. Can lifestyle changes reverse coronary heart disease? The lifestyle heart trial. Lancet 1990;336:129-33.
Esselstyn CB Jr., Ellis SG, Medendorp SV, Crowe TD. A strategy to arrest and reverse coronary artery disease: A 5-year longitudinal study of a single physician’s practice. J Fam Pract 1995;41:560-8.
van de Vijver S, Oti S, Addo J, de Graft-Aikins A, Agyemang C. Review of community-based interventions for prevention of cardiovascular disease in low and middle-income countries. Ethnic Health 2012;17:651-76.
Rankin P, Morton DP, Diehl H, Gobble J, Morey P, Chang E. Effectiveness of a volunteer-delivered lifestyle modification program for reducing cardiovascular disease risk factors. Am J Cardiol 2012;109:82-6.
Diehl HA. Coronary risk reduction through intensive community-based lifestyle intervention: The CHIP experience. Am J Cardiol 1998;82:83T-7.
Englert HS, Diehl HA, Greenlaw RL, Willich SN, Aldana S. The effect of a community-based coronary risk reduction: The Rockford CHIP. Prev Med 2007;44:513-9.
Merrill RM, Taylor P, Aldana SG. Coronary health improvement project (CHIP) is associated with improved nutrient intake and decreased depression. Nutrition 2008;24:314-21.
Thieszen CL, Merrill RM, Aldana SG, Diehl HA, Mahoney ML, Greenlaw RL, et al. The coronary health improvement project (CHIP) for lowering weight and improving psychosocial health. Psychol Rep 2011;109:338-52.
Morton DP, Rankin PM, Kent LM, Dysinger W. The complete health improvement program (CHIP): History, evaluation, and outcomes. Am J Lifestyle Med 2014;10:64-73.
Morton DP, Rankin P, Morey P, Kent L, Hurlow T, Chang E, et al. The effectiveness of the complete health improvement program (CHIP) in Australasia for reducing selected chronic disease risk factors: A feasibility study. N Z Med J 2013;126:43-54.
Morton DP, Rankin P, Kent L, Sokolies R, Dysinger W, Gobble J, et al. The effectiveness of the complete health improvement program (CHIP) in Canada for reducing selected chronic disease risk factors. Can J Diet Pract Res 2014;75:72-7.
Reflect. Available from: http://www.reflect-action.org. [Last accessed on 2014 Mar 03].
Sempere, K. Counting Seeds for Change; A Framework for Implementing, Monitoring and Evaluating Reflect. Johannesburg; 2009. Available from: http://www.reflect-action.org/sites/default/files/u5/Reflect%20Evaluation%20Framework%20-%20English.pdf. [Last accessed on 2014 Mar 03].
Howie B. Participatory Evaluation of ALIVE. United States: ADRA Australia; 2014.
Kent LM, Reierson P, Morton DP. Live more: Study protocol for a community-based lifestyle education program addressing non-communicable diseases in low-literacy areas of the South Pacific. BMC Public Health 2015;15:1221-8.
Tuso PJ. Nutritional update for physicians: Plant-based diets. Perm J 2013;17:61-6.
Kent LM, Morton DP, Mañez JT, Yabres GD, Muya AB, Rankin PM, et al. The complete health improvement program (CHIP) and reduction of chronic disease risk factors in the Philippines. Asian Pac J Health Sci 2015;2:67-75.
Kent L, Morton D, Rankin P, Ward E, Grant R, Gobble J, et al. The effect of a low-fat, plant-based lifestyle intervention (CHIP) on serum HDL concentrations and the implications for metabolic syndrome status-a cohort study. Nutr Metab 2013;10:58.
Ferdowsian HR, Barnard ND. Effects of plant-based diets on plasma lipids. Am J Cardiol 2009;104:947-56.
Ornish D. Serum lipids after a low-fat diet. JAMA 1998;279:1345-6.
Kong BW. Community-based hypertension control programs that work. J Health Care Poor Underserved 1997;8:409-15.
Hudgins LC, Seidman CE, Diakun J, Hirsch J. Human fatty acid synthesis is reduced after the substitution of dietary starch for sugar. Am J Clin Nutr 1998;67:631-9.
Kent L, Morton D, Hurlow T, Rankin P, Hanna A, Diehl H. Long-term effectiveness of the community-based complete health improvement program (CHIP) lifestyle intervention: A cohort study. BMJ Open 2013;3:e003751.
Copyright (c) 2020 Author(s)
This work is licensed under a Creative Commons Attribution 4.0 International License.
Asian Pacific Journal of Health Sciences applies the Creative Commons Attribution (CC-BY) license to published articles. Under this license, authors retain ownership of the copyright for their content, but they allow anyone to download, reuse, reprint, modify, distribute and/or copy the content as long as the original authors and source are cited. Appropriate attribution can be provided by simply citing the original article.