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Type 2 diabetes prevention: population and community-level interventions

This Guidelines for Nurses summary is deliberately concise—covering recommendations 4, 6, 8, 10, and 11. For the complete list of recommendations, please refer to the full guideline

Recommendation 4

Interventions for communities at high risk of type 2 diabetes

  • Work in partnership to develop cost-effective physical activity, dietary, and weight management interventions. Interventions should take into account the religious beliefs, cultural practices, age and gender, language and literacy of black, minority ethnic, and lower socioeconomic groups. (Interventions costing up to £10 per head would need to achieve an average weight loss of about 0.25 kg per head to be cost effective. Those costing up to £100 per head would need to achieve an average weight loss of about 1 kg per head)
  • Identify success criteria in the early stages of development to ensure interventions can be properly evaluated
  • Identify any skills gaps and train or recruit staff to fill the gaps
  • Identify and address barriers to participation. This includes developing communication strategies that are sensitive to the target audience's language and information requirements
  • Use community resources to improve awareness of the key messages and to increase accessibility to the interventions. For example, involve community organisations and leaders at the development stage, and use media, plan events, or attend festivals specifically aimed at black and minority ethnic communities, and lower socioeconomic groups. Also involve existing community and social groups or clubs, such as toddler groups, pubs, social clubs, and local sports clubs
  • Where they exist, use community links, outreach projects, and lay or peer workers (from black and minority ethnic communities, and from lower socioeconomic groups) to deliver interventions
  • Where necessary, train lay and peer workers in how to plan, design, and deliver community-based health promotion activities. Training should be based on proven training models and evaluation techniques. It should give participants the chance to practice their new skills in the community. It should also encourage them to pass on their knowledge to their peers
  • Lay and peer workers and health professionals should identify and encourage 'community champions' (for example, religious and community leaders) to promote healthy eating and physical activity
  • Encourage lay and peer workers to get other members of their community involved*
  • Ensure lay and peer workers are part of a wider team led by health professionals. They should be involved in the planning, design, and delivery of credible and culturally appropriate messages*. This includes helping people to develop the practical skills they need to adopt a healthier lifestyle. For example, they should be able to run nutrition education sessions (theory and practice) or physical activity sessions. Management and supervision of these activities should be provided by the health professionals leading these teams
  • Commission culturally appropriate and financially accessible weight management programmes either from the NHS or non-NHS providers, based on the guiding principles for effective weight-loss programmes. These should be provided in community settings in areas where populations at high risk of type 2 diabetes live. (For example, they could be provided in religious venues or community and social clubs)
  • Ensure the systems or initiatives used to assess someone from a high-risk community are culturally appropriate
  • Ensure identification and assessment systems or initiatives are linked to effective services and interventions for individuals deemed to be at high risk

Recommendation 6

Conveying messages to the local population

  • Work with local practitioners, role models, and peers to tailor national messages for the local community about preventing type 2 diabetes and other non-communicable diseases (such as cardiovascular disease and some cancers)
  • Ensure healthier lifestyle messages are consistent, clear, and culturally appropriate. Ensure they are integrated within other local health promotion campaigns or interventions. Provide details of the local support services available
  • Address any misconceptions in the local community about the risk of diabetes and other non-communicable diseases that could act as a barrier to change. This includes the belief that illness is inevitable (fatalism) and any misconceptions about what constitutes a healthy weight. Also address any stigma surrounding these conditions
  • Ensure messages and information are disseminated locally to groups at higher risk of type 2 diabetes than the general population, including black and minority ethnic and lower socioeconomic groups. Use local newspapers, online social media, and local radio channels targeted at these groups. Also make use of local shops and businesses, community workers and groups, social establishments, educational institutions, workplaces, places of worship, and local health care establishments, for example, hospitals
  • Offer communities support to improve their diet and physical activity levels, and ensure they are aware of the importance of both

Recommendation 8

Promoting a healthy diet: local action

  • Make people aware of their eligibility for welfare benefits and wider schemes that will supplement the family's food budget and improve their eating patterns. This includes free school meals, free school fruit, and Healthy Start food vouchers
  • Provide information on how to produce healthier meals and snacks on a budget
  • Work with local food retailers, caterers, and workplaces to encourage local provision of affordable fruit and vegetables, and other food and drinks that can contribute to a healthy, balanced diet
  • Provide nutrition education sessions (theory and practice) at times to suit people with children (or provide a crèche) or to fit with working hours. Sessions should take place in acceptable, accessible venues such as children's centres
  • Use existing planning mechanisms (for example, national planning guides or toolkits) to increase the opportunities available for local people to adopt a healthy, balanced diet. For example, ensure:
    • food retailers that provide a wide range of healthier products at reasonable cost are readily accessible locally, either on foot or via public transport
    • planning policies consider healthier eating when reviewing applications for new food outlets
  • Encourage local retailers to use incentives (such as promotional offers) to promote healthier food and drink options. The aim should be to make the healthier choice the easiest and relatively cheaper choice. The retailers targeted may include regional and national supermarkets, and convenience store chains, as well as street markets and small independent shops
  • Encourage local caterers to include details in menus on the calorie content of meals to help consumers make an informed choice. If the nutritional value of recipes is not known, they should consider listing ingredients and describing the cooking methods used
  • Ensure local authorities and NHS organisations develop internal policies to help prevent employees from being overweight or obese. Encourage local employers to develop similar policies. This is in line with existing NICE guidance and (in England) the local obesity strategy. For example, organisations could promote healthier food and drink choices in staff restaurants, hospitality suites, vending machines, and shops by using posters, pricing, and the positioning of products

Recommendation 10

Promoting physical activity: local action

  • Ensure local planning departments use existing mechanisms (for example, national planning guides) to:
    • prioritise the need for people (including those whose mobility is impaired) to be physically active as a routine part of their daily life (for example, when developing the local infrastructure and when dealing with planning applications for new developments)
    • provide open or green spaces to give people local opportunities for walking and cycling
    • make sure local facilities and services are easily and safely accessible on foot, by bicycle, and by other modes of transport involving physical activity (they should consider providing safe cycling routes and secure parking facilities for bikes)
    • provide for physical activities in safe locations that are accessible locally either on foot or via public transport
    • encourage people to be physically active inside buildings, for example, by using the internal infrastructure of buildings to encourage people to take the stairs rather than the lift
  • Enable and encourage people to achieve the national recommended levels of physical activity by including activities such as walking, cycling, or climbing stairs as part of their everyday life
  • Assess the type of physical activity opportunities needed locally, and at what times and where. Consider social norms, family practices, and any fears people may have about the safety of areas where physical activities take place (this includes fears about how safe it is to travel there and back)
  • Map physical activity opportunities against local needs and address any gaps in provision
  • Ensure commissioned leisure services are affordable and acceptable to those at high risk of developing type 2 diabetes. This means providing affordable childcare facilities. It also means public transport links should be affordable and the environment should be culturally acceptable. For example, local authorities should consider the appropriateness of any videos and music played. They should also consider providing single-gender facilities, exercise classes, swimming sessions, and walking groups—for both men and women
  • Provide information on local, affordable, practical, and culturally acceptable opportunities to be more active. If cultural issues affect people's ability to participate, work with them to identify activities which may be acceptable. (This may include, for example, single-gender exercise and dance classes, or swimming sessions with same-gender lifeguards)
  • Encourage local employers to develop policies to encourage employees to be more physically active, for example, by using healthier modes of transport to and from work. Walking and cycling can be encouraged by providing showers and secure cycle parking. Signposting and improved decor could encourage employees to use the stairs rather than the lift. In addition, people could be encouraged to be active in lunch breaks and at other times through organised walks and subsidies for local leisure facilities.§ Flexible working policies and incentives that promote physical activity in the workplace should be considered|
  • Ensure the basic training for professional fitness instructors covers: the role of physical activity in improving people's health, how to get marginalised groups involved, and cultural issues that may prevent them from participating

Recommendation 11

Training those involved in promoting healthy lifestyles

  • Ensure training programmes for those responsible for, or involved in, promoting a healthy lifestyle cover:
    • diversity, including cultural, religious, and economic issues, delivering health promotion interventions in a non-judgemental way, and meeting age, gender, language, and literacy needs
    • how to identify communities at increased risk of developing type 2 diabetes
    • strategies for changing behaviour (for those devising health promotion interventions)
    • how to provide advice on healthy eating, physical activity, and weight management in relation to the prevention of type 2 diabetes and related non-communicable diseases
    • how to challenge stigma and dispel myths around type 2 diabetes
  • Ensure those responsible for, or involved in, promoting healthy lifestyle choices are given time and support to develop and maintain the skills described above
  • Monitor health professionals' knowledge and awareness of how to encourage people to adopt a healthy lifestyle. Use, for example, personal development plans and annual reviews. Ensure they keep their knowledge and practical skills up-to-date
  • Ensure training programmes for all health professionals (including undergraduate, continuing professional development, and, where appropriate, post-graduate training):
    • incorporate the knowledge and skills needed to ensure health promotion interventions are culturally sensitive
    • cover nutrition, physical activity, and weight management in relation to the prevention of type 2 diabetes
    • are focused, structured, and based on proven models and evaluation techniques
    • offer opportunities to practice new skills in the community
    • encourage the sharing of knowledge among colleagues
    • provide up-to-date information on topics such as nutrition advice and physical activity (information should be updated regularly)
* This is an edited extract from a recommendation that appears in 'Community engagement' (2008). NICE public health guidance 9.
The second piece of NICE guidance will consider interventions aimed at preventing type 2 diabetes among individuals at high risk.
This is an edited extract from a recommendation that appears in 'Physical activity and the environment' (2008). NICE public health guidance 8.
§ This is an extract from a recommendation that appears in 'Obesity' (2006). NICE clinical guideline 43 and a recommendation that appears in 'Promoting physical activity in the workplace' (2008). NICE public health guidance 13.
| For further guidance on developing programmes and policies to encourage and support employees to be more physically active, see 'Promoting physical activity in the workplace' (NICE public health guidance 13).
 

 

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© NICE 2011. Type 2 diabetes prevention: population and community-level interventions. Available from: www.nice.org.uk/guidance/PH35. All rights reserved. Subject to Notice of rights.

NICE guidance is prepared for the National Health Service in England. All NICE guidance is subject to regular review and may be updated or withdrawn. NICE accepts no responsibility for the use of its content in this product/publication. 

First included: January 2016.