Khush Dil "A Healthy Lifestyle Leads to a Happy Heart"
| Description | A multi-agency project to improve diabetes care and provide education on reducing the risks of developing cardiovascular disease (CVD). |
|---|---|
| Setting | GP Practices |
| Populationting | South Asian people with type 2 diabetes living in Gloucester |
| Intervention summary | There are two approaches: GP practice approach and patients approach. Interventions include carrying out an audit, training practice staff in diabetes care and management, providing cookery lessons and supervised supermarket trips. |
| Outcome Summary | Reduce the risk of developing CVD among diabetes patients. |
| Startup Cost | £1359 The project has cost £4349 in the first five months. This does not include the costs of the team members’ time, which has been provided by each individual organisation. |
| Running Cost | £4842.80 was the total cost for the first five months (November 2006 – March 2007), £1359 of which was the start-up cost. All of this has been supported by Takeda UK, and does not factor in the cost of staff time |
| Funding | Through support from Takeda UK |
| Started | November 2006 |
| Ended | November 2007 |
| Location | Gloucester, Gloucestershire, England |
| Contact |
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Background
Khush Dil is a multi-agency project, which aims to improve the diabetes care and education of South Asian people with type 2 diabetes in Gloucester, and with a particular emphasis on reducing cardiovascular risk.
The Khush Dil team aim to improve awareness of the risks of diabetes, and involve the whole family in making healthy changes to their lifestyle where possible. The education programmes will enhance the clinical interventions provided in the surgeries, and reinforce the importance of self care with diabetes.
The team also targets local services in Gloucester, such as Asian meals on wheels providers and local shops servicing the community.
What is the problem you are trying to solve?
Khush Dil was developed to improve the awareness of the risks of cardiovascular disease within the South Asian diabetes population in Gloucester through lifestyle education and improved clinical care.
Khush Dil offers support to all of the surgeries in inner city Gloucester. The education sessions are all held in local community venues in the areas of Barton and Tredworth, which have been shown to have a high level of health inequalities and social deprivation. These areas also house the majority of Gloucester’s black and minority ethnic (BME) communities.
What local organisations are involved?
Khush Dil has been supported by Takeda UK, Gloucestershire Primary Care Trust (PCT) and the Health Inequalities Project. We also have input from local community groups, and financial and practical support from Kerry Whitcombe, the local Health Promotion Facilitator.
How many people are running this project and who are they?
The Khush Dil team comprises the following multi-agency health care workers: Suzy Allard [community diabetes specialist nurse (DSN)]; Gill Benge (diabetes dietitian); Khatija Panchbhaya, Khatija Mehter, Tahira Mia and Shereena Khan (peer supporters - volunteers trained in diabetes); Adrian Giles (regional account director, Takeda UK); Lynne Garner (healthy living coordinator) and Mariam Kholwadia (Cook and Eat trainer).
What local population are you targeting?
All people with type 2 diabetes (and their families and carers) from the South Asian communities in Gloucester.
How many people are you targeting?
Khush Dil aims to support not only South Asian people with diabetes in Gloucester, but also their families, carers and anyone else who is at risk of developing diabetes themselves. It is difficult to quantify how many people may be reached, although it is estimated that there are approximately 300 households in Gloucester with families from the South Asian community, and all of these will be offered information about Khush Dil.
Interventions
What interventions are you using to address the problem?
There are two main approaches to Khush Dil – the practice and the patient approach.
The practice approach
Local GP practices are supported by the Khush Dil team to provide quality diabetes care that is evidence based. The practices are offered support to undertake a detailed audit which identifies patients at risk of cardiovascular disease. Training is also given to the admin staff to ensure that they are able to code patients correctly, maintain their diabetes register and recall patients effectively. A workshop on the latest evidence for cardiovascular risk management in type 2 diabetes is then held in the practice, and the practice staff are assisted in developing (or updating) their treatment protocols for glucose control, blood pressure and lipids. These protocols can include specific targets or treatments for BME patients.
The practices are also encouraged to record ethnicity for their patients, and assist in this process if required. In-house audit is encouraged at six to nine months after undertaking the initial patient audit, and ongoing support is provided to the surgeries by the community DSN.
The patient approach
Once patients with a high risk of developing CVD have been identified through the practice audit, they can then access a "menu" of locally delivered services to help them make healthy lifestyle choices. This menu has been developed to focus on issues such as reducing dietary fat and the impact of activity on reducing cardiovascular risks, and promotes a hands-on approach to learning. For example, the Asian Cook and Eat sessions, where traditional meals will be made (and tasted!) by the group using healthy ingredients. These messages can be reinforced through attending Healthy Eating for Diabetes sessions, or attending supermarket tours. A 12 week Healthy Living course is also available to raise awareness of how increasing activity levels can positively impact on health. All services will offer translators and will be single sex where appropriate.
Is the project design based on evidence? If so, please state reference.
The project is not based on published research, but is supported by the requirements of the National Service Framework (NSF) for Diabetes 1 .
Outcome
What outcomes or planned outcomes are you measuring?
We are measuring clinical indicators such as HbA1c, blood pressure and lipids through clinical audit in the surgeries (data will not be publicly available).
We also look at the level of engagement of the local community members through attendance records, and lifestyle changes (particularly around reduction of fat intake, and choosing ‘healthier’ fats and oils) through verbal questioning and questionnaires.
Do you have any outcomes or results yet? If so, what are they?
Not available yet.
Is your project relevant to a government target or guideline?
NSF for Diabetes, standard 3 – empowering people to self manage their condition through education and support 1
Feedback
What obstacles did you have to overcome to set up this project?
The main hurdle has been encouraging people to attend the education sessions. The location of the sessions has had to be altered to suit the people attending, and the structure of the sessions has had to adapt to suit their specific needs. For example, our local community like to be able to drop in and out of the sessions rather than attend a complete course, so the healthy living course has been adapted to accommodate this.
What have you learned about the project so far?
Attendance to education sessions relies heavily on ‘word of mouth’ from the local community – we rely on support from the volunteers on the team to promote the sessions within their own communities.
Some surgeries have been reluctant to accept advice and have feared that Khush Dil would create more work for them. Therefore, we will spend more time with the surgeries explaining how the audit can benefit them (eg, improved QOF data) when approaching other surgeries. We are also encouraging the practices to share their experiences (good and bad!) of the Khush Dil project with other practices.
What would you do differently?
People do not like to walk far to the sessions, and we will be sourcing venues as centrally as possible in 2007, as certain locations have restricted attendance levels.