Paradis 2005.
| Methods |
Study design: prospectively controlled cohort Sampling frame: all elementary school children in study communities in grades 1 through 4 at baseline Sampling method: All children with written consent from parent/guardian were included Collection method: anthropomorphic measurements and run/walk tests administered by researchers; lifestyle questionnaires filled out by parents for participants in grades 1 through 3 and self administered for participants in grades 4 through 6 Description of the community coalition: The Kahnawake Schools Diabetes Prevention Project (KSDPP) was initiated by community leaders and was described as a partnership of the Kanien’keha:ka (Mohawk) community of Kahnawake with community‐based researchers and academic researchers working co‐operatively and collaboratively in the design, implementation, analysis, interpretation, conclusion, reporting, and publication of experiences of the project. During phase 1 of the project, the partnership included KSDPP staff (diabetes prevention facilitators and trainers, secretarial and administrative support staff, and researchers from the community or outside the community), a Community Advisory Board, academic researchers, and community researchers. The Community Advisory Board consisted of 40 members from the health, educational, political, recreational, social, spiritual, economic, and private sectors. KSDPP decisions were supported by a collective decision‐making process that involved representation from multiple partner groups |
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| Participants |
Communities: 2 native Mohawk territories southwest of Montreal Country: Canada Ages included in assessment: 6 to 11 years of age (n = 641) Reasons provided for selection of intervention community: Community leaders and elders requested a prevention program to address high observed rates of NIDDM and complications in adults, as well as a perceived increase in obesity among children Intervention community (population size): Kahnawake (6746) Comparison community (population size): Tyendinaga (2200) |
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| Interventions |
Name of intervention: Kahnawake Schools Diabetes Prevention Project (KSDPP) Theory: Social Learning Theory, Precede‐Proceed model Aim: to decrease the incidence of NIDDM by increasing physical activity and healthy eating and reducing obesity among children age 6 to 12 years, while incorporating Mohawk traditions and fostering community empowerment and ownership Description of costs and resources: not provided Components of the intervention: A culturally appropriate elementary school‐based health education program with complementary school and community activities, such as school walking programs, nutrition policy promotion, parent‐sponsored dining events, media campaigns, and a 2‐day community diabetes conference. Altogether more than 60 activities aimed at children, teachers, families, and the community were implemented during phase 1 Start date: 1994 Duration: 24 months |
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| Outcomes |
Outcomes and measures
Time points: baseline (1994) and follow‐up (1996) |
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| Notes | Ownership of KSDPP has evolved over time, but the description of the coalition herein refers to the project as organized in phase 1 (1994 to 1997), during the comparative evaluation time frame Funding source: government |
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| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | High risk | No randomization performed |
| Allocation concealment (selection bias) | High risk | No allocation concealment |
| Baseline outcome measurement similar | High risk | At baseline, intervention group had somewhat lower measures of body fatness and higher measures of physical activity; nutrition indices were similar |
| Baseline characteristics similar | Unclear risk | Agreement with participating nations stipulated that no direct comparisons of raw data would be made; no baseline characteristics were reported |
| Blinding of outcome assessment (detection bias) All outcomes | High risk | No blinding |
| Incomplete outcome data (attrition bias) All outcomes | Unclear risk | Numbers of participants and losses to follow‐up not reported |
| Blinding of participants and personnel (performance bias) All outcomes | High risk | No blinding |
| Protection against contamination | Unclear risk | Communities were 200 miles apart, but no other reported attempt was made to prevent contamination |
| Selective reporting (reporting bias) | Low risk | Range of body composition, nutrition, and physical fitness results presented |