Rowley K G, Daniel M, Skinner K, Skinner M, White G A, O'Dea K
Monash University, Centre for Population Health and Nutrition, Monash Medical Centre, Victoria.
Aust N Z J Public Health. 2000 Apr;24(2):136-44. doi: 10.1111/j.1467-842x.2000.tb00133.x.
To assess the sustainability and effectiveness of a community-directed program for primary and secondary prevention of obesity, diabetes and cardiovascular disease in an Aboriginal community in north-west Western Australia.
Evaluation of health outcomes (body mass index, glucose tolerance, and plasma insulin and triglyceride concentrations) in a cohort of high-risk individuals (n = 49, followed over two years) and cross-sectional community samples (n = 200 at baseline, 185 at two-year and 132 at four-year follow-ups), process (interventions and their implementation) and impact (diet and exercise behaviour).
For the high-risk cohort, involvement in diet and/or exercise strategies was associated with protection from increases in plasma glucose and triglycerides seen in a comparison group; however, sustained weight loss was not achieved. At the community level, significant reductions were observed in fasting insulin concentration but no change in prevalence of diabetes, overweight or obesity. Weight gain remained a problem among younger people. Sustainable improvements were observed for dietary intake and level of physical activity. These changes were related to supportive policies implemented by the community council and store management.
Community control and ownership enabled embedding and sustainability of program, in association with social environmental policy changes and long-term improvements in important risk factors for chronic disease.
Developmental initiatives facilitating planning, implementation and ownership of interventions by community members and organisations can be a feasible and effective way to achieve sustainable improvements in health behaviours and selected health outcomes among Aboriginal people.
评估一项针对澳大利亚西部西北部一个原住民社区肥胖、糖尿病和心血管疾病一级和二级预防的社区指导项目的可持续性和有效性。
对一组高危个体（n = 49，随访两年）和横断面社区样本（基线时n = 200，两年时n = 185，四年随访时n = 132）的健康结果（体重指数、糖耐量、血浆胰岛素和甘油三酯浓度）、过程（干预措施及其实施情况）和影响（饮食和运动行为）进行评估。
对于高危队列，参与饮食和/或运动策略与预防对照组中出现的血浆葡萄糖和甘油三酯升高相关；然而，并未实现持续的体重减轻。在社区层面，空腹胰岛素浓度显著降低，但糖尿病、超重或肥胖的患病率没有变化。体重增加在年轻人中仍然是一个问题。在饮食摄入和身体活动水平方面观察到可持续的改善。这些变化与社区委员会和商店管理层实施的支持性政策有关。
社区控制和自主权使项目得以融入并持续开展，同时伴随着社会环境政策的变化以及慢性病重要危险因素的长期改善。
促进社区成员和组织对干预措施进行规划、实施和自主掌控的发展举措，可能是实现原住民健康行为和特定健康结果可持续改善的一种可行且有效的方式。
