DIABETES PREVENTION AND CARDIOVASCULAR RISK REDUCTION IN PRIMARY CARE PRACTICEIN PRIMARY CARE PRACTICE

Despite extensive research demonstrating that moderate lifestyle changes can reduce risk for Type 2 diabetes and cardiovascular disease these two chronic conditions continue to account for an overwhelming amount of morbidity and mortality worldwide. Translation of successful prevention and risk reduction research into "real world" settings faces many challenges, while strategies for implementation are lacking. For many reasons, the primary care practice venue provides an ideal environment for provision of prevention services on a permanent basis. The dissertation consists of three related projects; the first two examined the main components of diabetes prevention and cardiovascular disease risk reduction while the third investigated the relationship between perception of disease risk and lifestyle intervention performance. Because current practices of prevention screening are often haphazard and tend to overlook those in greatest need, the first project focused on risk identification through prevention screening in a systematic manner. Feasibility in the primary care practice setting as well as differences between those invited to attend prevention screening and those not invited was examined.The second project investigated the effectiveness and feasibility of provision of a lifestyle change intervention in a primary care practice setting. The successful lifestyle intervention utilized in the Diabetes Prevention Program was modified for delivery in a group rather than individual setting. The effectiveness of the intervention was evaluated through risk assessment measures collected before and after participation in the intervention. Finally, motivation for making lifestyle changes remains a mystery and varies considerably from one individual to another. It has been hypothesized that perceived risk, i.e., the probability of developing a disease or condition may influence an individual's health behavior. Utilizing a modified version of the Risk Perception Survey for Developing Diabetes (RPS-DD) the final project examined baseline differences in responses as well as the relationship between perception of risk and subsequent performance in the group lifestyle intervention. Differences in risk perception before and after participation were also examined. The projects are significant from a public health perspective in that they seek to begin to establish a foundation for implementation of diabetes prevention and cardiovascular risk reduction for the general population