Evaluation of Apnee Sehat 2009

Summary of Evaluation Report by the University of Warwick

An evaluation of Apnee Sehat CIC in Coventry from June 2008 – May 2009 was conducted by the Institute of Health, University of Warwick to elicit the views and experiences of those who have experienced aspects of the Apnee Sehat community initiative.

From June 2008 to May 2009, Apnee Sehat had contact with 750 patients.

Apnee Sehat screened 605 participants for Blood Pressure, Blood Sugars and Cholesterol, out of which 459 participants had abnormal results. 76% of participants had at least one abnormal result.

7% participants screened had all three abnormal results, 42% had 2 abnormal results and 51% having one abnormal result.

Of those with raised Blood Glucose (a total of 211 participants) 68, (32%) were already diagnosed diabetic. However 143 (68%) participants were not diagnosed diabetics and therefore are possibly newly discovered diabetics.

Of those with raised Blood Pressure, (a total of 274 participants) 106, (39%) were already diagnosed hypertensive. However 168 (61%) participants were not diagnosed, and therefore possibly are newly discovered hypertensive.

It was not possible to identify those who may have previously undiscovered high cholesterol as baseline data collection had not taken place. However, this collection is now in process and in future this figure may also be assessed.

In order to assess any sustained impact of the health screening and education session, a sample of 65 participants were followed up by telephone at 6 weeks and 6 months post screening session. These interviews were conducted in the participants own language by a DSN.

Of the 65, at 6 weeks following the screening session:

75% (49) had been to their GP

6% (4) had been contacted by their GP

85% (56) Participants reported changes

11% (6) Participants reported changes to their lifestyle, for example exercise

31% (17) Participants reported changes to their diet

3% (2) Participants reported changes to both diet and lifestyle

At 6 months, of 46 participants:

80% (37) Participants had sustained their reported changes

These figures suggest that Apnee Sehat screening is effective and makes a difference to participants, the majority of participants who made changes appear to sustain those changes for at least six months.

Diabetes Education

Diabetic South Asian patients and their families attended Apnee Sehat diabetes education sessions. The majority of people attending were experiencing diabetes education for the first time, those who had accessed other diabetes education had not experienced a tailored provision and no one reported having experienced diabetes education delivered in their first language.

Post attendance follow-ups of diabetes education sessions, show almost all, (94%) of those attending reported having made lifestyle changes. Half claimed to have made changes to both their diet and to their exercise levels, the remainder having changed aspects of their diet only.

Shopping Tours

The dietician set the following aims for the session:

‘To empower people with knowledge and skills to be able to make informed choices when shopping for food’

By the end of the tour participants will:

• Be able to identify two different methods of nutrition labelling used by Identify the main nutrient (fat, calories, saturated fat or salt) they will look for when shopping
• Have discussed how the nutrient content of similar foods (e.g. brands of bread or yoghurt) differ
• Have a greater awareness of the healthy foods available in a large supermarket

‘It was very useful. I came to know many things. It has made me more aware of different foods. I didn’t know how to read the labels on the foods. I didn’t know sugar was hidden in the beans and tomato sauce’.

Cooking Sessions

Apnee Sehat’s Dietitian led Cooking sessions consisted of a practical demonstration of cooking two ‘healthy’ Asian dishes, a vegetable curry and a Dahl.

The sessions are interactive using South Asian languages with the dietician encouraging questions and comments.  Learning in established groups in this way offers opportunities for future discussion and reminders in their conversations regarding their food choices, challenges to adaptation and changes they may hope to make or have made.

The groups reported greatly enjoying this style of teaching and learning, a month following the cooking session much of the recall of the session centred on the issue of salt and many professed to have made changes and implemented strategies for gauging amounts used.

'Already salt and oil. Less using. Measuring it down, then putting it'

Some key messages

• Apnee Sehat has had contact with 750 participants, 101 have attended Diabetes Education, 643 attended Healthy Lifestyle and Screening sessions, 20 Shopping and 40 participants attended Cooking sessions.

• 76% of those screened exhibited an abnormal result of either Blood pressure, Blood Glucose or Cholesterol.

• The screening sessions suggest that there are areas of unmet health need within this community

• Apnee Sehat has been successful in identifying possible undiagnosed diabetics in the community and encouraging contact with health care services.

• Education and empowerment are fundamental to the approach of Apnee Sehat, encouraging participants to make healthy choices in diet and lifestyle.