Indian Health Service Online Submission, Consultation, and Reporting (OSCAR) System for Evidence Based and Promising Practices, Local Efforts, Policies and Resources. (logo: A Circle of Healthy Initiatives for American Indians and Alaska Natives)

Indian Health Care Resource Center of Tulsa American Indian Pre-Diabetes and Obesity HPDP

Program Type: Local Effort - Programs and/or activities that have not been evaluated but are identified by local programs as producing positive results.

Background: The Indian Health Care Resource Center [IHCRC] American Indian Pre-Diabetes and Obesity HPDP project identified, engaged, assessed and assisted American Indian children, youth and adults at risk of cardiovascular disease or diabetes in a voluntary effort to lead a healthier lifestyle. The project provided diabetes prevention interventions for participants living in or near the City of Tulsa, the geographic core of the service population of IHCRC. Tulsa is located on the traditional lands of the Cherokee, Muscogee Creek and Osage tribes in northeastern Oklahoma. Tulsa County is the second largest metropolitan statistical area [MSA] in the state containing 16.3 of the state’s total population. Oklahoma is home to 39 federally recognized tribal governments. Oklahoma’s Indian population is located in both the urban and rural areas of the state. According to Census data, 273,230 American Indians reside in Oklahoma with 20.4 of those in the Tulsa MSA. As of July 1, 2009 IHCRC served an active patient base of 16,073 individuals. Strategies: The goals of our project included improvement of participants’ health, fitness and quality of life. Specifically, our objectives were to increase fruit and vegetable consumption, decrease consumption of sugary beverages, increase physical activity and increase the number of visits that included educational counseling. Individual counseling session with a registered dietitian [RD] was the primary activity used to accomplish these objectives. The intervention included using a patient-centered motivational interviewing [MI] method in which the RD functions more as a guide than as a teacher. Throughout the MI process the patient decides whether he wants to make a change and what he wants to change, and then sets his own goal[s]. In addition to individual counseling sessions, our activities included facilitation of group classes for both IHCRC clients and employees. Evaluation Methods: To measure our outcomes we developed a nutrition and activity habits survey to measure our participants’ frequency of food choices, meal patterns, physical activity and leisure activity. Our participants periodically completed the survey during the program intervention. We designed the survey as a means to collect the data necessary to measure behavior change outcomes and used this form without modifications throughout the three years of the project. Changing the survey to simplify its content and/or design or replacing the written survey with a participant interview are examples of two programmatic changes we had considered making. We often observed differences in how a participant answered a question on the written survey versus how he or she answered the same question verbally in the counseling session. Results: Our objective to enroll at least 150 IHCRC child, adolescent, and adult clients in nutrition and physical activity counseling annually was met in years 1 and 2 of the project and was exceeded by more than 200 in year 3. We saw an increase in the number of visits that included education related to diet and nutrition and an increase in the number of participants in group health activities. We also saw a decrease in the number of participants consuming more than two weekly servings of beverages with added sugar and an increase in the number of participants who participated in physical activity. However, based on the survey results, we saw a decrease in the number of participants who consumed two daily servings of fruits and three daily servings of vegetables Sustainability: The need for continuation of a diabetes prevention program and screening for prediabetes was established with a CQI study conducted in year 3 of this project. As a result of data collected from this study, a prediabetes care coordinator position was created to improve patient care by early detection of elevated glucose so it can be treated and education can be provided to assist patients in making lifestyle changes. This position is responsible for coordination of care and resources for patients with prediabetes.

Age Group(s):
Children, Adolescents, Adults, Elderly

Site Type(s):
Clinic/Health Center

Health Indicator(s):
Diabetes , Health Education , Nutrition , Physical Activity

Service Area:

Behavioral health/behavioral change, Dietary guidelines, Health promotion and wellness, Motivation, Overweight and obesity, Physical activity, Sustainability


Overall Cost: $100,000.00

Name: Diana Kay Meek
Site or Location Name: Indian Health Care Resource Center
550 S Peoria
Tulsa, OK 74120
Phone: 918 382-2226

Primary Contact Name: Diana Kay Meek
Phone: 918 382-2220