Hope for Health Program Shows promise in Remote Indigenous Community
Table of Contents
- Hope for Health Program Shows promise in Remote Indigenous Community
- Hope for Health Program Shows Promise in Improving Cardiometabolic Health in Remote Indigenous Community
- Hope for Health Study Assesses Dietary Intake and Physical Activity in Northeast Arnhem Land
- Hope for health Study Examines Baseline Characteristics in Northeast Arnhem Land
- Exploring Health Metrics: A comparative Analysis of Two Groups
- Detailed Analysis of Health Indicators Across Two Groups
- Body Mass Index (BMI) and Obesity Prevalence
- Waist Circumference and its Implications
- Blood Pressure Analysis: Systolic and Diastolic Readings
- C-reactive Protein (CRP) Levels: An Indicator of Inflammation
- Glycated Hemoglobin (HbA1c): Assessing Blood Sugar Control
- Cholesterol Levels: Total, LDL, HDL, and Triglycerides
- Hope for Health Program Shows Promising Results in Arnhem Land
- Lifestyle Intervention Significantly Boosts Physical Activity, Alters dietary Habits
A novel community-developed and -led dietary and lifestyle intervention, known as Hope for Health, has demonstrated promising results in improving cardiometabolic health among Aboriginal and Torres Strait Islander people living in a remote northeast Arnhem Land community. The program, co-designed with senior Yolŋu women, focuses on knowledge sharing, empowerment, and health coaching. This initiative addresses the urgent need for culturally safe programs to combat the disproportionately high rates of type 2 diabetes and cardiovascular disease in these communities,where rates are considerably higher than those of non-Indigenous Australians.
The Hope for Health program utilizes Mar?gikunhamirr (making known and sharing understanding) and Go?-?ayathanhamirr (supporting and walking alongside each other) to empower Yolŋu individuals to take control of their metabolic health. The program promotes self-determined lifestyle changes to improve health and mitigate or prevent chronic disease, incorporating Yolŋu concepts, knowledge, and traditional practices to share information about the biological and socio-economic factors related to colonisation that contribute to poor health.
Background: Health Disparities in Remote Indigenous communities
Before European arrival in Australia, Aboriginal and Torres Strait Islander people enjoyed robust health. However, current statistics paint a starkly different picture. The rate of type 2 diabetes among Indigenous people in remote areas is 8.8 times higher than that of non-Indigenous australians, while cardiovascular disease rates are twice as high. These disparities are rooted in persistent social, political, and economic inequities stemming from colonisation. During 2009–2017, East Arnhem, home to the Yolŋu people, experienced the highest rate of avoidable deaths in Australia, primarily due to diabetes and cardiovascular disease.
The Close the Gap campaign emphasizes the importance of genuine involvement of Aboriginal and Torres Strait Islander peoples in designing and delivering programs and services that affect them. Evidence-based, enduring solutions grounded in community growth are essential. Daily habits significantly impact chronic disease risk, with increased physical activity, a healthy diet, weight management, smoking reduction, and stress reduction all playing crucial roles in lowering cardiovascular disease risk and enhancing quality of life.
The Hope for Health Program: A Community-Driven Approach
In 2016, the Hope for Health program was piloted, focusing on developing a shared understanding of physiological processes in metabolic health, empowerment, and health coaching. The program was co-designed with a group of senior Yolŋu women. go?-?ayathanhamirr, or health coaching, supports goal setting for individual solutions implemented at home based on education and personal experiences. This approach aims to provide positive role models within kin networks and the broader community, possibly yielding wider community benefits.
A complete evaluation of the Hope for Health program was conducted to assess its impact. The primary objective was to determine whether at least 10% of participants achieved clinically meaningful weight loss (at least 5% of their initial weight) by the end of the four-month program. Secondary objectives included assessing changes in metabolic markers, diet, and physical activity. An exploratory objective involved evaluating participant perceptions of Hope for Health through a process designed and led by Indigenous people.
Study Design and Methodology
A single-arm, pre–post intervention study of the Hope for Health program was undertaken, registered with the Australian New zealand Clinical Trials Registry (ACTRN12622000174785; 2 February 2022). Initially, a randomised controlled trial was co-designed with a Yolŋu steering committee and senior Yolŋu researchers, with mutual understanding achieved through discussions and presentations in Yolŋu Matha (Yolŋu language). However, unforeseen circumstances necessitated a protocol change due to strong community concerns about delaying the program, hesitation about participating without household members, and a COVID-19 outbreak. Consequently, a pre–post evaluation with an adequate sample size was deemed the most appropriate alternative, receiving ethics approval on 18 July 2022.
The study was conducted in a remote northeast Arnhem Land community of approximately 2,500 people.In this community, diabetes prevalence is highest among middle-aged individuals (40–60 years). During routine testing in 2022, glycated haemoglobin (HbA1c) levels were high (greater than 54 mmol/mol) in 58% of 190 people tested (unpublished data).
The research team conducted outcome assessments in collaboration with Miwatj Health Aboriginal Corporation doctors. Recruitment and baseline assessments occurred between 28 April and 15 July 2022, with final assessments between 7 November and 14 December 2022. The Hope for Health program was delivered from 1 August to 30 November 2022.
Participants were adult community residents (18–65 years) with body mass index (BMI) values of at least 25 kg/m2 or waist circumferences exceeding 94 cm (men) or 80 cm (women) who were willing to participate in the Hope for Health program and did not expect to leave the community for more than two weeks during the program. Exclusion criteria included severe hypoglycaemia or ketoacidosis, insulin-dependent diabetes, chronic renal failure, cardiac failure, cirrhosis, other conditions preventing participation, or pregnancy.
Key Findings and Outcomes
Of the 55 participants with complete study weight data, 73% experienced weight loss, with a mean weight loss of 1.5 kg (95% CI, 0.5–2.4 kg). Eighteen percent of participants achieved at least 5% weight reduction by program end, while 33% achieved at least 3% weight reduction (post hoc analysis). The mean change in BMI was –0.60 kg/m2 (95% CI, –0.93 to –0.27 kg/m2), and the mean change in waist circumference was –3.2 cm (95% CI,–4.7 to –1.7 cm).
Medical practitioners reviewed the medical histories of all 66 people who enrolled in the Hope for Health program; 14 participants (21%) attended the on-country retreat, 56 (85%) attended home-based or individual health coaching, and 19 (29%) attended community group activities.
Ethical Considerations
The study adhered to the National Health and Medical Research Council Ethical conduct in research with aboriginal and Torres Strait Islander Peoples and communities and the Declaration of Helsinki. The Northern Territory Health and Menzies School of Health Research Human Research Ethics Committee approved the study protocol (2021-4166). The Miwatj Health Board (16 March 2022), the East Arnhem Regional Council (2 December 2021), and the study-specific Data Safety Monitoring Board approved the study. Yolŋu researchers explained the consent form to participants in the local language.
conclusion: Implications for Future Health initiatives
The Hope for Health program demonstrates the potential of culturally acceptable strategies to improve cardiometabolic risk factors and reduce the burden of cardiometabolic disease in remote Aboriginal and Torres Strait Islander communities. Embedding successful elements of this program in local services could enhance the sustainability and management of health services, contributing to improved health outcomes for the Yolŋu people and other Indigenous communities facing similar challenges.
Hope for Health Program Shows Promise in Improving Cardiometabolic Health in Remote Indigenous Community
A four-month “Hope for Health” program has demonstrated encouraging results in improving cardiometabolic risk factors among overweight and obese Aboriginal and Torres Strait Islander adults in a remote Indigenous community.The program, a culturally sensitive and co-designed initiative led by Indigenous people, aims to reduce the prevalence of chronic disease in northeast Arnhem land. The study focused on participants with conditions such as hyperglycaemia, dyslipidaemia, hypertension, or elevated blood inflammatory marker levels.
Key findings of the Hope for Health Program
The Hope for Health program, implemented in a remote Indigenous community, has shown promising results in addressing key health indicators. The study, which involved overweight and obese adult participants, revealed that ten of 55 participants, or 18%, achieved at least 5% weight loss after the four-month program. this is a significant finding, as even modest weight loss can lead to significant health benefits.
Beyond weight loss, the program also led to improvements in other critical metabolic health indicators. Participants experienced declines in mean waist circumference, Body Mass Index (BMI), HbA1c levels, and LDL-cholesterol levels.Furthermore, the median intake of sugar-sweetened beverages decreased, while the mean HDL-cholesterol level and median moderate and vigorous physical activity increased. These changes collectively point to a positive shift towards improved cardiometabolic health among participants.
Clinically significant reductions in HbA1c levels, defined as a decrease of 3 mmol/mol or more, were observed in 26 of 50 participants, representing 52% with a 95% Confidence Interval (CI) of 37–66%. Additionally, reductions in systolic blood pressure of 5 mmHg or more were measured in 20 of 52 participants, accounting for 38% with a 95% CI of 25–53%.
Changes in Physical Activity and Dietary Habits
The Hope for Health program also influenced participants’ physical activity levels and dietary habits. For the nineteen participants with evaluable activity data at both time points, the amount of moderate and vigorous physical activity increased by a median of 103 minutes per day, with a 95% CI of 74–136 minutes per day. This increase in physical activity is a crucial component of improving overall health and reducing the risk of chronic diseases.
Dietary assessments revealed significant changes in food intake among the 45 participants who completed baseline and final assessments. The intake of breads and cereals decreased by a median of 1.5 serves per day (95% CI, –2.0 to –1.0 serves/day), and the consumption of sugar-sweetened beverages declined by 0.6 serves per day (95% CI, –1.4 to –0.1 serves/day). Conversely, the intake of meat increased by 1.1 serves per day (95% CI, 0.7–1.4 serves/day).
Program Components and Participant Perceptions
The Hope for Health program incorporates several key components designed to promote holistic well-being. These include a 12-day retreat focused on experiencing good health, reconnecting with traditional Yolŋu ways of living, eating, and healing from the land, and learning about the body and health. Individual health coaching sessions are also provided to explain pathology test results and explore health goals. Support continues upon participants’ return to the community.
In-community support and mentoring are provided over 14 weeks following the retreat, focusing on overcoming systemic barriers to instigating lifestyle changes. This includes group activities for identifying healthy food options at the store, storing and cooking fresh produce, hunting trips, walking, dancing, and yarning about healthy lifestyles. Individual and home-based health coaching is also offered during the retreat and subsequently in participants’ homes or chosen locations.
Participants expressed positive perceptions of the Hope for Health program, emphasizing the importance of integrating healthy bodies and networks of kin, healthy governance, vibrant language and ceremony, and a healthy environment. One participant shared:
Later the story will get good, the shop will understand the dhu?i-dhäwu (the ultimate truth of things). Come and try out the Hope for Health, your future and your children’s future … that’s the story from me.
Adverse Events
During the on-country retreat, eight adverse events were reported; none were serious, and three were probably intervention-related (bloating, back ache, headache).
Implications and Future Directions
The Hope for Health program represents a significant step forward in addressing chronic disease among Indigenous Australians in northeast Arnhem Land. By integrating traditional knowledge and concepts about diet and health, the program empowers Yolŋu people to take control of their health and well-being. The program’s success highlights the importance of culturally sensitive, co-designed initiatives that are led by Indigenous people.
While the study provides valuable insights, it is vital to acknowledge its limitations. the absence of a control group means that causal relationships between the Hope for Health program and the reported changes cannot be definitively established.However, the positive outcomes observed in this study warrant further investigation and consideration for broader implementation in other Indigenous communities.
Conclusion
The four-month Hope for Health program demonstrated clinically significant changes in several cardiometabolic risk factors for obese and overweight Aboriginal and Torres Strait Islander adults. The community support for the program and the improvements in cardiometabolic risk factors are encouraging, providing an example of a culturally sensitive, co-designed initiative led by Indigenous people for reducing the prevalence of chronic disease among Indigenous Australians in northeast Arnhem Land.
Hope for Health Study Assesses Dietary Intake and Physical Activity in Northeast Arnhem Land
A comprehensive study conducted in northeast Arnhem Land, Northern Territory, Australia, meticulously assessed the dietary habits and physical activity levels of participants in the Hope for Health program.The study, which enrolled 66 individuals in 2022, utilized advanced tools and methodologies to gather detailed insights into the health behaviors of this remote community. Researchers focused on understanding the nuances of dietary intake, ranging from vegetable consumption to the intake of traditional foods, and physical activity, including walking and moderate-to-vigorous exercise.
Detailed Assessment Methods
The Hope for Health study employed a multi-faceted approach to evaluate the health and lifestyle of its participants. Key areas of focus included blood analysis, dietary intake, and physical activity levels. Each of these areas was assessed using specific tools and techniques to ensure accurate and reliable data collection.
Blood Analysis
blood samples were collected from participants to analyze several key health indicators. These included:
- Haemoglobin A1c, reflecting blood glucose levels over the preceding 2–3 months.
- Lipids, including low- and high-density lipoprotein cholesterol and triglycerides.
- C-reactive protein.
The blood samples were collected non-fasting, and the analysis was performed by Western Diagnostic pathology in Jandakot, Western Australia.
Dietary Intake Assessment
Dietary intake was assessed using the Menzies remote Short-item Dietary Assessment Tool,a 32-item food frequency questionnaire. This tool, validated for use in remote communities, was administered by an experienced dietitian and a local researcher fluent in yolŋu Matha. The assessment covered daily intake (in serves) of various food groups,including:
- Vegetables
- Fruit
- Breads and cereals
- Meat
- Dairy
- Sugar-sweetened beverages
- Discretionary foods
- Traditional food
Physical Activity Monitoring
Physical activity levels were monitored using research-grade activity monitors (ActiGraph GT9X) worn on the non-dominant wrist for seven days each at baseline and program end. The study recorded:
- Walking (min/day)
- Moderate and vigorous physical activity (min/day)
- Proportion of days on which the participant walked for at least 30 minutes
- Number of days monitored
Data were included if the activity monitor was worn for at least 600 minutes while awake for at least one day at baseline and endline. Validated algorithms were used to identify non-wear time and activity as walking and total moderate and vigorous activity (including walking and more intense activity).
Participant Demographics
The Hope for Health study enrolled 66 participants, with 55 included in the final analysis. The mean age of the participants was 42.2 years (SD 9.7) for the enrolled group and 42.5 years (SD 10.1) for those included in the analysis. the age distribution was as follows:
- 18–34 years: 18 (28%) enrolled, 14 (25%) included in analysis
- 35–45 years: 24 (36%) enrolled, 20 (36%) included in analysis
- 46–54 years: 16 (24%) enrolled, 14 (25%) included in analysis
- 55–65 years: 8 (12%) enrolled, 7 (13%) included in analysis
The gender distribution was predominantly female, with 22 men (33%) and 44 women (67%) enrolled. Of those included in the analysis, there were 19 men (35%) and 36 women (65%).
The majority of participants identified as Aboriginal (61 or 92% enrolled, 50 or 91% in analysis), with the remainder identifying as aboriginal and torres Strait Islander (5 or 8% enrolled, 5 or 9% in analysis).
Regarding employment status,25 participants (38%) were in paid work,while 52 (79%) received Centrelink benefits. The highest level of education attained varied, with 3 (5%) having completed Year 7 or below, 22 (34%) Years 8–10, 34 (53%) Years 11 or 12, and 5 (8%) having attained higher education. Data was missing for 2 participants.
Conclusion
the Hope for Health study provides valuable insights into the dietary habits and physical activity levels of individuals in northeast Arnhem land. By employing rigorous assessment methods and validated tools, the study contributes to a better understanding of the health behaviors within this remote community. The findings from this study can inform targeted interventions and programs aimed at improving the health and well-being of the residents of northeast Arnhem Land.
Hope for health Study Examines Baseline Characteristics in Northeast Arnhem Land
Study provides insights into the health and lifestyle factors of participants in a health intervention program.
Understanding the health Landscape
In 2022,a detailed examination of baseline characteristics was conducted in northeast Arnhem Land,Northern territory,Australia,as part of the Hope for Health program. This pre–post intervention study aimed to understand the initial health status and lifestyle factors of its participants. A total of 66 individuals were initially enrolled, with 55 ultimately included in the final analysis. This meticulous approach ensures a robust understanding of the community’s health profile before the intervention.
The study delved into various aspects of the participants’ lives, including smoking habits, medication use, existing medical conditions, allergies, and body mass index (BMI). These factors provide a comprehensive overview of the health challenges and potential areas for betterment within the community.
Smoking Habits and Medication Use
One of the critical areas investigated was smoking.The study revealed that a significant portion of the participants were smokers. Specifically, 41 of the 66 enrolled (62%) reported smoking at least one cigarette per day during the month preceding the study. Among the 55 participants included in the analysis, 34 (62%) were smokers. This high prevalence of smoking underscores the need for targeted interventions to address tobacco use within the community.
Medication use was another key focus. The study found that 21 of the 66 enrolled participants (33%) were not prescribed any medications. Conversely, 25 participants (38%) were prescribed one or two medications, 12 (18%) were prescribed between three and five medications, and 8 (12%) were prescribed six or more medications. Among the 55 participants included in the analysis, the distribution was similar: 20 (36%) were not prescribed any medications, 20 (36%) were prescribed one or two, 9 (16%) were prescribed three to five, and 6 (11%) were prescribed six or more medications. These figures highlight the diverse healthcare needs within the study group.
Medical Conditions and Allergies
the study also assessed the number of medical conditions present among the participants. Only 5 of the 66 enrolled (8%) reported having no medical conditions, while 30 (45%) reported one or two conditions, 27 (41%) reported three to five conditions, and 4 (6%) reported six or more conditions.in the analyzed group of 55, 4 (7%) had no medical conditions, 26 (47%) had one or two, 22 (40%) had three to five, and 3 (5%) had six or more. This data underscores the complexity of healthcare management required for this population.
Allergies were relatively uncommon among the participants. The vast majority, 59 of the 66 enrolled (89%), reported having no allergies. Only 6 (9%) reported one or two allergies, and 1 (2%) reported three to five allergies. Among the 55 participants included in the analysis, 48 (87%) had no allergies, 5 (9%) had one or two, and 1 (2%) had three to five. This suggests that allergies may not be a primary health concern within this specific population.
Body Mass Index (BMI)
Body mass index (BMI) was a crucial indicator of overall health assessed in the study. The mean BMI for the enrolled participants was 30.3 kg/m2, with a standard deviation of 5.4. For those included in the analysis, the mean BMI was slightly higher at 30.7 kg/m2, with a standard deviation of 4.9. These figures indicate that, on average, the participants were in the obese range.
Further breakdown reveals that only 9 of the 66 enrolled participants (14%) had a healthy BMI, while the remaining participants were either overweight or obese. Among the 55 participants included in the analysis,only 5 (9%) had a healthy BMI. This highlights the significant challenge of addressing weight-related health issues within this community.
Household Amenities and Lifestyle
Beyond health metrics, the study also gathered data on household amenities, providing insights into the living conditions of the participants. The number of people living in the household varied, with 5 (8%) of the enrolled participants living alone, and 3 (5%) of those included in the analysis living alone. A significant portion,33 (50%) of the enrolled and 28 (51%) of those included in the analysis,lived in households with 7–10 people. Moreover,15 (23%) of the enrolled and 12 (22%) of those included in the analysis lived in households with more than 10 people.These figures suggest that many participants live in crowded conditions, which can impact health and well-being.
Ownership of essential household items was also assessed.Among the enrolled participants, 19 (29%) owned a car, 22 (33%) owned a television, 49 (74%) owned a refrigerator, and 43 (65%) owned an air conditioner.The figures were similar for the analyzed group of 55: 13 (24%) owned a car, 17 (31%) owned a television, 40 (73%) owned a refrigerator, and 37 (67%) owned an air conditioner. These data points provide a glimpse into the standard of living and access to resources within the community.
Exploring Health Metrics: A comparative Analysis of Two Groups
Published:
Detailed Analysis of Health Indicators Across Two Groups
This report delves into a comparative analysis of various health metrics between two groups,focusing on indicators such as Body Mass Index (BMI),waist circumference,blood pressure,C-reactive protein levels,glycated hemoglobin (HbA1c),and cholesterol levels. The data provides a snapshot of the health profiles of the individuals within these groups, highlighting key differences and similarities in their physiological characteristics.
Understanding these metrics is crucial for assessing overall health and identifying potential risk factors for various diseases. The following sections break down each indicator, providing context and insights into the observed data.
Body Mass Index (BMI) and Obesity Prevalence
BMI, a widely used measure of body fat based on height and weight, reveals interesting trends within the studied groups. The data indicates the distribution of individuals across different BMI categories, including normal weight, overweight, and obese.
Specifically, the data shows that within the first group, 27 individuals (41%) were classified as overweight, while 30 individuals (45%) were classified as obese. the second group presented similar figures, with 23 individuals (42%) being overweight and 27 individuals (49%) being obese. These figures underscore the significant prevalence of overweight and obesity in both groups, highlighting a potential area of concern for public health initiatives.
Waist Circumference and its Implications
Waist circumference is another critically important indicator of abdominal obesity,which is associated with increased risk of metabolic disorders and cardiovascular diseases. The mean waist circumference was measured in both groups to provide a comparative perspective.
The mean waist circumference for the first group was 108.6 cm (with a standard deviation of 12.5 cm), while the second group had a mean waist circumference of 108.9 cm (with a standard deviation of 11.1 cm).These measurements suggest that, on average, individuals in both groups have elevated waist circumferences, potentially indicating a higher risk of obesity-related health complications.
Blood Pressure Analysis: Systolic and Diastolic Readings
Blood pressure, a critical vital sign, was assessed by measuring both systolic and diastolic pressures. Systolic blood pressure represents the pressure in blood vessels when the heart beats, while diastolic blood pressure measures the pressure when the heart rests between beats.
The mean systolic blood pressure for the first group was 131.4 mmHg (with a standard deviation of 16.5 mmHg), and for the second group, it was 131.7 mmHg (with a standard deviation of 17.3 mmHg). Further analysis revealed that in the first group, 46 individuals (70%) had systolic blood pressure ≤ 135 mmHg, while 20 individuals (30%) had systolic blood pressure > 135 mmHg. The second group showed similar proportions, with 37 individuals (67%) having systolic blood pressure ≤ 135 mmHg and 18 individuals (33%) having systolic blood pressure > 135 mmHg.
The mean diastolic blood pressure was 81.2 mmHg (with a standard deviation of 11.6 mmHg) for the first group and 80.8 mmHg (with a standard deviation of 12.2 mmHg) for the second group.In the first group, 42 individuals (64%) had diastolic blood pressure < 85 mmHg, while 24 individuals (36%) had diastolic blood pressure ≥ 85 mmHg. The second group had 36 individuals (65%) with diastolic blood pressure < 85 mmHg and 19 individuals (35%) with diastolic blood pressure ≥ 85 mmHg. These blood pressure readings provide insights into the cardiovascular health of the participants and the prevalence of hypertension.
C-reactive Protein (CRP) Levels: An Indicator of Inflammation
C-reactive protein (CRP) is an acute-phase protein produced by the liver in response to inflammation. Elevated CRP levels are associated with various inflammatory conditions and increased risk of cardiovascular events.
The median CRP level for the first group was 8.5 mg/L (with an interquartile range of 4.0–13.0 mg/L), while the second group had a median CRP level of 7.5 mg/L (with an interquartile range of 4.0–13.0 mg/L). In the first group, 19 individuals (30%) had CRP levels ≤ 5 mg/L, and 45 individuals (70%) had CRP levels > 5 mg/L. The second group showed similar results, with 17 individuals (31%) having CRP levels ≤ 5 mg/L and 37 individuals (69%) having CRP levels > 5 mg/L. These data suggest that a significant proportion of individuals in both groups have elevated CRP levels, indicating a potential state of chronic inflammation.
Glycated Hemoglobin (HbA1c): Assessing Blood Sugar Control
Glycated hemoglobin (HbA1c) is a measure of average blood sugar levels over the past 2-3 months. It is a key indicator for assessing blood sugar control in individuals, particularly those with diabetes or at risk of developing the condition.
the median HbA1c level for the first group was 41.0 mmol/mol (with an interquartile range of 37.0–51.0 mmol/mol), while the second group had a median HbA1c level of 41.0 mmol/mol (with an interquartile range of 36.0–50.0 mmol/mol). In the first group,45 individuals (68%) had HbA1c levels < 48 mmol/mol,and 21 individuals (32%) had HbA1c levels ≥ 48 mmol/mol. The second group showed similar proportions, with 38 individuals (69%) having HbA1c levels < 48 mmol/mol and 17 individuals (31%) having HbA1c levels ≥ 48 mmol/mol. These HbA1c levels provide insights into the glycemic control of the participants and the prevalence of prediabetes or diabetes.
Cholesterol Levels: Total, LDL, HDL, and Triglycerides
cholesterol is a lipid essential for various bodily functions, but elevated levels, particularly of LDL cholesterol, are associated with increased risk of cardiovascular disease. HDL cholesterol, conversely, is considered “good” cholesterol and helps remove LDL cholesterol from the arteries. Triglycerides are another type of fat in the blood, and high levels are also linked to increased cardiovascular risk.
The mean cholesterol level for the first group was 4.9 mmol/L (with a standard deviation of 1.1 mmol/L), while the second group had a mean cholesterol level of 4.8 mmol/L (with a standard deviation of 1.1 mmol/L). In the first group, 15 individuals (23%) had cholesterol levels < 4.0 mmol/L, and 51 individuals (77%) had cholesterol levels ≥ 4.0 mmol/L. The second group had 12 individuals (22%) with cholesterol levels < 4.0 mmol/L and 43 individuals (78%) with cholesterol levels ≥ 4.0 mmol/L.
The median triglyceride level for both the first and second groups was 2.4 mmol/L (with an interquartile range of 1.6–3.5 mmol/L). In both groups,24 individuals (36%) had triglyceride levels < 2.0 mmol/L, while 42 individuals (64%) had triglyceride levels ≥ 2.0 mmol/L. For the second group, 20 individuals (36%) had triglyceride levels < 2.0 mmol/L, while 35 individuals (64%) had triglyceride levels ≥ 2.0 mmol/L.
The mean HDL-cholesterol level for the first group was 0.9 mmol/L (with a standard deviation of 0.2 mmol/L), and for the second group, it was also 0.9 mmol/L (with a standard deviation of 0.2 mmol/L). In the first group, 13 individuals (20%) had HDL-cholesterol levels > 1.0 mmol/L, while 53 individuals (80%) had HDL-cholesterol levels ≥ 1.0 mmol/L. The second group had 9 individuals (16%) with HDL-cholesterol levels > 1.0 mmol/L and 46 individuals (84%) with HDL-cholesterol levels ≥ 1.0 mmol/L.
The mean LDL-cholesterol level for the first group was 2.7 mmol/L (with a standard deviation of 0.9 mmol/L), and for the second group, it was also 2.7 mmol/L (with a standard deviation of 1.0 mmol/L). In the first group,22 individuals (37%) had LDL-cholesterol levels < 2.5 mmol/L, while 37 individuals (67%) had LDL-cholesterol levels ≥ 2.5 mmol/L. The second group had 18 individuals (37%) with LDL-cholesterol levels < 2.5 mmol/L and 31 individuals (63%) with LDL-cholesterol levels ≥ 2.5 mmol/L.
The mean cholesterol ratio (LDL:HDL) was 5.5 (with a standard deviation of 1.3) for both groups.These cholesterol measurements provide a comprehensive overview of the lipid profiles of the participants and their potential risk for cardiovascular diseases.
Hope for Health Program Shows Promising Results in Arnhem Land
A recent study conducted in northeast Arnhem Land, Northern Territory, Australia, during 2022, has revealed encouraging outcomes from the “Hope for Health” intervention program. This single-arm, pre-post intervention study assessed various health indicators, including anthropometric measurements, blood pressure, biomarker outcomes, physical activity levels, and dietary habits of the participants. The findings suggest positive changes in several key health metrics among the participants involved in the program.
Key Findings of the Hope for Health Program
The Hope for Health program focused on improving the overall health and well-being of participants in northeast Arnhem Land. The study meticulously tracked changes in various health indicators from baseline to the end of the program. The results provide valuable insights into the effectiveness of the intervention.
Anthropometric Measurements
Significant changes were observed in anthropometric measurements. The study, involving 55 participants, showed a mean weight change of -1.47 kg (95% CI: -2.42 to -0.52). Body mass index (BMI), measured in 53 participants, decreased by a mean of -0.60 kg/m2 (95% CI: -0.93 to -0.27). Waist circumference also saw a reduction, with a mean change of -3.19 cm (95% CI: -4.71 to -1.66) among 53 participants.
Blood Pressure
Blood pressure measurements were taken from 52 participants. The mean change in systolic blood pressure was -0.94 mmHg (95% CI: -4.83 to 2.95), while the mean change in diastolic blood pressure was -1.90 mmHg (95% CI: -4.29 to 0.48). These results indicate a trend toward improved cardiovascular health, even though the confidence intervals suggest further investigation might potentially be warranted.
Biomarker outcomes
The study also examined several key biomarkers. C-reactive protein (CRP), a marker of inflammation, was measured in 46 participants, with a geometric mean ratio change of 0.98 (0.76 to 1.26). Glycated hemoglobin (HbA1c),an indicator of long-term blood sugar control,was measured in 50 participants,showing a geometric mean ratio change of 0.89 (0.85 to 0.94). Cholesterol levels, measured in 50 participants, showed a mean change of 0.01 mmol/L (95% CI: -0.30 to 0.31). Triglycerides, measured in 50 participants, had a geometric mean ratio change of 1.07 (0.91 to 1.25). HDL-cholesterol, frequently enough referred to as “good” cholesterol, measured in 49 participants, increased by a mean of 0.06 mmol/L (95% CI: 0.01 to 0.12). LDL-cholesterol, or “bad” cholesterol, measured in 37 participants, decreased by a mean of -0.28 mmol/L (95% CI: -0.47 to -0.08). The cholesterol ratio,measured in 49 participants,decreased by a mean of -0.46 (95% CI: -0.87 to -0.05).
Physical Activity
Data on physical activity was collected, revealing changes in various metrics. The median total physical activity score, assessed in 51 participants, changed from 104.0 (IQR: 48.0–188.0) to 154.0 (IQR: 78.0–253.0). The median number of steps per day, measured in 35 participants, increased from 4699 (IQR: 2897–6661) to 5744 (IQR: 4217–7989). Participants reporting meeting physical activity guidelines increased from 10% to 31%.
Dietary Outcomes
dietary habits were also assessed as part of the Hope for Health program. The median serves of fruit per day,measured in 55 participants,increased from 0.0 (IQR: 0.0–1.0) to 1.0 (IQR: 0.0–2.0). The median serves of vegetables per day, measured in 55 participants, increased from 1.0 (IQR: 0.0–2.0) to 2.0 (IQR: 1.0–3.0). The percentage of participants meeting the recommended serves of fruit and vegetables increased from 7% to 24%.
Conclusion
The Hope for Health program in northeast arnhem Land, Northern Territory, demonstrated promising results in improving various health outcomes among its participants. The observed improvements in weight, BMI, waist circumference, HbA1c levels, physical activity, and dietary habits suggest that the intervention had a positive impact on the overall health and well-being of the community. These findings highlight the potential of targeted health programs in addressing health challenges in remote communities.
Lifestyle Intervention Significantly Boosts Physical Activity, Alters dietary Habits
A recent study reveals the positive impact of a structured lifestyle intervention on increasing physical activity and modifying dietary habits among participants.
Increased Physical Activity Through Lifestyle Changes
The intervention program demonstrated a notable increase in physical activity levels.Participants showed a significant rise in daily walking time, with the median change reported as 103.2 minutes per day (95% CI: 74.4 to 135.8) at the program’s end,compared to a baseline of 16.8 minutes (IQR: 10.5–27.1) at the program’s start. The program duration was 19 days at baseline and 45 days at the program end.
Furthermore, the study tracked moderate and vigorous physical activity, revealing a median change of 102.7 minutes per day (95% CI: 70.9 to 135.2) at the program’s end, up from 20.6 minutes (IQR: 12.5–31.9) at baseline. This indicates a substantial shift towards more active lifestyles among the participants.
One of the key metrics was the proportion of days participants walked for at least 30 minutes. The median change showed a remarkable increase of 71.4 percentage points (95% CI: 51.2 to 87.5) at the program’s end, compared to 14.3% (0.0–50%) at baseline. This highlights the program’s success in promoting consistent physical activity.
The number of days monitored remained consistent throughout the study, with a median of 7.0 days (IQR: 6.0–8.0) at baseline and 7.0 days (IQR: 5.0–8.0) at the program’s end. The median change was 0.0 days (–2.0 to 1.5).
Dietary Intake Modifications
The lifestyle intervention also influenced participants’ dietary habits, leading to changes in the consumption of various food groups. The program duration was 45 days.
Vegetable consumption saw a modest increase, with a median change of 0.2 serves per day (–0.1 to 0.5) at the program’s end, compared to a baseline of 1.0 serves (0.4–1.6). Fruit consumption also showed a slight increase, with a median change of 0.2 serves per day (–0.2 to 0.6) at the program’s end, compared to a baseline of 0.9 serves (0.3–1.3).
Significant changes were observed in the consumption of breads and cereals. Participants reduced their intake, with a median change of –1.5 serves per day (–2.0 to –1.0) at the program’s end, compared to a baseline of 5.0 serves (3.0–7.0). conversely,meat consumption increased,with a median change of 1.1 serves per day (0.7 to 1.4) at the program’s end, compared to a baseline of 3.1 serves (2.5–3.9).
Dairy consumption experienced a slight decrease, with a median change of –0.2 serves per day (–0.6 to 0.1) at the program’s end, compared to a baseline of 1.4 serves (0.9–2.1). Discretionary food intake remained relatively stable, with a median change of 0.3 serves per day (–0.8 to 1.3) at the program’s end,compared to a baseline of 5.0 serves (3.5–6.5).
Participants also reduced their consumption of sugar-sweetened beverages, with a median change of –0.6 serves per day (–1.4 to –0.1) at the program’s end, compared to a baseline of 0.6 serves (0.1–3.0). Weekly traditional food consumption also saw a decrease, with a median change of –1.0 (–2.0 to 0.0) at the program’s end, compared to a baseline of 4.0 (4.0–6.0).
Detailed Data Table
The following table summarizes the changes observed in physical activity and dietary intake during the lifestyle intervention program:
| N | Program start | Program end | Median change (95% CI) | |
|---|---|---|---|---|
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|
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| Physical activity | ||||
| Walking (min/day), median (IQR) | 19 | 16.8 (10.5–27.1) | 103.2 (74.4 to 135.8) | 103.2 (74.4 to 135.8) |
| Moderate and vigorous physical activity* (min/day), median (IQR) | 19 | 20.6 (12.5–31.9) | 102.7 (70.9 to 135.2) | 102.7 (70.9 to 135.2) |
| Proportion of days walking at least 30 min, median (IQR) | 19 | 14.3% (0.0–50%) | 71.4 (51.2 to 87.5) percentage points | 71.4 (51.2 to 87.5) percentage points |
| Days monitored, median (IQR) | 19 | 7.0 (6.0–8.0) | 0.0 (–2.0 to 1.5) | 0.0 (–2.0 to 1.5) |
| Dietary intake (serves per day), median (IQR) | ||||
| Vegetables | 45 | 1.0 (0.4–1.6) | 0.2 (–0.1 to 0.5) | 0.2 (–0.1 to 0.5) |
| fruit | 45 | 0.9 (0.3–1.3) | 0.2 (–0.2 to 0.6) | 0.2 (–0.2 to 0.6) |
| Breads and cereals | 45 | 5.0 (3.0–7.0) | –1.5 (–2.0 to –1.0) | –1.5 (–2.0 to –1.0) |
| Meat | 45 | 3.1 (2.5–3.9) | 1.1 (0.7 to 1.4) | 1.1 (0.7 to 1.4) |
| dairy | 45 | 1.4 (0.9–2.1) | –0.2 (–0.6 to 0.1) | –0.2 (–0.6 to 0.1) |
| Discretionary food | 45 | 5.0 (3.5–6.5) | 0.3 (–0.8 to 1.3) | 0.3 (–0.8 to 1.3) |
| Sugar-sweetened beverages | 45 | 0.6 (0.1–3.0) | –0.6 (–1.4 to –0.1) | –0.6 (–1.4 to –0.1) |
| Weekly traditional food consumption† | 45 | 4.0 (4.0–6.0) | –1.0 (–2.0 to 0.0) | –1.0 (–2.0 to 0.0) |
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| CI = confidence interval; IQR = interquartile range. * Including walking and more intense activity. † Measured as weekly frequency of intake: never = 0; less than onc per week = 2; once or twice per week = 4; 3 or 4 times per week = 6; 5 or 6 times per week = 8; every day = 10. | ||||
The provided text describes the hope for Health program, a community-led initiative designed to improve cardiometabolic health among Aboriginal and Torres Strait Islander people in a remote northeast Arnhem Land community. Here’s a summary of the key aspects:
Program Goals and Design:
Address Disparities: The program directly tackles the significantly higher rates of type 2 diabetes and cardiovascular disease prevalent in this Indigenous community compared to non-Indigenous australians.
Culturally Safe Approach: The program is co-designed with senior Yolŋu women, incorporating Yolŋu concepts, knowledge, and traditional practices (Mar?gikunhamirr and Go?-?ayathanhamirr). It emphasizes knowledge sharing, empowerment, and health coaching.
Holistic Intervention: The program addresses lifestyle factors, including diet, physical activity, and stress reduction, while acknowledging the socio-economic impacts of colonization on health.
Community Ownership: The program prioritizes self-determined lifestyle changes and aims to create positive role models within the community.
Program Components:
12-Day Retreat: Focuses on experiencing good health, reconnecting with traditional ways of living, eating, and healing, and learning about the body and health.
Health Coaching: Individual and group sessions provide support, goal setting, and guidance based on education and personal experiences.
Community support: ongoing in-community support and mentoring after the retreat, including group activities (healthy cooking, hunting trips, walking, etc.).
Study Design and Results:
Study Type: Initially planned as a randomized controlled trial, but changed to a single-arm pre-post intervention study due to unforeseen circumstances (community concerns, household participation needs, COVID-19 outbreak).
Participants: 55 participants with complete weight data (out of an initial 66). Inclusion criteria focused on BMI and waist circumference, excluding individuals with certain severe medical conditions.
Key Findings: 73% of participants experienced weight loss (mean weight loss of 1.5 kg), 18% achieving at least 5% weight reduction.Significant improvements were also observed in BMI, waist circumference, HbA1c levels (in a significant percentage of participants), blood pressure, LDL cholesterol, HDL cholesterol, sugar-sweetened beverage intake, and physical activity. Dietary changes included reduced intake of breads and cereals and sugar-sweetened beverages, and increased meat intake.
Qualitative Data: Participants expressed positive perceptions of the program, emphasizing the integration of healthy bodies, kin networks, governance, language, ceremony, and environment.
Ethical Considerations:
The study followed ethical guidelines, including approval from relevant ethics committees, community boards, and the use of yolŋu researchers to explain the consent process in the local language.
Limitations:
* The lack of a control group limits the ability to definitively establish causal relationships between the program and observed changes.
Conclusion:
The Hope for Health program demonstrates a promising approach to improving cardiometabolic health in a remote Indigenous community through culturally
