title: Sustaining modified behaviours learnt in a diabetes prevention program in regional Australia: the role of social context.
abstract: BACKGROUND
  The Greater Green Triangle diabetes prevention program was conducted in primary health care setting of Victoria and South Australia in 2004-2006. This program demonstrated significant reductions in diabetes risk factors which were largely sustained at 18 month follow-up. The theoretical model utilised in this program achieved its outcomes through improvements in coping self-efficacy and planning. Previous evaluations have concentrated on the behavioural components of the intervention. Other variables external to the main research design may have contributed to the success factors but have yet to be identified. The objective of this evaluation was to identify the extent to which participants in a diabetes prevention program sustained lifestyle changes several years after completing the program and to identify contextual factors that contributed to sustaining changes.
  
  
  METHODS
  A qualitative evaluation was conducted. Five focus groups were held with people who had completed a diabetes prevention program, several years later to assess the degree to which they had sustained program strategies and to identify contributing factors.
  
  
  RESULTS
  Participants value the recruitment strategy. Involvement in their own risk assessment was a strong motivator. Learning new skills gave participants a sense of empowerment. Receiving regular pathology reports was a means of self-assessment and a motivator to continue. Strong family and community support contributed to personal motivation and sustained practice.
  
  
  CONCLUSIONS
  Family and local community supports constitute the contextual variables reported to contribute to sustained motivation after the program was completed. Behaviour modification programs can incorporate strategies to ensure these factors are recognised and if necessary, strengthened at the local level.
authors.affiliation: Chronic Illness Alliance, Melbourne, VIC, Australia.
authors.forename: Christine
authors.initials: C
authors.lastname: Walker
authors.forename: Andrea
authors.initials: A
authors.lastname: Hernan
authors.forename: Prasuna
authors.initials: P
authors.lastname: Reddy
authors.forename: James A
authors.initials: JA
authors.lastname: Dunbar
mesh_terms: D001524:Behavioral Medicine; D003159:Community-Institutional Relations; D003924:Diabetes Mellitus, Type 2 / Q000175:diagnosis / Q000517:prevention & control* / Q000523:psychology; D005195:Family Relations; D005260:Female; D017144:Focus Groups; D007722:Health Knowledge, Attitudes, Practice; D006293:Health Promotion / Q000379:methods*; D006801:Humans; D008016:Life Change Events; D008019:Life Style; D008297:Male; D010043:Outcome and Process Assessment, Health Care; D010342:Patient Acceptance of Health Care / Q000523:psychology; D011209:Power, Psychological; D015397:Program Evaluation; D036301:Qualitative Research; D018570:Risk Assessment; D012932:Social Facilitation; D013021:South Australia; D014739:Victoria