Official Journal Of The Trinidad & Tobago Medical - the Trinidad and ...

Caribbean Medical Journal
Development of a Nationwide T&T Diabetes Outreach Program
Part 2: Specific Programs
inform public health decisions related to diabetes care, including
what initiatives to fund and where to put resources, based on
solid evidence developed in T&T. Second, conducting research
in T&T will bring advances in diabetes care more quickly to
the bedside and to the clinics in T&T and will keep health care
professionals aware of the latest in diabetes research by actually
participating in it. Third, it will provide an opportunity for
young health care professionals interested in careers in diabetes
research to be exposed and mentored by established investigators
in T&T and at Johns Hopkins. A vigorous research program
can increase options for new doctors interested in diabetes and
help to keep them in T&T. Finally, a thriving research program
would help establish T&T as a regional and international leader
in diabetes among middle-income countries, which are often
neglected by international organizations.
Needs Assessment and Priority Setting
Using methods of community-based participatory research
applied to developing countries 19 , a series of individual and
group meetings were held with members of the T&T health
sciences community for the purposes of fact-finding, needs
assessment, and priority setting. Participants included key
government stakeholders, academic institution leaders, research
organizations, diabetes organizations, researchers and clinicians
interested in diabetes. On the advice of senior investigators
from the University of the West Indies (UWI), we sought to
match areas of research that have a priority in T&T, have
interested T&T professionals, and fit special expertise available
at Johns Hopkins.
These meetings identified a consistent set of priority research
areas in T&T: (a) diabetes prevention, especially among children;
(b) patient behavioral and educational interventions to improve
self-care behaviors and adoption of lifestyle modification; and
(c) epidemiological research to capture national diabetes-related
prevalence, incidence, trends and costs, beyond convenience
samples, to set priorities for public health initiatives and policy.
The St. James study, which collected baseline data from 1977-
1981, is one model of a successful diabetes and cardiovascular
disease surveillance study of this nature in Trinidad 20, 21 . Active
diabetes research is in progress currently in T&T, but there is
clearly room for, and a need for, further initiatives to build the
next generation of established investigators, mentors,
collaborators, and trainees.
The assessment meetings also identified potential Trinidadbased
research entities with whom to partner for sustainability
of initiatives. These include several faculty members at UWI
who are actively engaged in research; the CHRC, which has
served as a major provider of training in research skills,
monitoring and evaluation, grant writing, and research ethics 22 ;
and the Caribbean Epidemiology Center (CAREC), which is
administered on behalf of PAHO and provides epidemiological
research services and data to PAHO member countries, largely
focused, however, on communicable diseases.
Implementation Plan Components
Based on these findings, the major components of TTHSI’s
Diabetes Outreach Program research implementation plan are:
• Establishment of a Research Advisory Committee comprised
of Trinidadian and Johns Hopkins researchers to oversee,
monitor, and evaluate the Diabetes Outreach Program research
initiatives.
• Funding for 3 major research projects focused on the priority
areas identified: prevention, behavioral intervention, and
epidemiology. Each research project will require a full
proposal and a Trinidadian and Johns Hopkins Co-Principal
Investigator team (see below).
• Compilation of a Researcher Directory, listing local
researchers conducting diabetes-related studies, and a
Collaborator Directory of Johns Hopkins diabetes researchers
from the School of Medicine and Bloomberg School of
Public Health, representing specialties including genetics,
epidemiology, clinical research, and health services research.
In addition, potential collaborators from the Johns
Hopkins/University of Maryland Diabetes Research and
Training Center and the Welch Center for Prevention,
Epidemiology and Clinical Research will be included.
• Organization of one or more research conferences or
workshops, in collaboration with the CHRC, geared
specifically toward research methods exemplified in the
Diabetes Outreach Program funded research projects.
Specific Research Topic Areas
1) Prevention: As mentioned in the accompanying Overview
essay, prevention of diabetes is an enormous challenge, but
one that should be engaged. There is great interest in this
at the levels of the Regional Health Authorities and the
Ministry of Health. Johns Hopkins investigators have
experience, notably from 13 years as a clinical center for
the federally funded Diabetes Prevention Program (DPP)23.
A protocol will be developed collaboratively to address the
challenge of prevention, particularly in young people.
2) Behavioral Medicine: It is frequently noted that it makes
little difference what health care professionals say or do if
people with diabetes do not adhere to recommendations,
take medicines, and have other elements of good self care.
Behavioral Medicine studies the influences that help or
hinder people from doing what would be good for them.
Dr. Felicia Hill-Briggs from Johns Hopkins is not only a
leading expert in this area of research but is directing our
Diabetes Outreach Program’s research effort. She looks
forward to developing one or more protocols for the study
of behavioral factors influencing diabetes self-care in T&T.
3) Epidemiology: The current world of epidemiologic research
depends to a large degree on reliable, complete databases
of health. The U.S. government’s National Health and
Nutrition Epidemiologic Survey (NHANES) is a prototype,
and considerable expertise exists in the Johns Hopkins
Bloomberg School of Public Health on epidemiologic
database development. The plan is therefore to develop
collaborations that can help T&T establish a database that
when fully implemented, could facilitate epidemiologic
research.
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