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Trial registered on ANZCTR
Registration number
ACTRN12624000850572
Ethics application status
Approved
Date submitted
5/06/2024
Date registered
9/07/2024
Date last updated
9/07/2024
Date data sharing statement initially provided
9/07/2024
Type of registration
Retrospectively registered
Titles & IDs
Public title
Implementation and evaluation of co-designed strategies with Aboriginal and Torres Strait Islander women aiming to reduce diabetes-related risks before, during and after pregnancy
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Scientific title
Evaluation of implementation to support healthy lifestyles for Aboriginal and Torres Strait Islander women with diabetes in pregnancy (Part C)
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Secondary ID [1]
312237
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Nil known
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Universal Trial Number (UTN)
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Trial acronym
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Linked study record
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Health condition
Health condition(s) or problem(s) studied:
Diabetes in pregnancy (including gestational diabetes, overt diabetes in pregnancy and pre-existing diabetes)
333941
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Obesity
333942
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Condition category
Condition code
Metabolic and Endocrine
330612
330612
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0
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Diabetes
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Public Health
330613
330613
0
0
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Health promotion/education
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Reproductive Health and Childbirth
330614
330614
0
0
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Fetal medicine and complications of pregnancy
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Reproductive Health and Childbirth
330615
330615
0
0
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Antenatal care
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Reproductive Health and Childbirth
330616
330616
0
0
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Breast feeding
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Reproductive Health and Childbirth
330617
330617
0
0
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Childbirth and postnatal care
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Reproductive Health and Childbirth
330618
330618
0
0
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Other reproductive health and childbirth disorders
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Reproductive Health and Childbirth
330904
330904
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0
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Contraception
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Intervention/exposure
Study type
Interventional
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Description of intervention(s) / exposure
A multi-component program co-designed with Aboriginal and Torres Strait Islander women, communities and health services, conducted across three sites.
Intervention components include:
1. Face-to-face group health education sessions with women, facilitated by an Aboriginal or Torres Strait Islander woman with a guest 'expert' relevant to the topic. Topics are tailored to each study site, having been nominated by co-design participants in the formative phase of this study, and include topics relating to diabetes (what is diabetes, managing diabetes, preventing diabetes, understanding intergenerational diabetes), healthy eating, pregnancy planning and contraception, healthy infant feeding, postpartum support, sexual health, and social and emotional wellbeing. Group education sessions will be delivered in a community space (i.e. not in a clinical setting), with the specific space being determined by stakeholders in each site. Education sessions in each region will occur monthly for 2-3 hours. Facilitators will have all completed a culturally appropriate short course in facilitation either prior to or in the early phase of implementation. Attendance logs will be kept, and session facilitators will debrief after sessions to discuss how the session was run, including adherence to pre-planned session goals and structure.
2. Supporting community members to produce locally-made videos to share health promotion messages relating to diabetes in pregnancy in local languages. Research staff will provide support to produce short (less than 3 minute) live action videos. Health promotion messages, languages and dissemination strategies will be determined by video participants, although based on formative work it is anticipated dissemination will include through social media.
3. Advocacy with communities and in partnership with other key stakeholders regarding food security; specific components of this will be determined by an action group of community and agency stakeholders brought together within the first month of implementation, and may include:
a. The facilitating of the action group itself, comprising community and agency stakeholders
b. Development or distribution of existing health promotion materials and promoting these through a community campaign, e.g. review of existing health promotion materials by action group members and study staff; identification of gaps where development of new resources may be required; identification of contextually appropriate dissemination methods and support from study staff and action group members to implement these
c. Working with stores to maximise the potential of store as health promoting environments, e.g. modifications to product placement and pricing, sales promotions on healthy foods and water
4. Enhancing the knowledge and confidence of healthcare professionals to support women with diabetes in pregnancy by providing information, research updates and networking opportunities, such as through the :
a. Diabetes in Pregnancy Clinical Reference Group (quarterly online meetings) - one hour meeting providing updates of recent contextually relevant research findings, feedback from reference group members regarding relevance of findings to clinical practice and policies, and input from reference group members regarding any additional concerns/priority areas which could be addressed through research/quality improvement projects
b. Dissemination of policy and practice briefs (twice per year, distributed by email) to health services and clinicians across the Northern Territory and Far North Queensland, including summaries of relevant research findings and implications for policy and practice
c. Annual Diabetes Across the Lifecourse; Northern Australia Partnership Educational Symposium (in-person and online) - full-day educational meeting with multiple presentations from local and national/international guest speakers on topics relevant to diabetes care, with dedicated time for networking and interactive component for attendees to discuss relevance of presentations to practice
Attendance lists, dissemination logs and minutes will be reviewed to monitor adherence
5. Improving access to physical activity through monthly water fitness activities, e.g. aquarobics, facilitated by an experienced physiotherapist with plan to build the capacity of local community members to continue delivery of the physical activity program through training interested local members to be facilitators
Intervention components will be delivered over a 12 months period. The specific components implemented in each site are determined by co-design participants, i.e. it is anticipated that not all components will be implemented in every site. Implementation of program components will be conducted in each region as a collaboration between study staff and staff of partner organisations such as the participating Aboriginal Community Controlled Health Service. Implementation and evaluation of activities in each region will be supported by a working group, comprising study staff, Aboriginal and Torres Strait Islander women and representatives from local stakeholder organisations.
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Intervention code [1]
328761
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Prevention
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Intervention code [2]
328762
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Lifestyle
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Intervention code [3]
328763
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Behaviour
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Comparator / control treatment
No control group
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Control group
Uncontrolled
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Outcomes
Primary outcome [1]
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Impact on individual measures of participant metabolic health and wellbeing - HbA1c
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Assessment method [1]
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HbA1c
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Timepoint [1]
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Baseline, 6 and 12 months (primary timepoint) after baseline assessment
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Primary outcome [2]
338456
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Impact on individual measures of participant metabolic health and wellbeing - urine albumin-creatinine ratio
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Assessment method [2]
338456
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urine albumin-creatinine ratio
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Timepoint [2]
338456
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Baseline, 6 and 12 months (primary timepoint) after baseline assessment
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Primary outcome [3]
338457
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Impact on individual measures of participant metabolic health and wellbeing - blood lipid profile
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Assessment method [3]
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Fasting lipid profile
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Timepoint [3]
338457
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Baseline, 6 and 12 months (primary timepoint) after baseline assessment
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Secondary outcome [1]
436017
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Impact on individual measures of participant metabolic health and wellbeing - weight
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Assessment method [1]
436017
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Measured weight by digital scales
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Timepoint [1]
436017
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Baseline, 6 and 12 months after baseline
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Secondary outcome [2]
436018
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Impact on individual measures of participant metabolic health and wellbeing - waist circumference
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Assessment method [2]
436018
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Measured waist circumference (by measuring tape)
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Timepoint [2]
436018
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Baseline, 6 and 12 months after baseline
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Secondary outcome [3]
436019
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Impact on individual measures of participant metabolic health and wellbeing - waist/hip ratio
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Assessment method [3]
436019
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Measured waist/hip ratio (by measuring tape)
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Timepoint [3]
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Baseline, 6 and 12 months after baseline
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Secondary outcome [4]
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Impact on individual measures of participant metabolic health and wellbeing - body mass index
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Assessment method [4]
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Calculated body mass index from measured weight (digital scales) and height (stadiometer)
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Timepoint [4]
436020
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baseline, 6 and 12 months after baseline
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Secondary outcome [5]
436021
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Impact on individual measures of participant metabolic health and wellbeing - dietary intake/diet quality
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Assessment method [5]
436021
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Menzies Remote Short-Item Dietary Assessment Tool (MRSDATv5) - survey
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Timepoint [5]
436021
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Baseline, 6 and 12 months after baseline
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Secondary outcome [6]
436022
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Impact on individual measures of participant metabolic health and wellbeing - dietary intake/diet quality
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Assessment method [6]
436022
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FIGO (International Federation of Gynecology and Obstetrics) Nutrition Checklist (survey)
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Timepoint [6]
436022
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Baseline, 6 and 12 months after baseline
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Secondary outcome [7]
436023
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Impact on individual measures of participant metabolic health and wellbeing - physical activity
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Assessment method [7]
436023
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Physical Activity Questionnaire
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Timepoint [7]
436023
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Baseline, 6 and 12 months after baseline
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Secondary outcome [8]
436024
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Impact on individual measures of participant metabolic health and wellbeing - medication adherence
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Assessment method [8]
436024
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Self-reported and primary care health records
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Timepoint [8]
436024
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Baseline, 6 and 12 months after baseline
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Secondary outcome [9]
436025
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Impact on individual measures of participant metabolic health and wellbeing - knowledge of diabetes and ability to self-manage diabetes (composite outcome)
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Assessment method [9]
436025
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Diabetes knowledge, attitudes and practices questionnaire; and qualitative data from semi-structured interviews
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Timepoint [9]
436025
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Baseline, 6 and 12 months after baseline
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Secondary outcome [10]
436026
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Impact on individual measures of participant metabolic health and wellbeing - knowledge of available supports/services
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Assessment method [10]
436026
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Semi-structured interviews (qualitative data)
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Timepoint [10]
436026
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Baseline, 6 and 12 months after baseline
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Secondary outcome [11]
436027
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Impact on individual measures of participant metabolic health and wellbeing - health service utilisation
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Assessment method [11]
436027
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Primary care health records
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Timepoint [11]
436027
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Baseline, 6 and 12 months after baseline
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Secondary outcome [12]
436028
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Impact on individual measures of participant metabolic health and wellbeing - social and emotional wellbeing
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Assessment method [12]
436028
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Adapted Patient Health Questionnaire (PHQ)-9
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Timepoint [12]
436028
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Baseline, 6 and 12 months after baseline
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Secondary outcome [13]
436029
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Impact on individual measures of participant metabolic health and wellbeing - social and emotional wellbeing
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Assessment method [13]
436029
0
Strong Souls Questionnaire
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Timepoint [13]
436029
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Baseline, 6 and 12 months after baseline
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Secondary outcome [14]
436030
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Impact on individual measures of participant metabolic health and wellbeing - cultural connectedness
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Assessment method [14]
436030
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Semi-structured interview
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Timepoint [14]
436030
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Baseline, 6 and 12 months after baseline
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Secondary outcome [15]
436031
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Impact of the program on sites (communities and health services) as health promoting environments - clinician knowledge and confidence in managing health relating to risks before, during and after a pregnancy complicated by diabetes
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Assessment method [15]
436031
0
Semi-structured health professional interviews
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Timepoint [15]
436031
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Baseline, 6 and 12 months after baseline
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Secondary outcome [16]
436032
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Impact of the program on sites (communities and health services) as health promoting environments - changes in community capacity such as knowledge of the issues, community climate, leadership, and resourcing
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Assessment method [16]
436032
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Qualitative interviews/focus groups with community stakeholders
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Timepoint [16]
436032
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Baseline, 6 and 12 months after baseline
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Secondary outcome [17]
436033
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Determine the acceptability of the implementation of the evidence-based, co-designed strategies at the study sites - participation rates
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Assessment method [17]
436033
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Acceptability - participation rates - proportion of eligible women within the community who have participated in the program. Will be based on site records.
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Timepoint [17]
436033
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6 and 12 months after commencement
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Secondary outcome [18]
436034
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Determine the sustainability of the implementation of the evidence-based, co-designed strategies at the study sites
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Assessment method [18]
436034
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Perceived value of the intervention by individuals, community and health service (qualitative interviews/focus groups), required resources (funding and capacity e.g. time, knowledge, pathways to action - log of resources, qualitative interviews/focus groups), contextual factors (values of stakeholders, study site characteristics, implementation and sustainability infrastructure, relevant policies and guidelines - qualitative interview/focus group data (semi-structured face-to-face, phone or online with 1-2 members of the research team) and relevant policy/guideline documents) - composite outcome
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Timepoint [18]
436034
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12 months after commencement of implementation
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Secondary outcome [19]
436035
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To identify the enablers and barriers to implementation
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Assessment method [19]
436035
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Barriers and enablers to attending/adopting information and strategies (interviews and focus groups with participants, study staff, stakeholders (semi-structured face-to-face, phone or online with 1-2 members of the research team); adaptations to implementation and reasons for changes - composite outcome
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Timepoint [19]
436035
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6 and 12 months after commencement of implementation
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Secondary outcome [20]
436980
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Determine the acceptability of the implementation of the evidence-based, co-designed strategies at the study sites - participation rates
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Assessment method [20]
436980
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Proportion of women approached/invited to participate who declined participation according to site records.
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Timepoint [20]
436980
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6 and 12 months after commencement
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Secondary outcome [21]
436981
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Determine the acceptability of the implementation of the evidence-based, co-designed strategies at the study sites - factors influencing participation
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Assessment method [21]
436981
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Qualitative interviews/focus groups (semi-structured face-to-face, phone or online with 1-2 members of the research team)
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Timepoint [21]
436981
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6 and 12 months after commencement
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Secondary outcome [22]
436982
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Determine the acceptability of the implementation of the evidence-based, co-designed strategies at the study sites - attendance rate of participants
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Assessment method [22]
436982
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Attendance logs
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Timepoint [22]
436982
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6 and 12 months after commencement
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Eligibility
Key inclusion criteria
Three participant groups:
1. Aboriginal and Torres Strait Islander women between 16-45 years of age who have had an experience of diabetes in pregnancy - defined as All Aboriginal and Torres Strait Islander women who are between the ages of 16-45 and who have connections with the study site (i.e. living in the community, and/or who have received health care at the community’s clinic) and who have an experience of diabetes in pregnancy (any type of diabetes and at any point during the woman’s life)
2. Aboriginal and Torres Strait Islander community members above the age of 16 including family members - defined as community members residing in the study sites and who are over the age of 16
3. Health professionals, health stakeholders, community stakeholders (councils, NGOs), researchers and advocates - defined as either members of the health workforce or community services (clinic, NGOs, councils) who are interested in diabetes prevention/management (all over the age of 16) OR those involved in supporting implementation of system-wide components (i.e. policy makers, clinical champions, health service managers).
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Minimum age
16
Years
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Maximum age
No limit
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Sex
Both males and females
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Can healthy volunteers participate?
Yes
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Key exclusion criteria
* Unable to provide informed consent
* Under the age of 16 years
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Study design
Purpose of the study
Prevention
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Allocation to intervention
Non-randomised trial
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Procedure for enrolling a subject and allocating the treatment (allocation concealment procedures)
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Methods used to generate the sequence in which subjects will be randomised (sequence generation)
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Masking / blinding
Open (masking not used)
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Who is / are masked / blinded?
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Intervention assignment
Single group
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Other design features
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Phase
Not Applicable
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Type of endpoint/s
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Statistical methods / analysis
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Recruitment
Recruitment status
Recruiting
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Date of first participant enrolment
Anticipated
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Actual
7/02/2024
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Date of last participant enrolment
Anticipated
30/06/2025
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Actual
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Date of last data collection
Anticipated
30/06/2026
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Actual
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Sample size
Target
150
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Accrual to date
19
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Final
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Recruitment in Australia
Recruitment state(s)
NT,QLD
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Funding & Sponsors
Funding source category [1]
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Government body
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Name [1]
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Medical Research Future Fund - Department of Health and Ageing
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Address [1]
316615
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Country [1]
316615
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Australia
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Funding source category [2]
316687
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Other Collaborative groups
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Name [2]
316687
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Centre of Research Excellence Health in Preconception & Pregnancy
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Address [2]
316687
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Country [2]
316687
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Australia
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Primary sponsor type
University
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Name
Menzies School of Health Research
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Address
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Country
Australia
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Secondary sponsor category [1]
318879
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None
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Name [1]
318879
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Address [1]
318879
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Country [1]
318879
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Ethics approval
Ethics application status
Approved
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Ethics committee name [1]
315400
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Human Research Ethics Committee of the Northern Territory Department of Health and Menzies School of Health Research
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Ethics committee address [1]
315400
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https://www.menzies.edu.au/page/About_Us/Menzies_committees/Human_research_ethics_committee/
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Ethics committee country [1]
315400
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Australia
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Date submitted for ethics approval [1]
315400
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01/03/2023
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Approval date [1]
315400
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27/04/2023
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Ethics approval number [1]
315400
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2023-4551
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Summary
Brief summary
This study aims to evaluate the implementation of an evidence-based, multi-component intervention that improves the metabolic health and wellbeing of Aboriginal and Torres Strait Islander women before, during and after a pregnancy complicated by diabetes. The intervention consists of co-designed strategies, informed by previous research. The implementation will continue to use participatory approaches (co-design), with participants monitoring progress and collaborating to enhance sustainability. The mixed-methods evaluation of the implementation will: a) Explore the impact of the multi-component intervention on the metabolic health and wellbeing of participants at the study sites; b) Explore the impact of the multi-component intervention on the study sites (communities/services) as health promoting environments; c) Determine the acceptability and sustainability of the multi-component intervention at the study sites; d) Identify the enablers and barriers to implementation of the multi-component intervention.
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Trial website
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Trial related presentations / publications
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Public notes
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Contacts
Principal investigator
Name
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Prof Louise Maple-Brown
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Address
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Menzies School of Health Research, JMB 105 Rocklands Drive, Tiwi, NT, 0810
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Country
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Australia
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Phone
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+61 416 163 814
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Fax
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Email
134582
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[email protected]
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Contact person for public queries
Name
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Tara Dias
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Address
134583
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Menzies School of Health Research, JMB 105 Rocklands Drive, Tiwi, NT, 0810
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Country
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Australia
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Phone
134583
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+61 08 8946 8528
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Fax
134583
0
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Email
134583
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[email protected]
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Contact person for scientific queries
Name
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Diana MacKay
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Address
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Menzies School of Health Research, JMB 105 Rocklands Drive, Tiwi, NT, 0810
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Country
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Australia
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Phone
134584
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+61 08 8922 8888
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Fax
134584
0
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Email
134584
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[email protected]
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Data sharing statement
Will individual participant data (IPD) for this trial be available (including data dictionaries)?
No
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No/undecided IPD sharing reason/comment
Unable to share due to sensitive nature of the data
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What supporting documents are/will be available?
No Supporting Document Provided
Results publications and other study-related documents
Documents added manually
No documents have been uploaded by study researchers.
Documents added automatically
No additional documents have been identified.
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