Case 3

Involving citizens in health promotion

research-based interventions with strong element of community participation in ‘tingbjerg changing diabetes’

Short case summary:Tingbjerg Changing Diabetes’ refers to a research-based intervention initiative involving residents of socially disadvantaged public housing neighborhoods of Tingbjerg, which is located about 8 kilometers north-west of the city center of Copenhagen. Tingbjerg faces disproportionate amounts of social challenges and has appeared on the so-called "ghetto list" since its introduction by the Danish government in 2010. The ethnic residents of Tingbjerg have limited resources to invest in personal cares and healthy lifestyles which increase the prevalence and the incidence of type 2 diabetes. Therefore, ‘Tingbjerg Changing Diabetes aims to promote healthy living and strengthen the prevention of type 2 diabetes among the high-risk population groups. It is organized as a formalized partnership between academic and development partners across sectors and professions such as culture and social support, architectural design, health and care, housing and food service etc. The interventions are co-created with local residents, which contain three physically, thematically and structurally-linked community-engaged projects: 1) food literacy project, 2) community garden and 3) community restaurant. Food courses are the first activites under the food literacy project. Other intervention activites are being established. In the above podcast from a food course, the families participated at community cooking reported stronger senses of cohesion within the neighborhood and thier children were more interested in eating healthy foods after becoming a part of the healthy cooking processes.

Click the website: https://www.tingbjergchangingdiabetes.dk/to learn more about the latest research and development of Tingbjerg Changing Diabetes.

Relevance to CAR?

This case is relevant to CAR because…

  • Each intervention project involves strong element of participation, they are all based on the residents’ long-time desires for, for example, capacity building in food literacy and entrepreneurship. The researchers work with the residents to define and select a health promotion topic, one of which is healthy cooking for families with children and healthy cooking in a multicultural context. Another segment of residents in Tingbjerg has requested support to entrepreneurship in the food service sector. The food literacy project component responds to both demands.

  • The intervention framework is co-produced (for frame-setting and strategy-developing) with local professional stakeholders. The preparation process involves concept and strategy development workshops using design-based thinking methodology and participatory action research methodology.

  • The project activities are co-created (for design and content development) with actively participating residents. The intervention development process involves workshops using design-based thinking methodology and participatory action research methodology. A working group comprising professional stakeholders and trained residents are established to organise and coordinate activities.

  • The project activities are further implemented, evaluated and adjusted through participatory and iterative processes of engagement of academic partners, development partners, local community stakeholders and residents of Tingbjerg. The long-term involvement and commitment of the working group would be sustained in the long run through iterative action research methodology.

Summary reflection:

We want to briefly highlight the strengths we see in the case…

  • Tingbjerg Changing Diabetes rests on a solid foundation of the research and development of the supersetting approach which involves the coordinated engagement of multiple stakeholders in multiple settings of the residents’ everyday life, in efforts to mobilise local resources and strengthen social networks for collective community action. The five principles of the supersetting approach- Integration, Participation, Action competence, Context sensitive and Knowledge, are illustrated in Bloch(2014) [1].

    Complying with the principles of the supersetting approach, ‘Health and Local Community project’ (in Danish ‘SoL’, implemented from 2012-2015) [2] has demonstrated that the supersetting approach delivered sustainable structural and behavioural outcomes. Read full length of ‘SoL’ [2] to know more about its values and impacts in community health promotion.

  • Tingbjerg Changing Diabetes rests on a solid foundation of the research and development of the ‘SoL-Tingbjerg initiative’ aiming to promote sustainable social and health development for all population groups in the socially disadvantaged neighbourhood of Tingbjerg. Since 2014 Steno Diabetes Center and academic partners have established relations with stakeholders in Tingbjerg and have conducted organisational, epidemiological [3] and sociological [4] investigations to prepare for action. Steno Diabetes Center and academic partners have also established a quantitative population-based baseline on residents' well-being and social capital in support of the rolling social development plan of the neighbourhood of Tingbjerg.

  • We believe Tingbjerg Changing Diabetes illustrates the iterative process cycle–showing lessons learnt from Project ‘SoL’, from ‘SoL-Tingbjerg initiative’ and the iterative processes of engagement of some professionals and community stakeholders connecting the project and initiatives to each other. For example, the project activities in Tingbjerg Changing Diabetes are setting-based and include formal institutions, organisations and associations as well as informal social networks such as women groups, ethnic clubs, food clubs etc. There are numerous such organisation structures in Tingbjerg and the project has already established good relations with most of them.

References:

[1] Bloch, P., Toft, U., Reinbach, H.C. et al. (2014). Revitalizing the setting approach – supersettings for sustainable impact in community health promotion. International Journal of Behavioral Nutrition and Physical Activity, 11:118, click here [2] Toft, U., Bloch. P. et al. (2018). Project SoL - a community-based, multi-component health promotion intervention to improve eating habits and physical activity among Danish families with young children. Part 1: Intervention development and implementation. Int J Env Res Pub He. 15:1097, click here [3] Holm, A.L., Andersen, G.S., Jørgensen, M.E. et al. (2018). Is the Rule of Halves framework relevant for diabetes care in Copenhagen today? A register-based crosssectional study. BMJ Open, 8:e023211, click here [4] Sørensen, M.E.S.B., Bloch, P. (2015). The social and structural environments in selected neighbourhoods of Copenhagen. Scientific report, click here