A group-based lifestyle intervention for diabetes prevention in low- and middle-income country: implementation evaluation of the Kerala Diabetes Prevention Program

Autor: Kavumpurathu Raman Thankappan, Elezebeth Mathews, Zahra Aziz, Sajitha Balachandran, Suman S. Shetty, Thirunavukkarasu Sathish, Brian Oldenburg, John Oldroyd, Pilvikki Absetz
Přispěvatelé: Lee Kong Chian School of Medicine (LKCMedicine), Centre for Population Health Sciences
Jazyk: angličtina
Rok vydání: 2018
Předmět:
Male
Program evaluation
Psychological intervention
Pilot Projects
Peer support
law.invention
0302 clinical medicine
RE-AIM framework
Randomized controlled trial
law
Medicine
Science::Medicine [DRNTU]
030212 general & internal medicine
Cluster randomised controlled trial
Child
Lifestyle interventions
Implementation evaluation
lcsh:R5-920
PIPE impact metric
Low- and middle-income countries
Health Policy
Health services research
General Medicine
Middle Aged
3. Good health
Female
lcsh:Medicine (General)
Adult
medicine.medical_specialty
Diabetes risk
India
030209 endocrinology & metabolism
Health Informatics
Health Promotion
03 medical and health sciences
Implementation Evaluation
Patient Education as Topic
Type 2 diabetes mellitus
Humans
Diabetes prevention
Life Style
Behavioural interventions
business.industry
Research
Public Health
Environmental and Occupational Health
Type 2 Diabetes Mellitus
Health promotion
Diabetes Mellitus
Type 2
Family medicine
business
Program Evaluation
Zdroj: Implementation Science, Vol 13, Iss 1, Pp 1-14 (2018)
Implementation Science : IS
ISSN: 1748-5908
DOI: 10.1186/s13012-018-0791-0
Popis: Background While several efficacy trials have demonstrated diabetes risk reduction through targeting key lifestyle behaviours, there is a significant evidence gap in relation to the successful implementation of such interventions in low- and middle-income countries (LMICs). This paper evaluates the implementation of a cluster randomised controlled trial of a group-based lifestyle intervention among individuals at high-risk of developing type 2 diabetes mellitus (T2DM) in the state of Kerala, India. Our aim is to uncover provider-, participant- and community-level factors salient to successful implementation and transferable to other LMICs. Methods The 12-month intervention program consisted of (1) a group-based peer-support program consisting of 15 sessions over a period of 12 months for high-risk individuals, (2) peer leader (PL) training and ongoing support for intervention delivery, (3) diabetes education resource materials and (4) strategies to stimulate broader community engagement. The evaluation was informed by the RE-AIM and PIPE frameworks. Results Provider-level factors: Twenty-nine (29/30, 97%) intervention groups organised all 15 sessions. A 2-day PL training was attended by 51(85%) of 60 PLs. The PL handbook was found to be ‘very useful’ by 78% of PLs. Participant-level factors: Of 1327 eligible individuals, 1007(76%) participants were enrolled. On average, participants attended eight sessions. Sixty-eight percent rated their interest in group sessions as ‘very interested’, and 55% found the group sessions ‘very useful’ in making lifestyle changes. Inconvenient time (43%) and location (21%) were found to be important barriers for participants who did not attend any sessions. Community-level factors: Community-based activities reached to 41% of the participants for walking groups, 40% for kitchen garden training, and 31% for yoga training. PLs were readily available for support outside the sessions, as 75% of participants reported extracurricular contacts with their PLs. The commitment from the local partner institute and political leaders facilitated the high uptake of the program. Conclusion A comprehensive evaluation of program implementation from the provider-, participant- and community-level perspectives demonstrates that the K-DPP program was feasible and acceptable in changing lifestyle behaviours in high-risk individuals. The findings from this evaluation will guide the future delivery of structured lifestyle modification diabetes programs in LMICs. Trial registration Trial registration: Australia and New Zealand Clinical Trials Registry ACTRN12611000262909. Registered 10 March 2011.
Databáze: OpenAIRE
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