PMID- 30021592 OWN - NLM STAT- MEDLINE DCOM- 20190114 LR - 20220408 IS - 1748-5908 (Electronic) IS - 1748-5908 (Linking) VI - 13 IP - 1 DP - 2018 Jul 18 TI - A group-based lifestyle intervention for diabetes prevention in low- and middle-income country: implementation evaluation of the Kerala Diabetes Prevention Program. PG - 97 LID - 10.1186/s13012-018-0791-0 [doi] LID - 97 AB - 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. FAU - Aziz, Zahra AU - Aziz Z AUID- ORCID: 0000-0002-1755-4187 AD - Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia. azizz@student.unimelb.edu.au. AD - Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia. azizz@student.unimelb.edu.au. AD - WHO Collaborating Centre on Implementation Research for Prevention & Control of NCDs, Melbourne, Australia. azizz@student.unimelb.edu.au. FAU - Mathews, Elezebeth AU - Mathews E AD - Department of Public Health and Community Medicine, Central University of Kerala, Kasaragod, India. FAU - Absetz, Pilvikki AU - Absetz P AD - School of Health Sciences, University of Tampere, Tampere, Finland. AD - Collaborative Care Systems Finland, Helsinki, Finland. FAU - Sathish, Thirunavukkarasu AU - Sathish T AD - Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia. AD - Centre for Population Health Sciences, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore. FAU - Oldroyd, John AU - Oldroyd J AD - Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia. FAU - Balachandran, Sajitha AU - Balachandran S AD - Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, India. FAU - Shetty, Suman S AU - Shetty SS AD - Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia. FAU - Thankappan, K R AU - Thankappan KR AD - Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, India. FAU - Oldenburg, Brian AU - Oldenburg B AD - Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia. AD - Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia. AD - WHO Collaborating Centre on Implementation Research for Prevention & Control of NCDs, Melbourne, Australia. LA - eng SI - ANZCTR/ACTRN12611000262909 GR - 1005324/National Health and Medical Research Council/International PT - Journal Article PT - Randomized Controlled Trial PT - Research Support, Non-U.S. Gov't DEP - 20180718 PL - England TA - Implement Sci JT - Implementation science : IS JID - 101258411 SB - IM MH - Adult MH - Child MH - Diabetes Mellitus, Type 2/*prevention & control MH - Female MH - Health Promotion/*methods/organization & administration MH - Humans MH - India MH - *Life Style MH - Male MH - Middle Aged MH - Patient Education as Topic/*methods MH - Pilot Projects MH - Program Evaluation/*methods PMC - PMC6052531 OTO - NOTNLM OT - Behavioural interventions OT - Diabetes prevention OT - Implementation evaluation OT - Lifestyle interventions OT - Low- and middle-income countries OT - PIPE impact metric OT - Peer support OT - RE-AIM framework OT - Type 2 diabetes mellitus COIS- ETHICS APPROVAL AND CONSENT TO PARTICIPATE: The study was approved by the Institutional Ethics Committee of the Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, and by the Human Research Ethics Committees of Monash University, Australia, and the University of Melbourne, Australia. The study was also approved by the Health Ministry Screening Committee of the Government of India. CONSENT FOR PUBLICATION: Not applicable. COMPETING INTERESTS: The authors declare that they have no competing interests. PUBLISHER'S NOTE: Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. EDAT- 2018/07/20 06:00 MHDA- 2019/01/15 06:00 PMCR- 2018/07/18 CRDT- 2018/07/20 06:00 PHST- 2017/11/28 00:00 [received] PHST- 2018/07/03 00:00 [accepted] PHST- 2018/07/20 06:00 [entrez] PHST- 2018/07/20 06:00 [pubmed] PHST- 2019/01/15 06:00 [medline] PHST- 2018/07/18 00:00 [pmc-release] AID - 10.1186/s13012-018-0791-0 [pii] AID - 791 [pii] AID - 10.1186/s13012-018-0791-0 [doi] PST - epublish SO - Implement Sci. 2018 Jul 18;13(1):97. doi: 10.1186/s13012-018-0791-0.