Abstract
BackgroundIn Southeast Asia, diabetes and hypertension are on the rise and have become major causes of death. Community-based interventions can achieve the required behavioural change for better prevention. The aims of this review are 1) to assess the core health-components of community-based interventions and 2) to assess which contextual factors and program elements affect their impact in Southeast Asia.MethodsA realist review was conducted, combining empirical evidence with theoretical understanding. Documents published between 2009 and 2019 were systematically searched in PubMed/Medline, Web of Science, Cochrane Library, Google Scholar and PsycINFO and local databases. Documents were included if they reported on community-based interventions aimed at hypertension and/or diabetes in Southeast Asian context; and had a health-related outcome; and/or described contextual factors and/or program elements.ResultsWe retrieved 67 scientific documents and 12 grey literature documents. We identified twelve core health-components: community health workers, family support, educational activities, comprehensive programs, physical exercise, telehealth, peer support, empowerment, activities to achieve self-efficacy, lifestyle advice, activities aimed at establishing trust, and storytelling. In addition, we found ten contextual factors and program elements that may affect the impact: implementation problems, organized in groups, cultural sensitivity, synergy, access, family health/worker support, gender, involvement of stakeholders, and referral and education services when giving lifestyle advice.ConclusionsWe identified a considerable number of core health-components, contextual influences and program elements of community-based interventions to improve diabetes and hypertension prevention. The main innovative outcomes were, that telehealth can substitute primary healthcare in rural areas, storytelling is a useful context-adaptable component, and comprehensive interventions can improve health-related outcomes. This extends the understanding of promising core health-components, including which elements and in what Southeast Asian context.
Highlights
In Southeast Asia, diabetes and hypertension are on the rise and have become major causes of death
We identified a considerable number of core health-components, contextual influences and program elements of community-based interventions to improve diabetes and hypertension prevention
We identified documents based on the following inclusion criteria: documents that report on communitybased interventions/activities/programs aimed at the prevention, curing, or caring of diabetes and/or hypertension in Southeast Asian context; documents that report on health-related outcome, and/or impact, and/or output of community programs, for instance: quality of life or burden of Noncommunicable disease (NCD); documents describing contextual factors and/or program elements affecting the characteristics and core health-components in communitybased interventions, for instance: gender and accessibility; documents published between 2009 and 2019
Summary
In Southeast Asia, diabetes and hypertension are on the rise and have become major causes of death. Community-based interventions can achieve the required behavioural change for better prevention. Genetic, acquired, environmental and societal risk factors of diabetes and hypertension are expected to increase [3]. This is due to reasons such as urbanization, low-income status, low awareness, upward trends in smoking, obesity, and alcohol use. Decreasing the burden of NCDs is difficult [4], mainly because environmental and economic factors are difficult to control and it requires behavioural changes in order to effectively reduce risk factors, which is not easy to achieve
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