Lifestyle change in Kerala, India: needs assessment and planning for a community-based diabetes prevention trial

Meena Daivadanam,Edwin B Fisher,Elezebeth Mathews,K R Thankappan,Brian Oldenburg,Neena Elezebeth Philip,Thirunavukkarasu Sathish,Pilvikki Absetz

doi:10.1186/1471-2458-13-95

Abstract

BackgroundType 2 Diabetes Mellitus (T2DM) has become a major public health challenge in India. Factors relevant to the development and implementation of diabetes prevention programmes in resource-constrained countries, such as India, have been under-studied. The purpose of this study is to describe the findings from research aimed at informing the development and evaluation of a Diabetes Prevention Programme in Kerala, India (K-DPP).MethodsData were collected from three main sources: (1) a systematic review of key research literature; (2) a review of relevant policy documents; and (3) focus groups conducted among individuals with a high risk of progressing to diabetes. The key findings were then triangulated and synthesised.ResultsPrevalence of risk factors for diabetes is very high and increasing in Kerala. This situation is largely attributable to rapid changes in the lifestyle of people living in this state of India. The findings from the systematic review and focus groups identified many environmental and personal determinants of these unhealthy lifestyle changes, including: less than ideal accessibility to and availability of health services; cultural values and norms; optimistic bias and other misconceptions related to risk; and low expectations regarding one’s ability to make lifestyle changes in order to influence health and disease outcomes. On the other hand, there are existing intervention trials conducted in India which suggests that risk reduction is possible. These programmes utilize multi-level strategies including mass media, as well as strategies to enhance community and individual empowerment. India’s national programme for the prevention and control of major non-communicable diseases (NCD) also provide a supportive environment for further community-based efforts to prevent diabetes.ConclusionThese findings provide strong support for undertaking more research into the conduct of community-based diabetes prevention in the rural areas of Kerala. We aim to develop, implement and evaluate a group-based peer support programme that will address cultural and family determinants of lifestyle risks, including family decision-making regarding adoption of healthy dietary and physical activity patterns. Furthermore, we believe that this approach will be feasible, acceptable and effective in these communities; with the potential for scale-up in other parts of India.

Highlights

Type 2 Diabetes Mellitus (T2DM) has become a major public health challenge in India
A large proportion of individuals are at “high risk” of progression to diabetes [1] which occurs more quickly than in most developed countries [2]. These observations, together with the high rates of complications and mortality [3] associated with T2DM, demonstrate that diabetes prevention should be an urgent priority for the government and other organizations in India
This paper describes the findings from a needs assessment for a diabetes prevention programme in Kerala by triangulating and synthesizing the evidence from three different sources: 1) A review of empirical studies relevant to understanding lifestyle risk factors, their determinants and lifestyle interventions for diabetes prevention in India and Kerala

Summary

Introduction

Factors relevant to the development and implementation of diabetes prevention programmes in resource-constrained countries, such as India, have been under-studied. A large proportion of individuals are at “high risk” of progression to diabetes [1] which occurs more quickly than in most developed countries [2]. These observations, together with the high rates of complications and mortality [3] associated with T2DM, demonstrate that diabetes prevention should be an urgent priority for the government and other organizations in India. Evidence supports lifestyle interventions for diabetes prevention A number of efficacy trials from China [4], Finland [5], U.S.A. A series of ensuing implementation trials conducted in different countries in recent years [7,16,17,18] have demonstrated that the findings from efficacy trials can be replicated in ‘real world’ community settings with more feasible, acceptable and cost-effective delivery systems [19,20] and with similar outcomes [5,16,21,22,23,24]

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