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BMC Public Health
Published in: BMC Public Health 1/2017

Open Access 01-12-2017 | Research article

Cultural adaptation of a peer-led lifestyle intervention program for diabetes prevention in India: the Kerala diabetes prevention program (K-DPP)

Authors: Elezebeth Mathews, Emma Thomas, Pilvikki Absetz, Fabrizio D’Esposito, Zahra Aziz, Sajitha Balachandran, Meena Daivadanam, Kavumpurathu Raman Thankappan, Brian Oldenburg

Published in: BMC Public Health | Issue 1/2017

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Abstract

Background

Type 2 diabetes mellitus (T2DM) is now one of the leading causes of disease-related deaths globally. India has the world’s second largest number of individuals living with diabetes. Lifestyle change has been proven to be an effective means by which to reduce risk of T2DM and a number of “real world” diabetes prevention trials have been undertaken in high income countries. However, systematic efforts to adapt such interventions for T2DM prevention in low- and middle-income countries have been very limited to date. This research-to-action gap is now widely recognised as a major challenge to the prevention and control of diabetes. Reducing the gap is associated with reductions in morbidity and mortality and reduced health care costs. The aim of this article is to describe the adaptation, development and refinement of diabetes prevention programs from the USA, Finland and Australia to the State of Kerala, India.

Methods

The Kerala Diabetes Prevention Program (K-DPP) was adapted to Kerala, India from evidence-based lifestyle interventions implemented in high income countries, namely, Finland, United States and Australia. The adaptation process was undertaken in five phases: 1) needs assessment; 2) formulation of program objectives; 3) program adaptation and development; 4) piloting of the program and its delivery; and 5) program refinement and active implementation.

Results

The resulting program, K-DPP, includes four key components: 1) a group-based peer support program for participants; 2) a peer-leader training and support program for lay people to lead the groups; 3) resource materials; and 4) strategies to stimulate broader community engagement. The systematic approach to adaptation was underpinned by evidence-based behavior change techniques.

Conclusion

K-DPP is the first well evaluated community-based, peer-led diabetes prevention program in India. Future refinement and utilization of this approach will promote translation of K-DPP to other contexts and population groups within India as well as other low- and middle-income countries. This same approach could also be applied more broadly to enable the translation of effective non-communicable disease prevention programs developed in high-income settings to create context-specific evidence in rapidly developing low- and middle-income countries.

Trial registration

Australia and New Zealand Clinical Trials Registry: ACTRN12611000262​909. Registered 10 March 2011.
Literature
1.
International Diabetes Federation. Diabetes Atlas - 7th Edition. Brussels, Belgium: International Diabetes Federation; 2015.
2.
Shaw JE, Sicree RA, Zimmet PZ. Global estimates of the prevalence of diabetes for 2010 and 2030. Diabetes Res Clin Pract. 2010;87:4–14.CrossRefPubMed
3.
Ramachandran A, Snehalatha C, Mary S, Selvam S, Kumar CK, Seeli AC, Shetty AS. Pioglitazone does not enhance the effectiveness of lifestyle modification in preventing conversion of impaired glucose tolerance to diabetes in Asian Indians: results of the Indian diabetes prevention Programme-2 (IDPP-2). Diabetologia. 2009:1019–26.
4.
Thankappan KR, Shah B, Mathur P, Sarma PS, Srinivas G, Mini GK, Soman MDB, Vasan RS. Risk factor profile for chronic non-communicable diseases: results of a community-based study in Kerala, India. Indian J Med Res. 2010;131:53–63.PubMed
5.
Shah B, Mathur P. Surveillance of cardiovascular disease risk factors in India: the need & scope. Indian J Med Res. 2010;132:634–42.PubMedPubMedCentral
6.
Menon VU, Kumar KV, Gilchrist A, Sugathan TN, Sundaram KR, Nair V, Kumar H. Prevalence of known and undetected diabetes and associated risk factors in central Kerala--ADEPS. Diabetes Res Clin Pract. 2006;74:289–94.CrossRefPubMed
7.
Raman KV, Joseph A, Soman RC. High prevalence of type 2 diabetes in an urban settlement in Kerala, India. Ethn Health. 1999;4:231–9.CrossRef
8.
Tuomilehto J, Lindström J, Eriksson J, Valle T, Hämäläinen H, Ilanne-Parikka P, Keinänen-Kiukaanniemi S, Laakso M, Louheranta A, Rastas M, Salminen V. Prevention of type 2 diabetes mellitus by changes in lifestyle among subjects with impaired glucose tolerance. N Engl J Med. 2001;344:1343–50.CrossRefPubMed
9.
Knowler WC, Barrett-Connor E, Fowler SE, Hamman RF, Lachin JM, Walker EA, Nathan DM. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med. 2002;346:393–403.CrossRefPubMed
10.
Kosaka K, Noda M, Kuzuya T. Prevention of type 2 diabetes by lifestyle intervention: a Japanese trial in IGT males. Diabetes Res Clin Pract. 2005;67:152–62.CrossRefPubMed
11.
Li G, Zhang P, Wang J, Gregg EW, Yang W, Gong Q, Li H, Li H, Jiang Y, An Y, et al. The long-term effect of lifestyle interventions to prevent diabetes in the China Da Qing diabetes prevention study: a 20-year follow-up study. Lancet. 2008;371:1783–9.CrossRefPubMed
12.
Ramachandran A, Snehalatha C, Mary S, Mukesh B, Bhaskar AD, Vijay V. Idpp: the Indian diabetes prevention programme shows that lifestyle modification and metformin prevent type 2 diabetes in Asian Indian subjects with impaired glucose tolerance (IDPP-1). Diabetologia. 2006;49:289–97.CrossRefPubMed
13.
Absetz P, Oldenburg B, Hankonen N, Valve R, Heinonen H, Nissinen A, Fogelholm M, Talja M, Uutela A. Type 2 diabetes prevention in the real world: three-year results of the GOAL lifestyle implementation trial. Diabetes Care. 2009;32:1418–20.CrossRefPubMed
14.
Absetz P, Valve R, Oldenburg B, Heinonen H, Nissinen A, Fogelholm M, Ilvesmaki V, Talja M, Uutela A. Type 2 diabetes prevention in the "real world": one-year results of the GOAL implementation trial. Diabetes Care. 2007;30:2465–70.CrossRefPubMed
15.
Laatikainen T, Dunbar JA, Chapman A, Kilkkinen A, Vartiainen E, Heistaro S, Philpot B, Absetz P, Bunker S, O'Neil A, et al. Prevention of type 2 diabetes by lifestyle intervention in an Australian primary health care setting: greater green triangle (GGT) diabetes prevention project. BMC Public Health. 2007;7:249.CrossRefPubMedPubMedCentral
16.
Ackermann RT, Finch EA, Brizendine E, Zhou H, Marrero DG. Translating the diabetes prevention program into the community. The DEPLOY pilot study. Am J Prev Med. 2008;35:357–63.CrossRefPubMedPubMedCentral
17.
Katula JA, Vitolins MZ, Rosenberger EL, Blackwell C, Espeland MA, Lawlor MS, Rejeski WJ, Goff DC. Healthy living partnerships to prevent diabetes (HELP PD): design and methods. Contemp Clin Trials. 2010;31:71–81.CrossRefPubMed
18.
Kumanyika SK, Fassbender JE, Sarwer DB, Phipps E, Allison KC, Localio R, Morales KH, Wesby L, Harralson T, Kessler R, Tan-Torres S. One-year results of the think health! Study of weight Management in Primary Care Practices. Obesity. 2012;20:1249–57.CrossRefPubMed
19.
Oldroyd JC, Unwin NC, White M, Mathers JC, Alberti KGMM. Randomised controlled trial evaluating lifestyle interventions in people with impaired glucose tolerance. Diabetes Res Clin Pract. 2006;72:117–27.CrossRefPubMed
20.
Penn L, White M, Oldroyd J, Walker M, Alberti KGMM, Mathers JC. Prevention of type 2 diabetes in adults with impaired glucose tolerance: the European diabetes prevention RCT in Newcastle upon Tyne, UK. BMC Public Health. 2009;9, p.342.
21.
Lakerveld J, Bot S, Chinapaw M, van Tulder M, Kingo L, Nijpels G. Process evaluation of a lifestyle intervention to prevent diabetes and cardiovascular diseases in primary care. Health Promot Pract. 2012;13:696–706.CrossRefPubMed
22.
Mensink M, Blaak EE, Corpeleijn E, Saris WH, de Bruin TW, Feskens EJ. Lifestyle intervention according to general recommendations improves glucose tolerance. Obes Res. 2003;11:1588–96.CrossRefPubMed
23.
Bo S, Ciccone G, Baldi C, Benini L, Dusio F, Forastiere G, Lucia C, Nuti C, Durazzo M, Cassader M, et al. Effectiveness of a lifestyle intervention on metabolic syndrome. A randomized controlled trial. J Gen Intern Med. 2007;22:1695–703.CrossRefPubMedPubMedCentral
24.
Vermunt PW, Milder IE, Wielaard F, van Oers JA, Westert GP. An active strategy to identify individuals eligible for type 2 diabetes prevention by lifestyle intervention in Dutch primary care: the APHRODITE study. Fam Pract. 2010;27:312–9.CrossRefPubMed
25.
Payne WR, Walsh KJ, Harvey JT, Livy MF, McKenzie KJ, Donaldson A, Atkinson MG, Keogh JB, Moss RS, Dunstan DW, Hubbard WA. Effect of a low-resource-intensive lifestyle modification program incorporating gymnasium-based and home-based resistance training on type 2 diabetes risk in Australian adults. Diabetes Care. 2008;31:2244–50.CrossRefPubMedPubMedCentral
26.
Sakane N, Sato J, Tsushita K, Tsujii S, Kotani K, Tsuzaki K, Tominaga M, Kawazu S, Sato Y, Usui T, et al. Prevention of type 2 diabetes in a primary healthcare setting: three-year results of lifestyle intervention in Japanese subjects with impaired glucose tolerance. BMC Public Health. 2011;11, p40.
27.
Tang TS, Nwankwo R, Whiten Y, Oney C. Training peers to deliver a church-based diabetes prevention program. Diabetes Educ. 2012;38:519–25.CrossRefPubMed
28.
Boltri JM, Davis-Smith M, Okosun IS, Seale JP, Foster B. Translation of the National Institutes of Health diabetes prevention program in African American churches. J Natl Med Assoc. 2011;103:194–202.CrossRefPubMed
29.
Brown BD, Harris KJ, Harris JL, Parker M, Ricci C, Noonan C. Translating the diabetes prevention program for Northern Plains Indian youth through community-based participatory research methods. Diabetes Educ. 2010;36:924–35.CrossRefPubMedPubMedCentral
30.
Davis-Smith YM, Boltri JM, Seale JP, Shellenberger S, Blalock T, Tobin B. Implementing a diabetes prevention program in a rural African-American church. J Natl Med Assoc. 2007;99:440–6.PubMedPubMedCentral
31.
Dodani S, Fields JZ. Implementation of the fit body and soul, a church-based life style program for diabetes prevention in high-risk African Americans: a feasibility study. Diabetes Educ. 2010;36:465–72.CrossRefPubMed
32.
Jiang LH, Manson SM, Beals J, Henderson WG, Huang HX, Acton KJ, Roubideaux Y, Indians SDP. Translating the diabetes prevention program into American Indian and Alaska native communities results from the special diabetes program for Indians diabetes prevention demonstration project. Diabetes Care. 2013;36:2027–34.CrossRefPubMedPubMedCentral
33.
Kramer MK, Cepak YP, Venditti EM, Semler LN, Kriska AM. Evaluation of the group lifestyle balance programme for diabetes prevention in a Hispanic women, infants and children (WIC) programme population in the USA. Divers Equality Health Care. 2013;10, p73-82.
34.
Ockene IS, Tellez TL, Rosal MC, Reed GW, Mordes J, Merriam PA, Olendzki BC, Handelman G, Nicolosi R, Ma YS. Outcomes of a Latino community-based intervention for the prevention of diabetes: the Lawrence Latino diabetes prevention project. Am J Public Health. 2012;102:336–42.CrossRefPubMedPubMedCentral
35.
Perez Siwik V, Kutob RM, Ritenbaugh C, Aickin M, Gordon JS. Families united/Familias Unidas: development and implementation of a family-based group office visit model for the primary prevention of type 2 diabetes. Diabetes Educ. 2012;38:811–21.CrossRefPubMed
36.
Mau MK, Keawe'aimoku Kaholokula J, West MR, Leake A, Efird JT, Rose C, Palakiko DM, Yoshimura S, Kekauoha PB, Gomes H. Translating diabetes prevention into native Hawaiian and Pacific islander communities: the PILI 'Ohana pilot project. Prog Community Health Partnersh. 2010;4:7–16.CrossRefPubMedPubMedCentral
37.
Satterfield DW, Volansky M, Caspersen CJ, Engelgau MM, Bowman BA, Gregg EW, Geiss LS, Hosey GM, May J, Vinicor F. Community-based lifestyle interventions to prevent type 2 diabetes. Diabetes Care. 2003;26:2643–52.CrossRefPubMed
38.
Aziz Z, Absetz P, Oldroyd J, Pronk NP, Oldenburg B. A systematic review of real-world diabetes prevention programs: learnings from the last 15 years. Implement Sci. 2015;10:172.CrossRefPubMedPubMedCentral
39.
Narayan KM, Benjamin E, Gregg EW, Norris SL, Engelgau M. Diabetes translation research: where are we and where do we want to be? Ann Intern Med. 2004;140:958–64.CrossRefPubMed
40.
Nobel J. Bridging the knowledge–action gap in diabetes: information technologies, physician incentives and consumer incentives converge. Chronic Illn. 2006;2:59–69.PubMed
41.
World Health Organization. A guide to implementation research in the prevention and control of noncommunicable diseases. World Health Organization;Geneva; 2016.
42.
Sathish T, Oldenburg B, Tapp RJ, Shaw JE, Wolfe R, Sajitha B, D'Esposito F, Absetz P, Mathews E, Zimmet PZ, Thankappan KR. Baseline characteristics of participants in the Kerala diabetes prevention program: a cluster randomized controlled trial of lifestyle intervention in Asian Indians. Diabet Med. 2016;34(5):647-53.
43.
Daivadanam M, Absetz P, Sathish T, Thankappan KR, Fisher EB, Philip NE, Mathews E, Oldenburg B. Lifestyle change in Kerala, India: needs assessment and planning for a community-based diabetes prevention trial. BMC Public Health. 2013;13:95.CrossRefPubMedPubMedCentral
44.
Sathish T, Williams ED, Pasricha N, Absetz P, Lorgelly P, Wolfe R, Mathews E, Aziz Z, Thankappan KR, Zimmet P, et al. Cluster randomised controlled trial of a peer-led lifestyle intervention program: study protocol for the Kerala diabetes prevention program. BMC Public Health. 2013;13:1035.CrossRefPubMedPubMedCentral
45.
The Diabetes Prevention Program (DPP) Research Group. The diabetes prevention program (DPP) description of lifestyle intervention. Diabetes Care. 2002;25:2165–71.CrossRef
46.
Bartholomew LK, Parcel GS, Gerjo K, Gottlieb NH, Fernández ME: Planning health promotion programs: an intervention mapping approach. 3 edn: United States of America: Wiley; 2011.
47.
Schwarzer R. Modeling health behavior change: how to predict and modify the adoption and maintenance of health Behaviors. Appl Psychol. 2008;57:1–29.
48.
Michie S, Richardson M, Johnston M, Abraham C, Francis J, Hardeman W, Eccles MP, Cane J, Wood CE. The behavior change technique taxonomy (v1) of 93 hierarchically clustered techniques: building an international consensus for the reporting of behavior change interventions. Ann Behav Med. 2013;46:81–95.CrossRefPubMed
49.
Sokol R, Fisher E. Peer support for the hardly reached: a systematic review. Am J Public Health. 2016;106:E1–8.CrossRefPubMed
50.
Mohan V, Deepa M, Deepa R, Shanthirani CS, Farooq S, Ganesan A, Datta M. Secular trends in the prevalence of diabetes and impaired glucose tolerance in urban South India--the Chennai urban rural epidemiology study (CURES-17). Diabetologia. 2006;49:1175–8.CrossRefPubMed
51.
Balagopal P, Kamalamma N, Patel TG, Misra R. A community-based diabetes prevention and management education program in a rural village in India. Diabetes Care. 2008;31:1097–104.CrossRefPubMed
52.
Ramachandran A, Arun N, Shetty AS, Snehalatha C. Efficacy of primary prevention interventions when fasting and postglucose dysglycemia coexist: analysis of the Indian diabetes prevention programmes (IDPP-1 and IDPP-2). Diabetes Care. 2010;33:2164–8.CrossRefPubMedPubMedCentral
53.
Krishnan A, Ekowati R, Baridalyne N, Kusumawardani N, Suhardi, Kapoor SK, Leowski J. Evaluation of community-based interventions for non-communicable diseases: experiences from India and Indonesia. Health Promot Int. 2011;26:276–89.CrossRefPubMed
54.
Kumar V, Kumar A, Das V, Srivastava NM, Baqui AH, Santosham M, Darmstadt GL, Saksham Study G. Community-driven impact of a newborn-focused behavioral intervention on maternal health in Shivgarh, India. Int J Gynaecol Obstet. 2012;117:48–55.CrossRefPubMed
55.
Murukutla N, Turk T, Prasad CV, Saradhi R, Kaur J, Gupta S, Mullin S, Ram F, Gupta PC, Wakefield M. Results of a national mass media campaign in India to warn against the dangers of smokeless tobacco consumption. Tob Control. 2012;21:12–7.CrossRefPubMed
56.
Varatharajan D, Thankappan R, Jayapalan S. Assessing the performance of primary health centres under decentralized government in Kerala, India. Health Policy Plan. 2004;19:41–51.CrossRefPubMed
57.
58.
59.
Tabak RG, Sinclair KA, Baumann AA, Racette SB, Sebert Kuhlmann A, Johnson-Jennings MD, Brownson RC. A review of diabetes prevention program translations: use of cultural adaptation and implementation research. Transl Behav Med. 2015;5:401–14.CrossRefPubMedPubMedCentral
60.
Centers of Disease Control and Prevention: Diabetes prevention recognition program standards and operating procedures. 2015.
61.
World Health Organization: Global action plan for the prevention and control of non-communicable diseases 2013 - 2020. 2013.
62.
Cabassa LJ, Baumann AA. A two-way street: bridging implementation science and cultural adaptations of mental health treatments. Implement Sci. 2013;8:90.CrossRefPubMedPubMedCentral
63.
Chen EK, Reid MC, Parker SJ, Pillemer K. Tailoring evidence-based interventions for new populations: a method for program adaptation through community engagement. Eval Health Prof. 2013;36:73–92.CrossRefPubMed
64.
Daivadanam M, Wahlstrom R, Thankappan KR, Ravindran TK. Balancing expectations amidst limitations: the dynamics of food decision-making in rural Kerala. BMC Public Health. 2015;15:644.CrossRefPubMedPubMedCentral
65.
Navaneetham K, Dharmalingam A. Utilization of maternal health care services in southern India. Soc Sci Med. 2002;55:1849–69.CrossRefPubMed
Metadata
Title
Cultural adaptation of a peer-led lifestyle intervention program for diabetes prevention in India: the Kerala diabetes prevention program (K-DPP)
Authors
Elezebeth Mathews
Emma Thomas
Pilvikki Absetz
Fabrizio D’Esposito
Zahra Aziz
Sajitha Balachandran
Meena Daivadanam
Kavumpurathu Raman Thankappan
Brian Oldenburg
Publication date
01-12-2017
Publisher
BioMed Central
Published in
BMC Public Health / Issue 1/2017
Electronic ISSN: 1471-2458
DOI
https://doi.org/10.1186/s12889-017-4986-0

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