We propose a cluster randomised community-based intervention of a culturally tailored, context specific and group-based lifestyle intervention for people with diagnosed T2DM in rural parts of Nepal. We will engage trained community health workers, in the intervention design and implementation process. The CHWs will be trained in terms of T2DM prevention, management and care aspects, where emphasis will be given for lifestyle and diabetes-self management. Importance of self-monitoring of diabetes including determining high risk signs and symptoms of diabetes will also be taught to CHW and the skills of facilitation such knowledge and skills to patients with T2DM of managing diabetes will be given during the training.
With the comprehensive review of international and national guidelines and practices, a facilitators’ handbook will be developed and be used by the trained CHWs in the process of intervention implementation. At least two lay peer supporters from each cluster will be identified, who also have similar status as other participants, but have great interest to manage lifestyle themselves and also help others. They will be provided with the training, which will mainly focus on facilitation and communication skills and will work closely with the trained CHWs and also facilitate the group-based sessions. Further, a regular telephone calls to the participants will be made by the study nurse/ staff where any issues with living with and managing diabetes will be discussed and advices for better management and care will be provided. Evidence suggest that use of regular telephone calls to the patients with T2DM are effective in terms of diabetes self-management, and we expect to have such combination to our proposed community based intervention will enhance implementation effectiveness of the diabetes self-management intervention. The proposed research project will target individuals who have developed type 2 diabetes, in selected 30 rural village councils of Dolakha and Nuwakot districts, Nepal.
The districts lie within the province number 3 of Nepal. The proposed interventions will be implemented through group based 12 monthly sessions with ongoing support, facilitated by trained CHWs and peer supporters. Regular telephone calls plus short message to patients in intervention groups will also be included, in order to enhance implementation effectiveness of the intervention. Diabetes self-management education to all participants also will be provided prior to the randomization. This will be the first real world community-based implementation trial of a lifestyle intervention targeting the adults with T2DM in rural Nepal. This study will be conducted in selected 12 village clusters of Dolakha district and 12 of Nuwakot district rural Nepal.
- Tomohiko Sugishita Tokyo Women’s Medical University * Rajendra Koju Kathmandu University * Andre Renzaho Western Sydney University
- Lal Rawal Western Sydney University
- Biraj Karmacharya Dhulikhel Hospital Kathmandu University Hospital