Participatory Engagement for City Communities Against NCD Risk in Bangladesh and Nepal (The PECAN Project)

Background

People living in cities in South Asia are exposed to a high burden of non-communicable disease (NCD) risk throughout their lives. These risks include unhealthy diet, physical inactivity, alcohol and tobacco use, and environmental pollution. Risk exposure is driven by factors at the individual, household, community, and environmental levels and so modifying these exposures is rarely a matter of personal choice, but rather is determined by wider socio-cultural, socio-political, and economic factors, including traditions and customs, gender norms, living conditions and housing arrangements, rural-urban migration cycles, health service provision, and market forces and regulation.

Intervention responses that foster and facilitate broad community action to address the structural, political, and economic factors common to multiple risks and diseases to reduce risk are needed. We have previously shown that community mobilisation using Participatory Learning and Action (PLA) that raises awareness of issues and facilitates collective community action is highly effective in tackling the wider determinants of health in a range of setting.

Aims

To equip policymakers and practitioners in Nepal and Bangladesh with evidence-based, equitable and sustainable strategies for promoting health and reducing NCD risk in cities.

Project plan

Our project will provide a comparative case study on adaptation, application and evaluation of the evidence-based approach of PLA in cities in Nepal and Bangladesh to address a wide range of risk determinants and consequences. We will deliver an intervention of facilitated participation, learning and collective action and work with communities to co-develop strategies of group-based physical activity, digital (mHealth) health promotion, and arts-based methods and evaluate their implementation and impact on a range of NCD risks. Further, we will have a specific focus of physical activity outcomes among women aged 50 years and above as an exemplar of a neglected population group in NCD intervention research and an outcome that reflects broad determinants, including social interactions, environment and gender-norms.

The evaluation will employ mixed-methods implementation science approaches, including process and economic evaluation, population-level epidemiological surveys and an Interrupted Time Series design. Success in increasing physical activity among older women will be illustrative of our intervention’s ability to tackle broad determinants of NCD risk, with likely positive impacts across genders, generations and environments.

Impact

Using community-led participation in Bangladesh and Nepal to reduce urban non-communicable disease risk by addressing the social, environmental, and structural drivers of poor health.

Publications and output

To access publications and other outputs relating to this project, see our publications webpage.