Structured Health Interventions to reduce cardiometaboLic risk among adoLescents and yOuNG adults in tribal communities in North-eastern India (SHILLONG): A type 2 hybrid Cluster-Randomized Trial

Background

Meghalaya is a hilly state in northeastern India where the Khasi indigenous people make up 50% of the population. Almost 25% of their population is aged less than 25 years. Traditionally, tribal populations who live in rural India were presumed to have a healthy lifestyle. However, our research has demonstrated that this is no longer the case with overweight/obesity (21%), smoking among men (54%), hypertension (22%), and diabetes (11%), now all very common among tribal populations, compared to the rest of the population. Furthermore, the tribal population is not well equipped to deal with the epidemiological transition from communicable diseases to the rapidly increasing burden of NCDs. Hence, they are very vulnerable to risk factors for chronic disease and subsequent NCDs arising from them, causing a huge drain on the state, communities and families. Moreover, as the origins of cardiometabolic disease begin early in life and have been progressing unchecked for decades, it is urgent to address the prevention of cardiometabolic disease among adolescents and young adults in rural Meghalaya.

Our program – abbreviated as SHILLONG (the capital of Meghalaya), which also means ‘The Abode of Clouds’ – will comprise community, family and individual level interventions adapted from the US HEALTHY study and the European Feel4Diabetes study. Guided by the ADAPT process model, the cultural adaptation and implementation of the intervention will actively involve adolescents and young adults. We will apply the Implementation Research Logic model and the RE-AIM Framework to guide implementation and evaluation of the program. The primary outcome will be cardiometabolic health as measured by Life’s Simple 7, developed by the American Heart Association and adapted for use in this population. The SHILLONG program has strong support from the Meghalaya state health department and local communities. Our Knowledge Translation Reference Group will also consider the adaptation and ‘reverse innovation’ of relevant findings to Indigenous communities in Australia.

Aims

Our project aims to co-design, implement and evaluate an evidence-based lifestyle intervention program to improve cardiometabolic health among adolescents and young adults in tribal populations of rural Meghalaya, a North-eastern state in India.

Project plan

We will co-design, implement, and evaluate a multi-level, multi-component and scalable intervention, involving communities and individuals’ families, to improve cardiometabolic health among indigenous adolescents and young adults in rural Meghalaya. We will identify factors that influence implementation of the program in rural tribal populations and its potential for future scaleup in tribal populations in India. We will also determine the cost-effectiveness of the program. Using a hybrid type 2 cluster-randomized design and mixed-methods approach, the program will target adolescents and young adults – 20 clusters (villages) with 35 at risk and 35 non-risk participants from each cluster. We will utilise effective community engagement strategies by adapting a culture-centered approach using the Maori He Pikinga Waiora (Enhancing Wellbeing) implementation framework for indigenous health interventions.

Publications and output

You may visit the project website for more information.

Principal investigators

Funding organisations

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