Family centred approach to enhance lifestyle change and behavioural modification for prevention of cardiovascular diseases (CVD) among adolescents and their families in Uganda (FaCe-D) study

Background

As HIV has become better treated and controlled in Uganda, more attention must be focused on the current burden of cardiovascular diseases to prevent premature morbidity and mortality. Uganda suffers a dual burden of Non-Communicable Diseases (NCDs) and HIV/AIDS with an overall prevalence of pre-hypertension of 38.8% among its 42 million population (adolescents account for 23.6% of this) and 5.50 % for HIV/AIDS. The clinical signs and symptoms of cardiovascular disease (CVD) may present in adulthood, but the atherosclerotic process often begins in adolescence and is often influenced by modifiable CVD risk factors such as unhealthy diet, physical inactivity, dyslipidemia, overweight and obesity. We would like to address risk factors for CVD in Uganda using an adapted version of an evidenced-based family-based intervention referred to as a family centered Approach (FCA) among adolescents (both HIV positive and negative) and their families.

Aims

Our primary aim is to adapt and implement an evidenced and family-based intervention that has been successful in reducing the Cardiovascular disease risk factors in South Asia and the UK and determine uptake, effectiveness, cost-effectiveness while assessing barriers and facilitators of implementation in Uganda.

Project plan

The study will involve a formative phase, baseline surveys, series of cross sectional surveys, process evaluation and post – intervention survey. We will conduct a type 2 – hybrid step-wedge study in Jinja (rural) and Kampala (urban) districts of Uganda. Our sample size is 41 Villages/clusters (half in urban; half in rural). We propose to use four steps and will select 10 clusters for the first implementation step (baseline), each contributing 32 participants, then expose them to the intervention while the others will continue with standard practice. The study will last 5 years but the data collection will take place from time of exposure of the first clusters at time 0 (January 2024), to June, 2026. We will be guided by the implementation science frameworks; Reach, Effectiveness, Adoption, Implementation and Maintenance (RE-AIM) and Consolidate Framework for Implementation Research (CFIR).

Intervention: The family centred approach (FCA) involves; a. weekly health education sessions focused on a healthy diet, physical activity, and the importance of regular screening; b. identifying enjoyable physical activities to incorporate into adolescents’ routine; and c. bi-weekly relay of health diet education text messages by community health Workers but co-designed with adolescents.

The primary outcomes will be; acceptability, adoption, appropriateness, cost, feasibility, fidelity, reach, self-efficacy, sustainability, scalability and the Secondary outcomes will be effectiveness (change in knowledge on CVD risk factors and prevention, blood pressures, body mass index)

This study will provide blueprint for an innovative model to tackle NCD risk in Uganda.

Funding organisations

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