Community-based lifestyle intervention for diabetes management in rural Nepal

Background

We proposed 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 aimed to engage trained community health workers, in the intervention design and implementation process. The CHWs were to be trained in terms of T2DM prevention, management and care aspects, where emphasis was to be given for lifestyle and diabetes-self management. Importance of self-monitoring of diabetes including determining high risk signs and symptoms of diabetes was to 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.

The proposed research project targeted individuals who have developed type 2 diabetes in selected 30 rural village councils of Kavrepalanchowk and Nuwakot districts, Nepal.

Aims

To determine the effectiveness of a culturally appropriate lifestyle intervention in improving management and care of people with T2DM in Nepal.

Project plan

With the comprehensive review of international and national guidelines and practices, a facilitators’ handbook was to be developed and used by the trained CHWs in the process of intervention implementation. At least two lay peer supporters from each cluster were identified, who also have similar status as other participants, but have great interest to manage lifestyle themselves and also help others. They were provided with the training, which focused on facilitation and communication skills. The trained peer supporters worked closely with the trained CHWs and also facilitated the group-based sessions. Further, regular telephone calls to the participants were made by the study nurse/ staff where any issues with living with and managing diabetes will be discussed and advice for better management and care were provided. Evidence suggest that use of regular telephone calls to the patients with T2DM are effective in terms of diabetes self-management, and we expected to have such combination to our proposed community based intervention which would enhance implementation effectiveness of the diabetes self-management intervention.

The districts lie within the province number 3 of Nepal. The proposed interventions were to 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 were included, in order to enhance implementation effectiveness of the intervention. Diabetes self-management education to all participants was to be provided prior to the randomization. This would be the first real world community-based implementation trial of a lifestyle intervention targeting the adults with T2DM in rural Nepal. This study was to be conducted in selected village clusters of Kavrepalanchowk and Nuwakot districts in rural Nepal.

Impact

The preliminary findings of the project showed that a lifestyle intervention for diabetes management, delivered by Community Health Workers, was effective in improving primary as well as secondary outcomes. These include improved HbA1c levels, depression, self-care behaviour, physical activity, healthy food habits and quality of lives. The project has built the capacity of community health workers to prevent and manage NCDs and by involving health policy makers it has influenced systems level changes.

Funding organisations

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