Scaling up interventions to improve the control of hypertension and diabetes in partnership with the governments of Kerala and Tamil Nadu

Background

There is an urgent need to reduce the health and economic impacts of diabetes and hypertension in low- and middle-income countries (LMIC). The Indian states of Kerala and Tamil Nadu are at an advanced stage of epidemiological transition relative to the rest of the country and have high rates of diabetes and hypertension. Therefore, learnings from Kerala and Tamil Nadu have important implications for the future trajectory of health outcomes for people living in other parts of India.

This proposal addresses the challenge of intervention scalability, which involves extending the limited reach of research findings from RCTs and the adaptation of those effective interventions to other settings and populations. The very limited evidence about how to achieve this in any context is compounded in LMIC such as India, where there are significant resource constraints and health workforce shortages, among other challenges. India’s National Program for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases and Stroke (NPCDCS) is variably implemented across India, and currently, in Kerala and Tamil Nadu, primary health care services and community health workers are not optimally utilised in the prevention and management of chronic conditions.

Aims

• Primary aim
  To evaluate the implementation outcomes of a peer support program and community mobilisation strategy to improve the prevention and control of diabetes and hypertension (using RE-AIM Framework & Theoretical Framework of Acceptability).

• Secondary aim
  To identify and address contextual factors within the community and health systems that act as enablers and barriers to scale up (using Normalisation Process Theory).

• Other aim(s)
  To determine the value and return on investment of the program by assessing program cost and cost effectiveness.

Project plan

In partnership with the governments of Kerala and Tamil Nadu, we will initially integrate our proposed structured lifestyle modification program with the existing opportunistic screening under the NPCDCS before expanding to a more population-based approach, in order to improve both states’ hypertension and diabetes outcomes. This research will also generate novel learnings for decision makers about how to link and integrate prevention with disease management at both a community and health system level. It will also strengthen government efforts under the NPCDCS by building the capacity of the existing health workforce and the health system to improve the prevention and management of diabetes and hypertension.

Funding organisations

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