Browsing by Author "Mathews, E"

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    Adapting and Validating the Global Physical Activity Questionnaire (GPAQ) for Trivandrum, India, 2013
    (Preventing Chronic Disease, 2016-07) Mathews, E; Salvo, D; Sarma, PS; Thankappan, KR; Pratt, M
    Introduction A limitation of the Global Physical Activity Questionnaire (GPAQ) in assessing physical activity in India is that it does not capture the diversity of activities across cultures and by sex. The purpose of this study was to culturally adapt and validate the GPAQ by using an accelerometer in Thiruvananthapuram City, India. Methods We developed a modified version of the GPAQ by adding a physical activity chart specific to the locale. We identified local physical activities through in-depth interviews, group discussions, and observation, and used Actigraph GT3X accelerometers to validate the modified GPAQ for a subsample of 47 women. Participants were drawn from a cross-sectional survey of 1,303 women aged 18 to 64 years, selected by multistage cluster sampling. Spearman rank correlation coefficients and intraclass correlation coefficients (ICC) were calculated to determine the correlation and level of agreement in moderate-to-vigorous physical activity (MVPA) on the basis of accelerometer measurement and the modified GPAQ. Results The correlation for MVPA between the modified GPAQ (overall) and the accelerometer (non-bouted MVPA) was 0.69 (95% confidence interval [CI], 0.39–0.85) with a moderately high ICC of 0.78 (95% CI, 0.56–0.90). The correlation for MVPA between the modified GPAQ and the accelerometer-based MVPA within bouts of at least 10 minutes was 0.60 (95% CI, 0.26–0.80) with an ICC of 0.55 (95% CI, 0.20–0.77) indicating a moderate level of agreement. Conclusion The GPAQ can be used for assessing physical activity among women in India, and its adaptation and validation may be useful in other low-income or middle-income countries where activities are diverse in type and intensity
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    Baseline characteristics of participants in the Kerala Diabetes Prevention Programme: a cluster randomized controlled trial of lifestyle intervention in Asian Indians
    (Diabetic Medicine, 2016-07) Sathish, T; Oldenburg, B; Tapp, RJ; Shaw, JE; Wolfe, R; Balachandran, S; D’Esposito, F; Absetz, P; Mathews, E; Zimmet, PZ; Thankappan, KR
    Aims To describe the baseline characteristics of participants in the Kerala Diabetes Prevention Program. Methods The Kerala Diabetes Prevention Program is a cluster randomized controlled trial of lifestyle intervention for prevention of Type 2 diabetes mellitus in India. Participants in the study were those aged 30–60 years who had an Indian Diabetes Risk Score ≥ 60 and who were without Type 2 diabetes on oral glucose tolerance test. Data on demographic, lifestyle, clinical and biochemical characteristics were collected using standardized tools. Results A total of 2586 individuals were screened with the Indian Diabetes Risk Score, of these 1529 people (59.1%) had a score ≥ 60, of whom 1209 (79.1%) underwent an oral glucose tolerance test. A total of 202 individuals (16.7%) had undiagnosed Type 2 diabetes and were excluded, and the remaining 1007 individuals were enrolled in the trial (control arm, n = 507; intervention arm, n = 500). The mean participant age was 46.0 ± 7.5 years, and 47.2% were women. The mean Indian Diabetes Risk Score was 67.1 ± 8.4. More than two-thirds (69.0%) had prediabetes and 31.0% had normal glucose tolerance. The prevalence of cardiometabolic risk factors was high, including current tobacco use (34.4% in men), current alcohol use (39.3% in men), no leisure time exercise (98.0%), no daily intake of fruit and vegetables (78.7%), family history of diabetes (47.9%), overweight or obesity (68.5%), hypertension (22.3%) and dyslipidemia (85.4%). Conclusions The Kerala Diabetes Prevention Program recruited participants using a diabetes risk score. A large proportion of the participants had prediabetes and there were high rates of cardiometabolic risk factors. The trial will evaluate the effectiveness of lifestyle intervention in a population selected on the basis of a diabetes risk score.
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    Cultural adaptation of a peer-led lifestyle intervention program for diabetes prevention in India: the Kerala diabetes prevention program (K-DPP)
    (BMC Public Health, 2018-01) Mathews, E; Thomas, E; Absetz, P; D’Esposito, F; Aziz, Z; Balachandran, S; Daivadanam, M; Thankappan, KR; Oldenburg, B
    Background: Type 2 diabetes mellitus (T2DM) is now one of the leading causes of disease-related deaths globally. India has the world’s second largest number of individuals living with diabetes. Lifestyle change has been proven to be an effective means by which to reduce risk of T2DM and a number of “real world” diabetes prevention trials have been undertaken in high income countries. However, systematic efforts to adapt such interventions for T2DM prevention in low- and middle-income countries have been very limited to date. This research-to-action gap is now widely recognised as a major challenge to the prevention and control of diabetes. Reducing the gap is associated with reductions in morbidity and mortality and reduced health care costs. The aim of this article is to describe the adaptation, development and refinement of diabetes prevention programs from the USA, Finland and Australia to the State of Kerala, India. Methods: The Kerala Diabetes Prevention Program (K-DPP) was adapted to Kerala, India from evidence-based lifestyle interventions implemented in high income countries, namely, Finland, United States and Australia. The adaptation process was undertaken in five phases: 1) needs assessment; 2) formulation of program objectives; 3) program adaptation and development; 4) piloting of the program and its delivery; and 5) program refinement and active implementation. Results: The resulting program, K-DPP, includes four key components: 1) a group-based peer support program for participants; 2) a peer-leader training and support program for lay people to lead the groups; 3) resource materials; and 4) strategies to stimulate broader community engagement. The systematic approach to adaptation was underpinned by evidence-based behavior change techniques. Conclusion: K-DPP is the first well evaluated community-based, peer-led diabetes prevention program in India. Future refinement and utilization of this approach will promote translation of K-DPP to other contexts and population groups within India as well as other low- and middle-income countries. This same approach could also be applied more broadly to enable the translation of effective non-communicable disease prevention programs developed in high-income settings to create context-specific evidence in rapidly developing low- and middle-income countries. Trial registration: Australia and New Zealand Clinical Trials Registry: ACTRN12611000262909. Registered 10 March 2011
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    Doctors' self-reported physical activity, their counselling practices and their correlates in urban Trivandrum, South India: should a full-service doctor be a physically active doctor?
    (BRITISH JOURNAL OF SPORTS MEDICINE, 2015) Patra, L; Mini, GK; Mathews, E; Thankappan, KR
    Background Doctors' self-reported physical activity (PA) is associated with their propensity for prescribing PA. Methods We surveyed 146 doctors (median age 42 years; men 58.9%), selected by multistage random sampling. Information on demographic details, selfreported PA and counselling offered to their patients was collected using a pretested, structured, self-administered questionnaire. Multivariate logistic regression analysis was carried out to find the predictors of PA and PA counselling offered to the patients. Results Moderate PA was reported by 37.7% (95% CI 29.8 to 45.5) of the doctors and the remaining 62.3% reported being inactive. Doctors who were motivated to perform PA (OR 4.01, 95% CI 1.82 to 8.86), who used exercise equipment at home (OR 3.97, CI 1.68 to 9.36) and who used a neighbourhood facility for PA (OR 2.36, CI 1.11 to 5.02) were more likely to perform moderate PA compared with their counterparts. 25% of the doctors always asked and advised their patients on PA. Doctors who believed that their own healthy lifestyle influenced advice practices (OR 9.13, CI 2.49 to 33.41), who consulted less than 30 patients/day (OR 5.35, CI 1.41 to 20.25) and who reported previous participation in sports activities (OR 4.22, CI 1.77 to 10.04) were more likely to always ask and advise their patients on PA compared with their counterparts. Conclusions A majority of the doctors in our study were inactive and did not ask or advise their patients on PA. Measures are warranted to enhance doctors' own PA and their counselling practices.
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    Doctors’ self reported physical activity, their counseling practices and their correlates in urban Trivandrum, South India: should a full-service doctor be a physically active doctor?
    (Br J Sports Med., 2013-06) Patra, L; Mini, GK; Mathews, E; Thankappan, KR
    Background :- Doctors’ self-reported physical activity (PA) is associated with their propensity for prescribing PA. Methods:- We surveyed 146 doctors (median age 42 years; men 58.9%), selected by multistage random sampling. Information on demographic details, self-reported PA and counselling offered to their patients was collected using a pretested, structured, self-administered questionnaire. Multivariate logistic regression analysis was carried out to find the predictors of PA and PA counselling offered to the patients. Results:- Moderate PA was reported by 37.7% (95% CI 29.8 to 45.5) of the doctors and the remaining 62.3%reported being inactive. Doctors who were motivated to perform PA (OR 4.01, 95% CI 1.82 to 8.86), who used exercise equipment at home (OR 3.97, CI 1.68 to 9.36) and who used a neighbourhood facility for PA (OR 2.36, CI 1.11 to 5.02) were more likely to perform moderate PA compared with their counterparts. 25% of the doctors always asked and advised their patients on PA. Doctors who believed that their own healthy lifestyle influenced advice practices (OR 9.13, CI 2.49 to 33.41), who consulted less than 30 patients/day (OR 5.35, CI 1.41 to 20.25) and who reported previous participation in sports activities (OR 4.22, CI 1.77 to 10.04) were more likely to always ask and advise their patients on PA compared with their counterparts. Conclusions:- A majority of the doctors in our study were inactive and did not ask or advise their patients on PA. Measures are warranted to enhance doctors’ own PA and their counselling practices.
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    . A group-based lifestyle intervention for diabetes prevention in low- and middleincome country: implementation evaluation of the Kerala Diabetes Prevention Program
    (Implementation Science, 2018-07) Aziz, Z; Mathews, E; Absetz, P; Sathish, T; Oldroyd, J; Balachandran, S; Shetty, SS; Thankappan, KR; Oldenburg, B
    Background While several efficacy trials have demonstrated diabetes risk reduction through targeting key lifestyle behaviours, there is a significant evidence gap in relation to the successful implementation of such interventions in low- and middle-income countries (LMICs). This paper evaluates the implementation of a cluster randomised controlled trial of a group-based lifestyle intervention among individuals at high-risk of developing type 2 diabetes mellitus (T2DM) in the state of Kerala, India. Our aim is to uncover provider-, participant- and community-level factors salient to successful implementation and transferable to other LMICs. Methods The 12-month intervention program consisted of (1) a group-based peer-support program consisting of 15 sessions over a period of 12 months for high-risk individuals, (2) peer leader (PL) training and ongoing support for intervention delivery, (3) diabetes education resource materials and (4) strategies to stimulate broader community engagement. The evaluation was informed by the RE-AIM and PIPE frameworks. Results Provider-level factors: Twenty-nine (29/30, 97%) intervention groups organised all 15 sessions. A 2-day PL training was attended by 51(85%) of 60 PLs. The PL handbook was found to be ‘very useful’ by 78% of PLs. Participant-level factors: Of 1327 eligible individuals, 1007(76%) participants were enrolled. On average, participants attended eight sessions. Sixty-eight percent rated their interest in group sessions as ‘very interested’, and 55% found the group sessions ‘very useful’ in making lifestyle changes. Inconvenient time (43%) and location (21%) were found to be important barriers for participants who did not attend any sessions. Community-level factors: Community-based activities reached to 41% of the participants for walking groups, 40% for kitchen garden training, and 31% for yoga training. PLs were readily available for support outside the sessions, as 75% of participants reported extracurricular contacts with their PLs. The commitment from the local partner institute and political leaders facilitated the high uptake of the program. Conclusion A comprehensive evaluation of program implementation from the provider-, participant- and community-level perspectives demonstrates that the K-DPP program was feasible and acceptable in changing lifestyle behaviours in high-risk individuals. The findings from this evaluation will guide the future delivery of structured lifestyle modification diabetes programs in LMICs.
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    Identifying people at high risk for type 2 diabetes: preliminary results from the Kerala Diabetes Prevention Programme
    (DIABETOLOGIA, 2015) Oldenburg, B; Sathish, T; Thankappan, KR; Balachandran, S; D'esposito, F; Mathews, E; Lorgelly, P; Absetz, P; Zimmet, PZ; Shaw, J; Tapp, RJ
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    Lifestyle change in Kerala, India: needs assessment and planning for a community-based diabetes prevention trial
    (BMC Public Health, 2013-02) Daivadanam, M; Absetz, P; Sathish, T; Thankappan, KR; Fisher, EB; Philip, NE; Mathews, E; Oldenburg, B
    Background Type 2 Diabetes Mellitus (T2DM) has become a major public health challenge in India. Factors relevant to the development and implementation of diabetes prevention programmes in resource-constrained countries, such as India, have been under-studied. The purpose of this study is to describe the findings from research aimed at informing the development and evaluation of a Diabetes Prevention Programme in Kerala, India (K-DPP). Methods Data were collected from three main sources: (1) a systematic review of key research literature; (2) a review of relevant policy documents; and (3) focus groups conducted among individuals with a high risk of progressing to diabetes. The key findings were then triangulated and synthesised. Results Prevalence of risk factors for diabetes is very high and increasing in Kerala. This situation is largely attributable to rapid changes in the lifestyle of people living in this state of India. The findings from the systematic review and focus groups identified many environmental and personal determinants of these unhealthy lifestyle changes, including: less than ideal accessibility to and availability of health services; cultural values and norms; optimistic bias and other misconceptions related to risk; and low expectations regarding one’s ability to make lifestyle changes in order to influence health and disease outcomes. On the other hand, there are existing intervention trials conducted in India which suggests that risk reduction is possible. These programmes utilize multi-level strategies including mass media, as well as strategies to enhance community and individual empowerment. India’s national programme for the prevention and control of major non-communicable diseases (NCD) also provide a supportive environment for further community-based efforts to prevent diabetes. Conclusion These findings provide strong support for undertaking more research into the conduct of community-based diabetes prevention in the rural areas of Kerala. We aim to develop, implement and evaluate a group-based peer support programme that will address cultural and family determinants of lifestyle risks, including family decision-making regarding adoption of healthy dietary and physical activity patterns. Furthermore, we believe that this approach will be feasible, acceptable and effective in these communities; with the potential for scale-up in other parts of India.
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    A peer-support lifestyle intervention for preventing type 2 diabetes in India: A cluster randomized controlled trial of the Kerala Diabetes Prevention Program
    (Plos Medicine, 2018-06) Thankappan, KR; Sathish, T; Tapp, RJ; Shaw, JE; Lotfaliany, M; Wolfe, R; Absetz, P; Mathews, E; Aziz, Z; Emily, D
    BACKGROUND: The major efficacy trials on diabetes prevention have used resource-intensive approaches to identify high-risk individuals and deliver lifestyle interventions. Such strategies are not feasible for wider implementation in low- and middle-income countries (LMICs). We aimed to evaluate the effectiveness of a peer-support lifestyle intervention in preventing type 2 diabetes among high-risk individuals identified on the basis of a simple diabetes risk score. METHODS AND FINDINGS: The Kerala Diabetes Prevention Program was a cluster-randomized controlled trial conducted in 60 polling areas (clusters) of Neyyattinkara taluk (subdistrict) in Trivandrum district, Kerala state, India. Participants (age 30-60 years) were those with an Indian Diabetes Risk Score (IDRS) ≥60 and were free of diabetes on an oral glucose tolerance test (OGTT). A total of 1,007 participants (47.2% female) were enrolled (507 in the control group and 500 in the intervention group). Participants from intervention clusters participated in a 12-month community-based peer-support program comprising 15 group sessions (12 of which were led by trained lay peer leaders) and a range of community activities to support lifestyle change. Participants from control clusters received an education booklet with lifestyle change advice. The primary outcome was the incidence of diabetes at 24 months, diagnosed by an annual OGTT. Secondary outcomes were behavioral, clinical, and biochemical characteristics and health-related quality of life (HRQoL). A total of 964 (95.7%) participants were followed up at 24 months. Baseline characteristics of clusters and participants were similar between the study groups. After a median follow-up of 24 months, diabetes developed in 17.1% (79/463) of control participants and 14.9% (68/456) of intervention participants (relative risk [RR] 0.88, 95% CI 0.66-1.16, p = 0.36). At 24 months, compared with the control group, intervention participants had a greater reduction in IDRS score (mean difference: -1.50 points, p = 0.022) and alcohol use (RR 0.77, p = 0.018) and a greater increase in fruit and vegetable intake (≥5 servings/day) (RR 1.83, p = 0.008) and physical functioning score of the HRQoL scale (mean difference: 3.9 score, p = 0.016). The cost of delivering the peer-support intervention was US$22.5 per participant. There were no adverse events related to the intervention. We did not adjust for multiple comparisons, which may have increased the overall type I error rate. CONCLUSIONS: A low-cost community-based peer-support lifestyle intervention resulted in a nonsignificant reduction in diabetes incidence in this high-risk population at 24 months. However, there were significant improvements in some cardiovascular risk factors and physical functioning score of the HRQoL scale.
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    Perceptions of barriers and facilitators in physical activity participation among women in Thiruvananthapuram City, India
    (Global Health Promotion., 2015-05) Mathews, E; Lakshmi, JK; Ravindran, TKS; Pratt, M; Thankappan, KR
    Background: Despite the known benefits of physical activity, very few people, especially women, are found to engage in regular physical activity. This study explored the perceptions, barriers and facilitators related to physical activity among women in Thiruvananthapuram City, India. Methods: Four focus group discussions were conducted among individuals between 25 and 60 years of age, in a few areas of Thiruvananthapuram City Corporation limits in Kerala, preparatory to the design of a physical activity intervention trial. An open-ended approach was used and emergent findings were analyzed and interpreted. Results: Women associated physical activity mostly with household activities. The majority of the women considered their activity level adequate, although they engaged in what the researchers concluded were quite low levels of activity. Commonly reported barriers were lack of time, motivation, and interest; stray dogs; narrow roads; and not being used to the culture of walking. Facilitators of activity were seeing others walking, walking in pairs, and pleasant walking routes. Walking was reported as the most feasible physical activity by women. Conclusion: Physical activity promotion strategies among women should address the prevailing cultural norms in the community, and involve social norming and overcoming cultural barriers. They should also target the modifiable determinants of physical activity, such as improving self-efficacy, improving knowledge on the adequacy of physical activity and its recommendations, facilitating goalsetting, and enhancing social support through peer support and group-based activities.
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    Self-reported Physical Activity and its Correlates among Adult Women in the expanded part of Thiruvananthapuram City, India
    (Indian Journal of Public Health, 2015) Mathews, E; Pratt, M; Jissa, VT; Thankappan, KR
    Data on correlates of physical activity (PA) are limited in India. This study estimated the prevalence and correlates of PA among women. A cross-sectional survey was conducted among 1303 women (mean age 45 years) selected by multistage cluster sampling. Information was collected using a pretested interview schedule. Multivariate logistic regression analysis was used to determine the correlates of PA. Self-reported moderate or high level PA prevalence was 73.4% [95% confidence interval (CI); 71.1-75.9]. Women who perceived themselves as being underweight [odds ratio (OR) 3.68: 1.97-6.74]; had an exercising member in the household (OR 3.41: 2.52-4.66); had access to exercise facilities (OR 2.17: 1.63-2.95); were married (OR 2.14: 1.40-3.25), were in the age group of 35-54 years (OR 1.91: 1.32-2.63); reported having knowledge about the benefits of PA (OR 1.62: 1.13-2.25); and who reported having the support of friends and neighbors (OR 1.42: 1.05-2.01) were more likely to report PA than their counterparts.