Cultural adaptation of a peer-led lifestyle intervention program for diabetes prevention in India: the Kerala diabetes prevention program (K-DPP)
No Thumbnail Available
Date
2018-01
Journal Title
Journal ISSN
Volume Title
Publisher
BMC Public Health
Abstract
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
Description
Keywords
Cultural adaptation, Diabetes prevention, Type 2 diabetes mellitus (T2DM), Low and middle income countries (LMICs), Community-based, Peer support, Lifestyle intervention, Implementation
Citation
Mathews E, Thomas E, Absetz P, D’Esposito F, Aziz Z, Balachandran S, Daivadanam M, Thankappan KR, Oldenburg B. 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 Jan;17(1):974.