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Randomized Controlled Trial
. 2018 Jan 4;17(1):974.
doi: 10.1186/s12889-017-4986-0.

Cultural adaptation of a peer-led lifestyle intervention program for diabetes prevention in India: the Kerala diabetes prevention program (K-DPP)

Elezebeth Mathews  1   2 , Emma Thomas  3 , Pilvikki Absetz  4   5   6 , Fabrizio D'Esposito  7 , Zahra Aziz  7 , Sajitha Balachandran  1 , Meena Daivadanam  8   9 , Kavumpurathu Raman Thankappan  1 , Brian Oldenburg  7
Affiliations
Randomized Controlled Trial

Cultural adaptation of a peer-led lifestyle intervention program for diabetes prevention in India: the Kerala diabetes prevention program (K-DPP)

Elezebeth Mathews et al. 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.

Keywords: Community-based; Cultural adaptation; Diabetes prevention; Implementation; Lifestyle intervention; Low and middle income countries (LMICs); Peer support; Type 2 diabetes mellitus (T2DM).

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Conflict of interest statement

Ethics approval and consent to participate

The research was approved by the Institutional Ethics Committee of the Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, India (SCT/IEC-333/May 2011), and by the Human Research Ethics Committee of Monash University, Australia (CF11/0457-2,011,000,194) and the University of Melbourne, Australia (1441736). The trial was registered on the Australia and New Zealand Clinical Trials Registry: ACTRN12611000262909.

All study participants provided written informed consent.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Overview of the Kerala Diabetes Prevention Program lifestyle change model
Fig. 2
Fig. 2
Kerala Diabetes Prevention Program components
See this image and copyright information in PMC

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