The Community Health Assessment Program in the Philippines (CHAP-P) diabetes health promotion program for low- to middle-income countries: study protocol for a cluster randomized controlled trial

Abstract

Background Type 2 diabetes is increasing globally, with the highest burden in low- to middle-income countries (LMICs) such as the Philippines. Developing effective interventions could improve detection, prevention, and treatment of diabetes. The Cardiovascular Health Awareness Program (CHAP), an evidence-based Canadian intervention, may be an appropriate model for LMICs due to its low cost, ease of implementation, and focus on health promotion and disease prevention. The primary aim of this study is to adapt the CHAP model to a Philippine context as the Community Health Assessment Program in the Philippines (CHAP-P) and evaluate the effect of CHAP-P on glycated hemoglobin (HbA1c) compared to a random sample of community residents in control communities. Methods Six-month, 26-community (13 intervention, 13 control) parallel cluster randomized controlled trial in Zamboanga Peninsula, an Administrative Region in the southern Philippines. Criteria for community selection include: adequate political stability, connection with local champions, travel feasibility, and refrigerated space for materials. The community-based intervention, CHAP-P sessions, are volunteer-led group sessions with chronic condition assessment, blood pressure monitoring, and health education. Three participant groups will be involved: 1) Random sample of community participants aged 40 or older, 100 per community (1300 control, 1300 intervention participants total); 2) Community members aged 40 years or older who attended at least one CHAP-P session; 3) Community health workers and staff facilitating sessions. Primary outcome: mean difference in HbA1c at 6 months in intervention group individuals compared to control. Secondary outcomes: modifiable risk factors, health utilization and access (individual); diabetes detection and management (cluster). Evaluation also includes community process evaluation and cost-effectiveness analysis. Discussion CHAP has been shown to be effective in a Canadian setting. Individual components of CHAP-P have been piloted locally and shown to be acceptable and feasible. This study will improve understanding of how best to adapt this model to an LMIC setting, in order to maximize prevention, detection, and management of diabetes. Results may inform policy and practice in the Philippines and have the potential to be applied to other LMICs. Trial registration ClinicalTrials.gov ( NCT03481335 ), registered March 29, 2018. Electronic supplementary material The online version of this article (10.1186/s12889-019-6974-z) contains supplementary material, which is available to authorized users.

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“…Vietnam is no exception, with a low level of diabetes knowledge among the general population aged 40–64 years, and significantly lower awareness in rural areas compared with urban areas [ 14 ]. Community-based programs, providing culturally appropriate diabetes health education, offer a practical, relatively low-resource solution [ 15 – 17 ]. One such program is the Ngaydautien project ( https://ngaydautien.vn ), which was launched in 2016 in collaboration with the Ministry of Health, Vietnam National Heart Association, Vietnam Association of Diabetes & Endocrinology, and the private sector.…”

Direct medical costs of type 2 diabetes mellitus in the Philippines: findings from two hospital databases and physician surveys

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Community-based intervention for managing hypertension and diabetes in rural Bangladesh

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