The effect of community groups and mobile phone messages on the prevention and control of diabetes in rural Bangladesh: study protocol for a three-arm cluster randomised controlled trial

Fottrell, Edward; Jennings, Hannah; Kuddus, Abdul; Ahmed, Naveed; Morrison, Joanna; Akter, Kohenour; Shaha, Sanjit Kumer; Nahar, Badrun; Nahar, Tasmin; Haghparast‐Bidgoli, Hassan; Khan, A K Azad; Costello, Anthony; Azad, Kishwar

doi:10.1186/s13063-016-1738-x

Cited by 28 publications

(40 citation statements)

References 37 publications

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“…Participants in the control arm requested for the intervention to be implemented in their own DSGs as they felt left out. This was already planned to meet the ethical obligation to ensure that control groups also benefit from the intervention [18]. This implementation in control arm DSGs was implemented subsequent to the trial.…”

Section: Inner Settingmentioning

confidence: 99%

Peer-support to increase uptake of screening for diabetic retinopathy: process evaluation of the DURE cluster randomized trial

et al. 2020

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Background: There is limited evidence on how implementation of peer support interventions influences effectiveness, particularly for individuals with diabetes. We conducted a cluster randomized controlled trial to compare the effectiveness of a peer-led health education package versus usual care to increase uptake of screening for diabetic retinopathy (DR). Methods: Our process evaluation used a mixed-method design to investigate the recruitment and retention, reach, dose, fidelity, acceptability, and context of implementation, and was guided by the Consolidated Framework for Implementation Research (CFIR). We reviewed trial documents, conducted semi-structured interviews with key informants (n = 10) and conducted four focus group discussions with participants in both arms of the trial. Three analysts undertook CFIR theory-driven content analysis of the qualitative data. Quantitative data was analyzed to provide descriptive statistics relevant to the objectives of the process evaluation. Results: The trial had positive implementation outcomes, 100% retention of clusters and 96% retention for participants, 83% adherence to delivery of content of group talks (fidelity), and 78% attendance (reach) to at least 50% (3/6) of the group talks (dose). The data revealed that intervention characteristics, outer setting, inner setting, individual characteristics, and process (all the constructs of CFIR) influenced the implementation. There were more facilitators than barriers to the implementation. Facilitators included the relative advantage of the intervention compared with current practice (intervention characteristics); awareness of the growing prioritization of diabetes in the national health policy framework (outer setting); tension for change due to the realization of the vulnerability to vision loss from DR (inner setting); a strong collective sense of accountability of peer supporters to implement the intervention (individual characteristics); and regular feedback on the progress with implementation (process). Potential barriers included the need to queue at the eye clinic (intervention characteristic), travel inconveniences (inner setting), and socio-political disruption (outer setting). Conclusions: The intervention was implemented with high retention, reach, fidelity, and dose. The CFIR provided a valuable framework for evaluating contextual factors that influenced implementation and helped to understand what adaptations may be needed during scale up.

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Section: Inner Settingmentioning

confidence: 99%

Peer-support to increase uptake of screening for diabetic retinopathy: process evaluation of the DURE cluster randomized trial

et al. 2020

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“…23 Our research partnership between the University College London Institute for Global Health and the Diabetic Association of Bangladesh conducted formative research to inform the development of two interventions that have been evaluated through a three arm cluster randomized controlled trial testing their effectiveness on noncommunicable disease risk factors, including lack of physical activity, overweight and obesity, and intermediate hyperglycaemia and diabetes. 24 One intervention was a mobile health (mHealth) intervention informed by the capability, opportunity, motivation theory of behaviour change (COM-B), 25,26 and the other was a group-based community mobilization intervention using participatory learning and action (PLA) cycles to promote healthy behaviours and transform communities. 27,28 Both approaches (COM-B and PLA) acknowledge the socially constructed nature of behaviours, social constraints on behaviour and the need to address these to enable behaviour change.…”

Section: Gender and Behaviour Changementioning

confidence: 99%

Gendered perceptions of physical activity and diabetes in rural Bangladesh: a qualitative study to inform mHealth and community mobilization interventions

Morrison

Jennings

Akter³

et al. 2019

WHO South-East Asia J Public Health

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Background Diabetes prevalence is increasing rapidly in Bangladesh, and there is an urgent need to promote preventive behaviours for type 2 diabetes, such as maintaining a healthy body weight, eating healthily, avoiding tobacco and being active for 150 minutes per week. Methods We used a qualitative methodology informed by the capability, opportunity, motivation theory of behaviour change to explore the factors affecting physical activity among men and women in rural Bangladesh. We conducted semi-structured interviews and focus group discussions with 64 purposively sampled participants with and without diabetes, and five health workers. From the results of descriptive content analysis, we identified key capabilities, opportunities and motivations to engage with in our mHealth and community mobilization interventions. Results Men and women without diabetes lacked awareness about the need to remain physically active to prevent diabetes, and most felt that their activity levels were sufficient. Housework was not commonly perceived as physical activity among all respondents. These knowledge and capability gaps could be addressed through mHealth messaging and community mobilization providing information on sufficiency and types of physical activity to prevent and control diabetes. Men were physically active while working outside the home, whereas women felt unsafe and conspicuous, and were constrained by family commitments and social expectations of appropriate behaviour. Women engaged in strategies to protect their own and their family's reputations. These opportunity factors affecting physical activity indicated the need for strategies developed through participatory processes to challenge unhealthy gender norms and increase women's safety. Conclusion Formative research data can enable the development of contextually relevant interventions. Data show that mHealth interventions should consider gendered barriers to physical activity, tailoring information to meet men's and women's needs, and that community mobilization interventions should enable unhealthy, gendered community norms to be challenged. Participatory interventions can enable communities to push the boundaries of socially acceptable behaviours to increase physical activity, helping to prevent and control diabetes.

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“…The overall primary outcome of the trial was the reduction in the prevalence of intermediate hyperglycaemia and T2DM and a decrease in the two-year cumulative incidence of T2DM among individuals with intermediate hyperglycaemia [12]. Secondary and explanatory trial outcomes include a range of outcomes related to risk factors, awareness and control of diabetes.…”

Section: Resultsmentioning

confidence: 99%

“…from the formative research as well as the secondary trial outcomes (reported in full elsewhere [12]). Having a clear understanding of the intended consequences of the intervention helped focus the messages of the intervention as well as identify the barriers and enablers to achieving them.…”

Section: Resultsmentioning

confidence: 99%

“…As part of a three-arm cluster randomised trial [12], we set out to develop, implement and evaluate an mHealth intervention aimed at preventing and managing diabetes among the adult population in rural Bangladesh. Our intervention targeted adults aged over 30, and focused on modifiable risk factors relating to diabetes as recommended by the World Health Organisation [9]: care seeking, diet, physical activity, smoking and stress.…”

Section: Diabetes In Bangladeshmentioning

confidence: 99%

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Developing a theory-driven contextually relevant mHealth intervention

Jennings

Morrison

Akter³

et al. 2019

Global Health Action

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Background: mHealth interventions have huge potential to reach large numbers of people in resource poor settings but have been criticised for lacking theory-driven design and rigorous evaluation. This paper shares the process we developed when developing an awareness raising and behaviour change focused mHealth intervention, through applying behavioural theory to in-depth qualitative research. It addresses an important gap in research regarding the use of theory and formative research to develop an mHealth intervention.Objectives: To develop a theory-driven contextually relevant mHealth intervention aimed at preventing and managing diabetes among the general population in rural Bangladesh.Methods: In-depth formative qualitative research (interviews and focus group discussions) were conducted in rural Faridpur. The data were analysed thematically and enablers and barriers to behaviour change related to lifestyle and the prevention of and management of diabetes were identified. In addition to the COM-B (Capability, Opportunity, Motivation-Behaviour) model of behaviour change we selected the Transtheoretical Domains Framework (TDF) to be applied to the formative research in order to guide the development of the intervention.Results: A six step-process was developed to outline the content of voice messages drawing on in-depth qualitative research and COM-B and TDF models. A table to inform voice messages was developed and acted as a guide to scriptwriters in the production of the messages.Conclusions: In order to respond to the local needs of a community in Bangladesh, a process of formative research, drawing on behavioural theory helped in the development of awareness-raising and behaviour change mHealth messages through helping us to conceptualise and understand behaviour (for example by categorising behaviour into specific domains) and subsequently identify specific behavioural strategies to target the behaviour.

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The effect of community groups and mobile phone messages on the prevention and control of diabetes in rural Bangladesh: study protocol for a three-arm cluster randomised controlled trial

Cited by 28 publications

References 37 publications

Peer-support to increase uptake of screening for diabetic retinopathy: process evaluation of the DURE cluster randomized trial

Peer-support to increase uptake of screening for diabetic retinopathy: process evaluation of the DURE cluster randomized trial

Gendered perceptions of physical activity and diabetes in rural Bangladesh: a qualitative study to inform mHealth and community mobilization interventions

Developing a theory-driven contextually relevant mHealth intervention

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