scholarly journals Adapting the Diabetes Prevention Program for low- and middle-income countries: preliminary implementation findings from lifestyle Africa

2020 ◽  
Vol 10 (1) ◽  
pp. 46-54
Author(s):  
Delwyn Catley ◽  
Thandi Puoane ◽  
Kathy Goggin ◽  
Lungiswa P Tsolekile ◽  
Ken Resnicow ◽  
...  
Keyword(s):  
Chronic Disease ◽  
Prevention Program ◽  
Diabetes Prevention ◽  
Diabetes Prevention Program ◽  
Text Messages ◽  
Adaptation Process ◽  
Middle Income ◽  
Middle Income Countries ◽  
Advisory Boards ◽  
Low And Middle Income

Abstract Rates of cardiovascular disease and diabetes are rising in low- and middle-income countries (LMIC), but there is a dearth of research devoted to developing and evaluating chronic disease interventions in these settings, particularly in Africa. Lifestyle Africa is a novel, culturally adapted version of the Diabetes Prevention Program (DPP) being evaluated in an ongoing community-based cluster-randomized trial in an underresourced urban community in South Africa. The purpose of this study is to describe the adaptations and adaptation process used to develop the program and to report preliminary implementation findings from the first wave of groups (n = 11; 200 individuals) who participated in the intervention. The RE-AIM model and community advisory boards guided the adaptation process. The program was designed to be delivered by community health workers (CHWs) through video-assisted sessions and supplemented with text messages. Participants in the trial were overweight and obese members of existing chronic disease “support groups” served via CHWs. Implementation outcomes included completion of sessions, session attendance, fidelity of session delivery, and participant satisfaction. Results indicated that 10/11 intervention groups completed all 17 core sessions. Average attendance across all sessions and groups was 54% and the percentage who attended at least 75% of sessions across all groups was 35%. Fidelity monitoring indicated a mean of 84% of all required procedures were completed while overall communication skills were rated as “good" to “excellent”. These preliminary results support the feasibility of culturally adapting the DPP for delivery by CHWs in underresourced settings in LMIC.

scholarly journals Adapting the Diabetes Prevention Program for low and middle-income countries: protocol for a cluster randomised trial to evaluate ‘Lifestyle Africa’

BMJ Open ◽  
2019 ◽  
Vol 9 (11) ◽  
pp. e031400 ◽  
Author(s):  
Delwyn Catley ◽  
Thandi Puoane ◽  
Lungiswa Tsolekile ◽  
Ken Resnicow ◽  
Kandace Fleming ◽  
...  
Keyword(s):  
South Africa ◽  
Usual Care ◽  
Community Health ◽  
Prevention Program ◽  
Diabetes Prevention ◽  
Cape Town ◽  
Diabetes Prevention Program ◽  
Middle Income ◽  
Middle Income Countries ◽  
Cluster Randomised

IntroductionLow and middle-income countries like South Africa are experiencing major increases in burden of non-communicable diseases such as diabetes and cardiovascular conditions. However, evidence-based interventions to address behavioural factors related to these diseases are lacking. Our study aims to adapt the CDC’s National Diabetes Prevention Program (DPP) within the context of an under-resourced urban community in Cape Town, South Africa.Methods/analysisThe new intervention (Lifestyle Africa) consists of 17 weekly sessions delivered by trained community health workers (CHWs). In addition to educational and cultural adaptations of DPP content, the programme adds novel components of text messaging and CHW training in Motivational Interviewing. We will recruit overweight and obese participants (body mass index ≥25 kg/m2) who are members of 28 existing community health clubs served by CHWs. In a 2-year cluster randomised control trial, clubs will be randomly allocated to receive the intervention or usual care. After year 1, usual care participants will also receive the intervention and both groups will be followed for another year. The primary outcome analysis will compare percentage of baseline weight loss at year 1. Secondary outcomes will include diabetes and cardiovascular risk indicators (blood pressure, haemoglobin A1C, lipids), changes in self-reported medication use, diet (fat and fruit and vegetable intake), physical activity and health-related quality of life. We will also assess potential psychosocial mediators/moderators as well as cost-effectiveness of the programme.Ethics/disseminationEthical approval was obtained from the University of Cape Town and Children’s Mercy. Results will be submitted for publication in peer-reviewed journals and training curricula will be disseminated to local stakeholders.Trial registration numberNCT03342274.

scholarly journals Leveraging Telemedicine for Chronic Disease Management in Low- and Middle-Income Countries During Covid-19

Global Heart ◽  
2020 ◽  
Vol 15 (1) ◽  
Author(s):  
Michael A. Hoffer-Hawlik ◽  
Andrew E. Moran ◽  
Daniel Burka ◽  
Prabhdeep Kaur ◽  
Jun Cai ◽  
...  
Keyword(s):  
Chronic Disease ◽  
Disease Management ◽  
Chronic Disease Management ◽  
Middle Income ◽  
Middle Income Countries ◽  
Low And Middle Income

Impact of a Digital Diabetes Prevention Program on Risk Factors for Chronic Disease in a Workforce Cohort

2020 ◽  
Vol 62 (12) ◽  
pp. 1040-1045
Author(s):  
Charles E. Birse ◽  
Dov Shiffman ◽  
Anita Satish ◽  
Maren S. Fragala ◽  
Andre R. Arellano ◽  
...  
Keyword(s):  
Risk Factors ◽  
Chronic Disease ◽  
Prevention Program ◽  
Diabetes Prevention ◽  
Diabetes Prevention Program

scholarly journals Addressing cost and time barriers in chronic disease management through telemedicine: an exploratory research in select low- and middle-income countries

2019 ◽  
Vol 10 ◽  
pp. 204062231989158 ◽  
Author(s):  
Saleem Sayani ◽  
Momina Muzammil ◽  
Karima Saleh ◽  
Abdul Muqeet ◽  
Fabiha Zaidi ◽  
...  
Keyword(s):  
Chronic Disease ◽  
Cost Savings ◽  
Economic Benefits ◽  
P Value ◽  
Middle Income ◽  
Low Resource ◽  
Middle Income Countries ◽  
Disease Outcomes ◽  
Significant Difference ◽  
Low And Middle Income

Background: Despite evidence supporting telehealth provision in developed countries, there is limited evidence regarding its economic benefits for patients living in areas where access and cost present major barriers to health care, particularly in low- and middle-income countries (LMICs). This study explores the economic benefits of telemedicine for patients, in terms of cost and times savings, and its potential role in improving chronic disease outcomes. Methods: This retrospective cross-sectional study compared telemedicine services with hypothetical in-person consultations, with a focus on patient travel time and travel cost savings. A database containing teleconsultation visits ( N = 25,182) conducted at health facilities in remote regions of Afghanistan, Pakistan, Tajikistan, and the Kyrgyz Republic, was analyzed. A two-sample homoscedastic t test was used to determine differences between the two groups. A one-way sensitivity analysis was also conducted, presuming in-person teleconsultations at 90%, 75%, and 50%. Results: The study extracted data from 25,182 teleconsultation visits (12,814 males; 12,368 females). The cumulative patient savings through the program amounted to USD 9,175,132, and 1,876,146 h, or 213.1 years. A significant difference was seen between the two groups in terms of mean time savings ( p-value <0.05), and a nearly significant difference was observed in terms of mean cost savings ( p-value = 0.05). Conclusions: This study suggests that considerable economic benefits imparted to patients in low-resource settings of LMICs via accessing telemedicine. Telemedicine has great potential to improve chronic disease outcomes in low-resource areas by reducing socioeconomic barriers related to cost and access, and increasing uptake of services, thereby enabling early intervention and long-term management.

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