title: A community-based participatory diabetes prevention and management intervention in rural India using community health workers.
abstract: OBJECTIVE
  The purpose of this study was to test the effectiveness of a 6-month community-based diabetes prevention and management program in rural Gujarat, India.
  
  
  METHODS
  A community-based participatory research method was used to plan and tailor the intervention by engaging trained community health workers as change agents to provide lifestyle education, serve as community advocates, and collect data from 1638 rural Indians (81.9% response rate). Ten culturally and linguistically appropriate health education messages were provided in face-to-face individual and group sessions (demonstrations of model meals and cooking techniques).
  
  
  RESULTS
  Mean age was 41.9 ± 15.9 years. Overall point prevalence of diabetes, prediabetes, obesity, and hypertension were 7.2%, 19.3%, 16.7%, and 28%, respectively, with significant differences between the low socioeconomic status (SES) participants (agricultural workers) and the high SES participants (business community) due to differing diet and activity levels. The intervention significantly reduced blood glucose levels by 5.7 and 14.9 mg/dL for individuals with prediabetes and diabetes, respectively, and systolic and diastolic blood pressure by 8 mm Hg and 4 mm Hg, respectively, in the overall population. Knowledge of diabetes and cardiovascular disease improved by 50% in the high SES group and doubled in the low SES group; general and abdominal obesity also decreased by ≤ 1%. High rates of undiagnosed hypertension (26.1%) were surprising. Among individuals with diabetes, metabolic complications such as diabetic nephropathy and chronic kidney disease were noted.
  
  
  CONCLUSIONS
  Through collective engagement of the community, participatory programs can serve as a prototype for future prevention and management efforts, which are rare and underutilized in India.
authors.affiliation: Manor College & Consultant Early Intervention, United States.
authors.forename: Padmini
authors.initials: P
authors.lastname: Balagopal
authors.forename: N
authors.initials: N
authors.lastname: Kamalamma
authors.forename: Thakor G
authors.initials: TG
authors.lastname: Patel
authors.forename: Ranjita
authors.initials: R
authors.lastname: Misra
mesh_terms: D000328:Adult; D055812:Community-Based Participatory Research; D003924:Diabetes Mellitus, Type 2 / Q000453:epidemiology / Q000517:prevention & control*; D004032:Diet; D005260:Female; D005500:Follow-Up Studies; D006266:Health Education / Q000379:methods* / Q000458:organization & administration / Q000639:trends; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D006973:Hypertension / Q000453:epidemiology / Q000517:prevention & control; D007194:India / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009043:Motor Activity; D009765:Obesity / Q000453:epidemiology / Q000517:prevention & control*; D010353:Patient Education as Topic / Q000379:methods; D011236:Prediabetic State / Q000453:epidemiology / Q000517:prevention & control; D015995:Prevalence; D011322:Primary Prevention / Q000379:methods / Q000458:organization & administration / Q000639:trends; D015397:Program Evaluation; D012189:Retrospective Studies; D040242:Risk Reduction Behavior; D019035:Rural Health Services / Q000458:organization & administration; D012424:Rural Population / Q000706:statistics & numerical data*; D012923:Social Class; D014029:Tobacco Use Disorder / Q000453:epidemiology / Q000517:prevention & control