title: Lifestyle change in Kerala, India: needs assessment and planning for a community-based diabetes prevention trial.
abstract: BACKGROUND
  Type 2 Diabetes Mellitus (T2DM) has become a major public health challenge in India. Factors relevant to the development and implementation of diabetes prevention programmes in resource-constrained countries, such as India, have been under-studied. The purpose of this study is to describe the findings from research aimed at informing the development and evaluation of a Diabetes Prevention Programme in Kerala, India (K-DPP).
  
  
  METHODS
  Data were collected from three main sources: (1) a systematic review of key research literature; (2) a review of relevant policy documents; and (3) focus groups conducted among individuals with a high risk of progressing to diabetes. The key findings were then triangulated and synthesised.
  
  
  RESULTS
  Prevalence of risk factors for diabetes is very high and increasing in Kerala. This situation is largely attributable to rapid changes in the lifestyle of people living in this state of India. The findings from the systematic review and focus groups identified many environmental and personal determinants of these unhealthy lifestyle changes, including: less than ideal accessibility to and availability of health services; cultural values and norms; optimistic bias and other misconceptions related to risk; and low expectations regarding one's ability to make lifestyle changes in order to influence health and disease outcomes. On the other hand, there are existing intervention trials conducted in India which suggests that risk reduction is possible. These programmes utilize multi-level strategies including mass media, as well as strategies to enhance community and individual empowerment. India's national programme for the prevention and control of major non-communicable diseases (NCD) also provide a supportive environment for further community-based efforts to prevent diabetes.
  
  
  CONCLUSIONS
  These findings provide strong support for undertaking more research into the conduct of community-based diabetes prevention in the rural areas of Kerala. We aim to develop, implement and evaluate a group-based peer support programme that will address cultural and family determinants of lifestyle risks, including family decision-making regarding adoption of healthy dietary and physical activity patterns. Furthermore, we believe that this approach will be feasible, acceptable and effective in these communities; with the potential for scale-up in other parts of India.
authors: Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India. meenadaivadanam@live.in
authors: Meena
authors: M
authors: Daivadanam
authors: Pilvikki
authors: P
authors: Absetz
authors: Thirunavukkarasu
authors: T
authors: Sathish
authors: K R
authors: KR
authors: Thankappan
authors: Edwin B
authors: EB
authors: Fisher
authors: Neena Elezebeth
authors: NE
authors: Philip
authors: Elezebeth
authors: E
authors: Mathews
authors: Brian
authors: B
authors: Oldenburg
mesh_terms: D003924:Diabetes Mellitus, Type 2 / Q000517:prevention & control*; D017144:Focus Groups; D006285:Health Planning; D006291:Health Policy; D006801:Humans; D007194:India; D008019:Life Style; D020380:Needs Assessment; D016730:Program Development; D015397:Program Evaluation
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