title: Culturally adapting the prevention of diabetes and obesity in South Asians (PODOSA) trial.
abstract: Type 2 diabetes is extremely common in South Asians, e.g. in men from Pakistani and Indian populations it is about three times as likely as in the general population in England, despite similarities in body mass index. Lifestyle interventions reduce the incidence of diabetes. Trials in Europe and North America have not, however, reported on the impact on South Asian populations separately or provided the details of their cross-cultural adaptation processes. Prevention of diabetes and obesity in South Asians (PODOSA) is a randomized, controlled trial in Scotland of an adapted, lifestyle intervention aimed at reducing weight and increasing physical activity to reduce type 2 diabetes in Indians and Pakistanis. The trial was adapted from the Finnish Diabetes Prevention Study. We describe, reflect on and discuss the following key issues: The core adaptations to the trial design, particularly the delivery of the intervention in homes by dietitians rather than in clinics. The use of both a multilingual panel and professional translators to help translate and/or develop materials. The processes and challenges of phonetic translation. How intervention resources were adapted, modified, newly developed and translated into Urdu and Gurmukhi (written Punjabi). The insights gained in PODOSA (including time pressures on investigators, imperfections in the adaptation process, the power of verbal rather than written information, the utilization of English and the mother-tongue languages simultaneously by participants and the costs) might help the research community, given the challenge of health promotion in multi-ethnic, urban societies.
authors.affiliation: Edinburgh Ethnicity and Health Research Group, Centre for Population Health Sciences, The University of Edinburgh, Medical School, Teviot Place, Edinburgh EH8 9AG, UK.
authors.forename: S
authors.initials: S
authors.lastname: Wallia
authors.affiliation: Edinburgh Ethnicity and Health Research Group, Centre for Population Health Sciences, The University of Edinburgh, Medical School, Teviot Place, Edinburgh EH8 9AG, UK raj.bhopal@ed.ac.uk.
authors.forename: R S
authors.initials: RS
authors.lastname: Bhopal
authors.affiliation: Edinburgh Ethnicity and Health Research Group, Centre for Population Health Sciences, The University of Edinburgh, Medical School, Teviot Place, Edinburgh EH8 9AG, UK.
authors.forename: A
authors.initials: A
authors.lastname: Douglas
authors.affiliation: Edinburgh Ethnicity and Health Research Group, Centre for Population Health Sciences, The University of Edinburgh, Medical School, Teviot Place, Edinburgh EH8 9AG, UK.
authors.forename: R
authors.initials: R
authors.lastname: Bhopal
authors.affiliation: Edinburgh Ethnicity and Health Research Group, Centre for Population Health Sciences, The University of Edinburgh, Medical School, Teviot Place, Edinburgh EH8 9AG, UK.
authors.forename: A
authors.initials: A
authors.lastname: Sharma
authors.affiliation: Edinburgh Ethnicity and Health Research Group, Centre for Population Health Sciences, The University of Edinburgh, Medical School, Teviot Place, Edinburgh EH8 9AG, UK.
authors.forename: A
authors.initials: A
authors.lastname: Hutchison
authors.affiliation: Edinburgh Ethnicity and Health Research Group, Centre for Population Health Sciences, The University of Edinburgh, Medical School, Teviot Place, Edinburgh EH8 9AG, UK.
authors.forename: G
authors.initials: G
authors.lastname: Murray
authors.affiliation: Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow G128QQ, UK.
authors.forename: J
authors.initials: J
authors.lastname: Gill
authors.affiliation: Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow G128QQ, UK.
authors.forename: N
authors.initials: N
authors.lastname: Sattar
authors.affiliation: Edinburgh Ethnicity and Health Research Group, Centre for Population Health Sciences, The University of Edinburgh, Medical School, Teviot Place, Edinburgh EH8 9AG, UK.
authors.forename: J
authors.initials: J
authors.lastname: Lawton
authors.affiliation: South Ostrobothnia Central Hospital, 60220 Seinäjoki, Finland Centre for Vascular Prevention, Danube-University Krems, 3500 Krems, Austria.
authors.forename: J
authors.initials: J
authors.lastname: Tuomilehto
authors.affiliation: Metabolic Unit, Anne Ferguson Building, Western General Hospital, Crewe Road, Edinburgh EH4 2XU, UK.
authors.forename: J
authors.initials: J
authors.lastname: Mcknight
authors.affiliation: Edinburgh Ethnicity and Health Research Group, Centre for Population Health Sciences, The University of Edinburgh, Medical School, Teviot Place, Edinburgh EH8 9AG, UK.
authors.forename: J
authors.initials: J
authors.lastname: Forbes
authors.affiliation: Centre for Population & Health Sciences, University of Glasgow, Glasgow, UK.
authors.forename: M
authors.initials: M
authors.lastname: Lean
authors.affiliation: Edinburgh Ethnicity and Health Research Group, Centre for Population Health Sciences, The University of Edinburgh, Medical School, Teviot Place, Edinburgh EH8 9AG, UK.
authors.forename: A
authors.initials: A
authors.lastname: Sheikh
mesh_terms: D015992:Body Mass Index; D003469:Culture; D003924:Diabetes Mellitus, Type 2 / Q000208:ethnology* / Q000517:prevention & control*; D004032:Diet; D015444:Exercise; D015438:Health Behavior; D006266:Health Education / Q000458:organization & administration; D006293:Health Promotion / Q000458:organization & administration*; D006801:Humans; D007194:India / Q000208:ethnology; D008019:Life Style; D064686:Nutritionists / Q000458:organization & administration; D009765:Obesity / Q000208:ethnology* / Q000517:prevention & control*; D010154:Pakistan / Q000208:ethnology; D012307:Risk Factors; D012606:Scotland / Q000453:epidemiology; D012959:Socioeconomic Factors; D014177:Translations
keywords: South Asians; cultural adaptation; diabetes prevention; lifestyle modification