title: 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.
abstract: Increasing rates of type 2 diabetes mellitus place a substantial burden on health care services, communities, families and individuals living with the disease or at risk of developing it. Estimates of the combined prevalence of intermediate hyperglycaemia and diabetes in Bangladesh vary, and can be as high as 30% of the adult population. Despite such high prevalence, awareness and control of diabetes and its risk factors are limited. Prevention and control of diabetes and its complications demand increased awareness and action of individuals and communities, with positive influences on behaviours and lifestyle choices. In this study, we will test the effect of two different interventions on diabetes occurrence and its risk factors in rural Bangladesh.
  
  
  
  A three-arm cluster randomised controlled trial of mobile health (mHealth) and participatory community group interventions will be conducted in four rural upazillas in Faridpur District, Bangladesh. Ninety-six clusters (villages) will be randomised to receive either the mHealth intervention or the participatory community group intervention, or be assigned to the control arm. In the mHealth arm, enrolled individuals will receive twice-weekly voice messages sent to their mobile phone about prevention and control of diabetes. In the participatory community group arm, facilitators will initiate a series of monthly group meetings for men and women, progressing through a Participatory Learning and Action cycle whereby group members and communities identify, prioritise and tackle problems associated with diabetes and the risk of developing diabetes. Both interventions will run for 18 months. The primary outcomes of the combined prevalence of intermediate hyperglycaemia and diabetes and the cumulative 2-year incidence of diabetes among individuals identified as having intermediate hyperglycaemia at baseline will be evaluated through baseline and endline sample surveys of permanent residents aged 30 years or older in each of the study clusters. Data on blood glucose level, blood pressure, body mass index and hip-to-waist ratio will be gathered through physical measurements by trained fieldworkers. Demographic and socioeconomic data, as well as data on knowledge of diabetes, chronic disease risk factor prevalence and quality of life, will be gathered through interviews with sampled respondents.
  
  
  
  This study will increase our understanding of diabetes and other non-communicable disease burdens and risk factors in rural Bangladesh. By documenting and evaluating the delivery, impact and cost-effectiveness of participatory community groups and mobile phone voice messaging, study findings will provide evidence on how population-level strategies of community mobilisation and mHealth can be implemented to prevent and control noncommunicable diseases and risk factors in this population.
  
  
  
  ISRCTN41083256 . Registered on 30 Mar 2016 (Retrospectively Registered).
  
  
  
  D-Magic: Diabetes Mellitus - Action through Groups or mobile Information for better Control.
authors.affiliation: Institute for Global Health, University College London, London, UK. e.fottrell@ucl.ac.uk.
authors.forename: Edward
authors.identifier: 0000-0003-0518-7161
authors.initials: E
authors.lastname: Fottrell
authors.affiliation: Institute for Global Health, University College London, London, UK.
authors.forename: Hannah
authors.initials: H
authors.lastname: Jennings
authors.affiliation: Diabetic Association of Bangladesh, Dhaka, Bangladesh.
authors.forename: Abdul
authors.initials: A
authors.lastname: Kuddus
authors.affiliation: Diabetic Association of Bangladesh, Dhaka, Bangladesh.
authors.forename: Naveed
authors.initials: N
authors.lastname: Ahmed
authors.affiliation: Institute for Global Health, University College London, London, UK.
authors.forename: Joanna
authors.initials: J
authors.lastname: Morrison
authors.affiliation: Diabetic Association of Bangladesh, Dhaka, Bangladesh.
authors.forename: Kohenour
authors.initials: K
authors.lastname: Akter
authors.affiliation: Diabetic Association of Bangladesh, Dhaka, Bangladesh.
authors.forename: Sanjit Kumar
authors.initials: SK
authors.lastname: Shaha
authors.affiliation: Diabetic Association of Bangladesh, Dhaka, Bangladesh.
authors.forename: Badrun
authors.initials: B
authors.lastname: Nahar
authors.affiliation: Diabetic Association of Bangladesh, Dhaka, Bangladesh.
authors.forename: Tasmin
authors.initials: T
authors.lastname: Nahar
authors.affiliation: Institute for Global Health, University College London, London, UK.
authors.forename: Hassan
authors.initials: H
authors.lastname: Haghparast-Bidgoli
authors.affiliation: Diabetic Association of Bangladesh, Dhaka, Bangladesh.
authors.forename: A K Azad
authors.initials: AK
authors.lastname: Khan
authors.affiliation: Institute for Global Health, University College London, London, UK.|World Health Organisation, Geneva, Switzerland.
authors.forename: Anthony
authors.initials: A
authors.lastname: Costello
authors.affiliation: Diabetic Association of Bangladesh, Dhaka, Bangladesh.
authors.forename: Kishwar
authors.initials: K
authors.lastname: Azad
mesh_terms: D001459:Bangladesh / Q000453:epidemiology; D040421:Cell Phone; D003153:Community Health Services; D019033:Delivery of Health Care, Integrated; D003924:Diabetes Mellitus, Type 2 / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy*; D005260:Female; D006126:Group Processes; D015438:Health Behavior; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D015994:Incidence; D007407:Interviews as Topic; D008297:Male; D010353:Patient Education as Topic; D015995:Prevalence; D012107:Research Design; D019035:Rural Health Services; D012648:Self Care; D017216:Telemedicine / Q000295:instrumentation*; D060145:Text Messaging / Q000295:instrumentation*; D013997:Time Factors; D016896:Treatment Outcome
keywords: Cluster randomised trial; Community mobilisation; Diabetes; Intermediate hyperglycaemia; Non-communicable disease; mHealth