Kerala, India: Peer-Led Lifestyle Intervention for Diabetes Prevention
Clayton Velicer, MPH
Diabetes in India
India has more than 60 million people with Type 2 diabetes, a number predicted to increase by nearly two-thirds by 2030. While improving self-management for those already with diabetes in India is extremely important, preventing or delaying the onset of diabetes for those at high risk is critical in a resource-constrained setting. Adapted from successful community-based programs in Australia and Finland, the Kerala Diabetes Prevention Program (K-DPP) is a peer-led group based lifestyle intervention, aimed at these high risk individuals in rural India. The protocol for this program was developed with the assistance of Peers for Progress Global Director Ed Fisher and Professor Brian Oldenburg, formerly at Monash University.
Peer-Led Small Groups & Education Sessions
This program is designed to improve behavioral, psychosocial, clinical, and biochemical measures of participants at a high-risk for developing diabetes compared to a control group at 24 months. The program participants were recruited from 60 randomly selected polling booths in the state of Kerala and assigned in clusters to receive either the intervention or a control condition that included delivery of a health education booklet, a copy of their blood pressure and biochemical measurements, and a recommendation to consult a healthcare provider if they had abnormal readings. The first wave of data was collected at the participants’ home with subsequent testing completed at mobile clinics.
The intervention has 4 main components:
Peer-Led small group sessions – Group sessions are held bi-weekly for the first 4 months of the study and monthly for the last 8. During these sessions, the group members set behavior goals and SMART (Specific, Measurable, Attainable, Relevant and Time-Bound) objectives, discuss topics including diet, exercise, tobacco cessation, and identify community resources.
Diabetes Prevention Education Sessions – Two education sessions feature specialist advisors in the nutrition, physical activity, and diabetes. The first education session, held within two weeks of the first group session, briefs participants on ways in which the intervention and peer support will help them break the chain of disease for themselves and their family members.
Resource materials for participants – All participants are given a handbook containing information about peer support, objectives and benefits of the small group meetings, risk factors for Type 2 diabetes and guides for the topics covered in the small group sessions. Participants also receive the same education booklet provided to those in the control group. Peer leaders receive cups and spoons to show participants how to measure different kinds of food.
Training and supervision for intervention delivery – Peer leader training was conducted prior to the group session. This 2-day course trained leaders in lifestyle behaviors, goal-setting, group facilitation, and communication skills. Peer leaders also receive instruction on how to document their sessions and their interactions with participants. From the supervisory side, peer leaders are contacted by telephone before and after each session to go over materials and how the program is progressing. Face-to-face meetings are also held at regular intervals to ensure ongoing supervisory support.
Aligned to the 4 Key Functions of Peer Support
It is important to note how closely this intervention aligns with Peers for Progress’s best practices for peer support, specifically, the 4 key functions of peer support.
Assistance in daily management – This is a focus of both the peer leader training and the small group sessions. The peer leader and participant workbooks provide additional resources for daily management on topics like nutrition, exercise, and goal-setting.
Social and Emotional Support – This support is provided to the participants in the group sessions by both other group members and the peer leaders. The peer leaders themselves receive emotional and social support from the intervention team through telephone contacts and face-to-face meetings.
Linkage to Clinical Care and Community Resources – Intervention staff promote community resources and provide assistance to obtain clinical care. The Diabetes Prevention Education Sessions provide a forum for participants to ask questions and learn about resources from experts in diabetes, exercise, and nutrition.
Ongoing Support – Groups have regular contact on a bi-weekly / monthly basis, and participants receive support between sessions. Peer leaders receive ongoing support from the intervention staff, which are able to provide additional resources to groups as issues arise throughout the program.
If this program maintains fidelity to these key functions, we expect to see a significant impact on the health of the communities in Kerala. The success of this program will provide a model of peer support for diabetes prevention that can be disseminated throughout India.
Peers for Progress is dedicated to accelerating the availability of best practices in peer support around the world. This mission began with 14 projects funded by Peers for Progress around the world including 6 short-term projects (Demonstration Grants) and 8 long-term projects (Evaluation Grants). Since this initial funding, the Peers for Progress global network has grown to include other peer support programs and communities around the world. We frequently highlight these programs as part of our monthly newsletters and here on the blog.