Equity impact of participatory learning and action community mobilisation and mHealth interventions to prevent and control type 2 diabetes and intermediate hyperglycaemia in rural Bangladesh: analysis of a cluster randomised controlled trial

Abstract

BackgroundA cluster randomised trial of mHealth and participatory learning and action (PLA) community mobilisation interventions showed that PLA significantly reduced the prevalence of intermediate hyperglycaemia and type 2 diabetes mellitus (T2DM) and the incidence of T2DM among adults in rural Bangladesh; mHealth improved knowledge but showed no effect on glycaemic outcomes. We explore the equity of intervention reach and impact.MethodsIntervention reach and primary outcomes of intermediate hyperglycaemia and T2DM were assessed through interview surveys and blood fasting glucose and 2-hour oral glucose tolerance tests among population-based samples of adults aged ≥30 years. Age-stratified, gender-stratified and wealth-stratified intervention effects were estimated using random effects logistic regression.ResultsPLA participants were similar to non-participants, though female participants were younger and more likely to be married than female non-participants. Differences including age, education, wealth and marital status were observed between individuals exposed and those not exposed to the mHealth intervention.PLA reduced the prevalence of T2DM and intermediate hyperglycaemia in all age, gender and wealth strata. Reductions in 2-year incidence of T2DM of at least 51% (0.49, 95% CI 0.26 to 0.92) were observed in all strata except among the oldest and least poor groups. mHealth impact on glycaemic outcomes was observed only among the youngest group, where a 47% reduction in the 2-year incidence of T2DM was observed (0.53, 95% CI 0.28 to 1.00).ConclusionLarge impacts of PLA across all strata indicate a highly effective and equitable intervention. mHealth may be more suitable for targeting higher risk, younger populations.Trial registration numberISRCTN41083256.

Analyzing the Effect of Telemedicine on Domains of Quality Through Facilitators and Barriers to Adoption: Systematic Review

“…As these were the result of a thematic analysis, there are cases of multiple observations of the same theme in the same article; therefore, the frequency may not have aligned with the number of references. Of the 92, there were 31 (34%) instances of an increase in physical health [ 30 , 33 , 39 - 42 , 44 , 47 , 49 , 51 - 55 , 57 , 58 ]. This theme included maximum oxygen consumption, comparison of bad cholesterol with good cholesterol, pain, diastolic blood pressure, systolic blood pressure, hypoglycemia, lipids, overall blood pressure, average blood sugar over last 3 months, physical function, fasting blood glucose, cholesterol, and BMI.…”

“…A total of 24 studies reported on satisfaction. Of the 33 studies, 22 (67%) reported satisfaction or high satisfaction [ 28 - 36 , 39 , 40 , 42 - 44 , 46 - 48 , 50 , 56 - 59 ], 2 (6%) reported dissatisfaction [ 38 , 45 ], and 9 (27%) did not report satisfaction or dissatisfaction [ 37 , 41 , 49 , 51 - 55 , 60 ].…”

“…All these 33 studies reported the positive effectiveness of telemedicine as a modality across all 6 domains of quality. These studies showed positive outcomes in physical [ 30 , 33 , 39 - 42 , 44 , 47 , 49 , 51 - 55 , 57 , 58 ] and mental health [ 31 , 32 , 37 , 39 , 43 , 45 , 47 , 54 , 57 ], medical engagement [ 28 , 30 , 32 , 35 , 36 , 40 , 43 , 46 , 48 , 60 ], changed behavior [ 29 , 32 , 34 , 50 , 53 , 55 , 56 , 58 - 60 ], increased QoL [ 31 , 36 , 37 , 39 - 41 , 45 , 54 , 56 , 57 , 59 , 60 ], increased self-efficacy [ 28 , 35 , 36 , 41 , 47 ], increased social support [ 28 , 32 ], and reduced costs [ 34 ].…”

Stakeholder perceptions on scaling-up community-led interventions for prevention and control of non-communicable diseases in Bangladesh: a qualitative study

“…Communities implemented strategies which addressed barriers to physical activity for women, they sought community-based blood glucose testing through village doctors, and made home visits to promote healthy eating and tobacco reduction [ 10 , 11 ]. The intervention was effective in reducing the incidence and prevalence of T2DM amongst all wealth groups and was cost effective [ 6 , 12 ]. Given the success of the intervention, further research is required to test the intervention at scale and explore with stakeholders how it could be effectively scaled-up and integrated into existing policies and plans.…”

Scoping review of community health participatory research projects in Ghana

“…Examples of the use of CHPR include a social psychology of participation applied to ‘diagnosing’ the social reality of cardiovascular diseases and exploring the development of community-centred interventions in Accra, Ghana [ 8 ] and a participatory learning and action (PLA) intervention to address T2DM in rural Bangladesh [ 9 ]. In the Bangladesh study, there was a large reduction in the combined prevalence of T2DM and intermediate hyperglycaemia in the PLA group compared with the control group [ 9 ] and participation in the intervention and its impact were found to be equitable [ 10 ]. A participatory approach has also been successfully used in Zimbabwe, where a community-based mental health intervention, proposed by community stakeholders, resulted in an improvement in symptoms [ 11 ].…”