Evaluation of community-based interventions for non-communicable diseases: experiences from India and Indonesia

Abstract

This paper reports the results of formative and outcome evaluation of two ongoing community-based intervention programmes for integrated non-communicable disease (NCD) prevention and control in urban low-income settings of Ballabgarh near New Delhi, India, and in Depok, West Java Province of Indonesia. At both sites, a coalition of community members facilitated by academic institution and the World Health Organization, planned and implemented the intervention since 2004. The intervention consisted of advocacy and mediation with stakeholders, training of volunteers and school teachers, communication campaigns, risk assessment camps and reorientation of health services. The formative evaluation was based on the review of documents, and outcomes were assessed using the standardized surveys for NCD risk factors in 2003-2004 and 2006-2007. The baseline surveys showed that tobacco use, low intake of fruits and vegetable, suboptimal levels of physical activity and obesity were prevalent in both the communities. A frequent change in local administrators and lack of perceived priority for health and NCDs limited their involvement. Pre-existing engagement of community-based organizations and volunteers in health activities facilitated its implementation. The reach of the programme among the population was modest (25-32%). Health system interventions resulted in increased diagnosis and better management of NCDs at health facilities. Early outcome measures showed mixed results of change in different risk factors. The experiences gained are being used in both countries to expand and provide technical support to national efforts. This paper adds to the knowledge base on the feasibility of designing and implementing large-scale community-based interventions for integrated prevention of NCDs through modification of risk factors.

How is Indonesia coping with its epidemic of chronic noncommunicable diseases? A systematic review with meta-analysis

“…However, while there has been a steady increase in citations using quantitative methods since 2000, it is only in recent years (2010 onwards) that qualitative studies on NCDs have emerged. Of the 130 included citations, nine used qualitative research designs [52, 59, 74, 77, 88, 92, 93, 100, 117], two utilized mixed methodologies [47, 113], and seven focused on the project design or evaluation of risk factor interventions or NCD prevention [30, 51, 57, 61, 65, 78, 86]. Ten of the citations were based on gray reports [134–143].…”

“…On the basis of deductive content analysis, the 130 included citations were grouped into seven topic areas: (1) risk factors, (2) morbidity, (3) functional limitations and disability, (4) mortality, (5) disease management, (6) interventions, prevention and management, and (7) social determinants of health; an overview of this is provided in Fig 2. A final quantitative synthesis meta-analyzed a subset of 12 studies related to the most common NCD risk factors: smoking (n = 7) [28, 40, 46, 65, 99, 101, 123], hypertension (n = 5) [28, 40, 46, 65, 134], and obesity (n = 7) [15, 28, 35, 46, 65, 67, 119]. Readers please note that a citation could belong to more than one topic area.…”

“…Seventy-three citations focused on behavioral (tobacco smoking, alcohol consumption, physical inactivity, unhealthy diet) and biological (overweight/obesity, hypertension) risk factors for NCDs [14, 15, 18–24, 26–29, 31, 33, 35, 37, 40, 42–50, 53, 60, 62, 64, 65, 67–71, 79, 80, 84, 85, 89, 96–99, 101, 102, 104, 111, 112, 117, 119, 122, 123, 125, 126, 128–140, 142, 143, 155]. …”

Cultural adaptation of a peer-led lifestyle intervention program for diabetes prevention in India: the Kerala diabetes prevention program (K-DPP)

“…These were corroborated from other studies in India [50][51][52][53][54][55][56]. In order to link with the needs of the broader community, each peer support group was encouraged to identify prevention activities that might engage other individuals in their community.…”

Public policy, health system, and community actions against illness as platforms for response to NCDs in Tanzania: a narrative review

“…This involvement has also been recommended in the Tanzania HSSP III as an objective in the NCD control strategy (7). Since community responses, including lifestyle changes, are shaped by sociocultural aspects and health system factors, effective mitigation of NCDs will therefore have to integrate community-based and individually targeted interventions (79) that are sensitive to variations in gender and cultural norms, for them to be acceptable (80). …”