The effect of youths as change agents on cardiovascular disease risk factors among adult neighbours: a cluster randomised controlled trial in Sri Lanka

Abstract

Background Mobilising non-professional health workers has been successful in improving community health, but the effectiveness of an education program targeting youths in a community-based approach remains unclear. The objective of this study was to investigate the effect of an intervention with youth on cardiovascular disease risk factors of community adults. Methods A 12-month cluster randomised trial was conducted in a semi-urban area of Colombo in Sri Lanka. Facilitators trained youth club members aged 15–29 years to assess cardiovascular disease risk factors and take actions in the community to address relevant issues. The control group received no intervention. Body weight and blood pressure as primary outcomes and lifestyle of adults as secondary outcomes were measured pre- and post-intervention. Multilevel linear and logistic regressions were used to assess the effects of the intervention on changes in continuous and binary outcomes, respectively, from baseline to endpoint. Results Of 512 participants at baseline, 483 completed the final assessment after the intervention. Regarding primary outcomes, the intervention group showed a significantly greater decrease in body weight after intervention than the control group. The mean (95% confidence interval) difference of body weight change for intervention versus control group was − 2.83 kg (− 3.31, − 2.35). There was no statistically significant difference in blood pressure between the two groups. Turning to the secondary outcomes, in diet, the intervention group had a higher probability of consuming at least one serving/day of fruits ( p = 0.02) and a lower probability of consuming snacks twice/day or more ( p < 0.001) than the control group. Conclusions An intervention employing youths as change agents was effective in lowering body weight among community adults in Sri Lanka. Trial registration Trial registration number: SLCTR/2017/002 , Name of registry: Sri Lanka Clinical Trials Registry, Date of registration: 19th January 2017, Date of enrolment of the first participant to the trial: 1st February 2017. Electronic supplementary material The online version of this article (10.1186/s12889-019-7142-1) contains supplementary material, which is available to authorized users.

Trends in body mass index among ever-married Bangladeshi women, 2004–14: evidence from nationally representative population-based surveys

“…The present study also observed that middle women aged (between 30 and 40 years) have relatively higher BMI than younger women. Thus, the community-level promotion of healthy lifestyles behaviours, especially among women aged in their 30's, could help to halt the rise of the overnutrition and obesity (43,44) .…”

Healthy lifestyle index and its association with hypertension among community adults in Sri Lanka: A cross-sectional study

“…Data for the present study were derived from a cluster randomized controlled trial that examined the effect of health-promoting activities by trained youth club members on CVD risk among community adults in a semi-urban area of Colombo, Sri Lanka [20]. To recruit study participants, we randomly selected 24 Grama Niladari (GN) divisions, i.e., the rural level administrative division in the country [21].…”

“…We defined non-smokers as the low-risk group, including never and former smokers, and the high-risk group as current smokers [24]. The low-risk group for alcohol consumption was defined as �2 drinks/day for men and �1 drink/day for women based on the Dietary Guidelines in the United States [25], which was also referred in the above-mentioned intervention study in Sri Lanka [20]. Food-based dietary guidelines for Sri Lankans recommend consuming 2-3 servings/day of fruits and 3-5 servings/day of vegetables [26].…”

Community-Based Interventions for Cardiovascular Disease Prevention in Low-and Middle-Income Countries: A Systematic Review

“…One study was conducted in Kenya in sub-Saharan Africa [ 32 ] and another in three countries, China, India and Mexico [ 55 ]. Of the remaining studies, seven were from India [ 33 – 37 , 43 , 55 ], five from China [ 46 – 50 ], and two from Iran [ 26 , 30 ], Pakistan [ 38 , 39 ] and Sri Lanka [ 42 , 44 ]. Bangladesh [ 40 ], Grenada [ 54 ], Malaysia [ 51 ], Nepal [ 56 ], Thailand [ 53 ], Russia [ 52 ] and Vietnam [ 41 ] each had a single study.…”

“…Nine studies were cluster randomized controlled trials [ 33 , 34 , 39 , 40 , 42 – 45 , 56 ], eight were randomized controlled trials [ 35 – 37 , 46 , 48 , 50 , 53 , 54 ] and ten were controlled before and after studies [ 26 , 30 , 32 , 38 , 41 , 47 , 49 , 51 , 52 , 55 ]. Studies were carried out in different contexts; eight in urban [ 30 , 32 , 36 , 37 , 39 , 48 , 50 , 56 ], three in semi-urban [ 42 , 44 , 51 ], eight in rural [ 33 , 35 , 40 , 41 , 43 , 45 , 49 , 53 ] and two in both rural and urban areas [ 26 , 38 ]. In six studies, the context was unclear [ 34 , 46 , 47 , 52 , 54 , 55 ].…”