Background
Methods
Study design, setting and recruitment
Intervention program
Sessions | Facilitate by | Content |
---|---|---|
Session 1—Introductory session | K-DPP team | • Program description • Participant handbook distribution • Peer leader selection |
Session 2—Diabetes Prevention Education Session (DPES1) | Expert panel (specialist advisors on diabetes) | • Information on type 2 diabetes mellitus (T2DM) • T2DM risk factors • T2DM management |
Session 3 | Peer leaders | • Setting ground rules • Setting key targets • Self-assessment |
Session 4—(DPES2) | Expert panel | • Modifying the risk factors to prevent T2DM |
Session 5 | Peer leaders | • Goal setting for diet and physical activity |
Session 6 | Peer leaders | • Goal setting for tobacco and alcohol |
Session 7–11 | Peer leaders | • Ongoing goal monitoring • Content review |
Session 12 | Peer leaders | • Interim evaluation of participants’ benefits |
Session 13–14 | Peer leaders | • Ongoing goal monitoring • Content review |
Session 15 | Peer leaders | • Overall program evaluation • Ongoing support |
Ethics approval
Design of the implementation evaluation
Evaluation frameworks
Data collection and analysis
Evaluation measures | Description | Data sources | Collected by | Time points | Data analysis |
---|---|---|---|---|---|
Provider-level factors | |||||
Penetration | Penetration into the target population | Recruitment records | Intervention team | At the beginning of the program | Numerator: # of individuals approached or invited to engage in the program Denominator: # of individuals in the target population |
Implementation | Delivery of intervention components and adherence to intervention protocol | Peer-leader training evaluation questionnaire, attendance sheet and group session reports completed by peer leaders | Peer leaders; and/or intervention team (for attendance) | Training evaluation at the end of the training; Attendance record during each session; and Group session reports at the end of each session | Assessment of intervention components (peer leader training, group sessions, resource material and ongoing support) to ascertain their delivery as planned |
Adoption | Provider-level (setting-level) participation | Group session reports completed by peer leaders | Peer leaders | At the end of each session | Numerator: # of polling areas enrolled in the program Denominator: total number of polling areas randomly selected for inclusion in the program, at the beginning of the program |
Facilitators and barriers | Provider-level facilitators and barriers | Group session reports completed by peer leaders | Peer leaders | At the end of each session | Assessment of facilitators and barriers to intervention delivery |
Participant-level factors | |||||
Reach | Proportion of eligible individuals enrolled in the program | Recruitment records | Intervention team | At the beginning of the program | Numerator: # of participants enrolled in the program Denominator: # of eligible individuals |
Participation | Participants’ attendance in the program | Attendance sheet/recruitment records | Peer leaders and/or intervention team | During each session | Average attendance in 15 group-based sessions |
Participants’ retention in the program | As needed | Numerator: # of participants who provided measurements at 12-months Denominator: # of participants enrolled in the program | |||
Effectiveness | Effectiveness according to primary and secondary outcomes | Clinical measurements records | Intervention team | At baseline, 12 months and 24 months | Numerator: # of participants who developed diabetes at 24 months Denominator: # of individuals who provided measurements at 24 months Changes in clinical and behavioural characteristics from baseline to 12 and/or 24 months. |
Adoption | Participation in goal setting for behaviour change | Intervention participants evaluation questionnaire | Intervention participants | At 12 months | Numerator: # of participants who made change(s) to their lifestyle to meet their goals Denominator: # of participants who set goals for behaviour change Numerator: # of participants who were willing to adhere to the lifestyle change after the intervention Denominator: # of participants who made lifestyle change(s) |
Utilisation of diabetes education resource materials | Numerator: # of participants who utilised the diabetes education resource materials Denominator: # of participants who received the diabetes education resource materials | ||||
Participants’ satisfaction with the program | Participants’ satisfaction with the peer-led groups based on a series of questions asked at the end of 12-months | ||||
Evaluation of control participants | Evaluation of control participants at 12-months | Control participants evaluation questionnaire | Control participants | At 12 months | Participant’s use of health information booklet and behaviour changes made by participants over the duration of the intervention |
Facilitators and barriers | Participant-level facilitators and barriers | Intervention participants evaluation questionnaire | Intervention participants | At 12 months | Assessment of facilitators and barriers to participate in the program |
Community-level factors | |||||
Community activities | Participation in community activities outside group sessions | Intervention participants evaluation questionnaire | Intervention participants | At 12 months | Numerator: # of participants who took part in community activities Denominator: # of participants enrolled in the program |
Community support | Frequency of additional contacts between peer leader and group member and among group members outside the group sessions | Intervention participants evaluation questionnaire | Intervention participants | At 12 months | Numerator: # of participants who contacted their peer leaders/group members outside the group sessions Denominator: # of participants enrolled in the program An average number of contacts made during the intervention. |
Support received during the intervention period from sources other than K-DPP | Numerator: # of participants who received support from other community sources Denominator: # of participants enrolled in the program | ||||
Facilitators and barriers | Community-level facilitators and barriers to participation and/or intervention delivery | Ongoing interactions between peer leaders and the K-DPP intervention team including telephone calls and face-to-face meetings Group session reports completed by peer leaders | Intervention team | Ongoing | Assessment of community-level facilitators and barriers |
Results
Provider-level factors
Penetration
Implementation
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Groups and sessions delivered: Twenty-nine [29] out of 30 intervention groups organised all 15 group-based sessions over the 12 months duration. One group did not participate in an intervention program due to lack of support from the local leadership in organising sessions in the locality. Hence, the group did not continue. The individuals from this group who were interested in participating in the program were then combined with the other neighbouring groups.
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Facilitation style as per protocol: To assess the autonomy supportive behaviours of peer leaders, we asked the group members a set of questions on the perceptions of autonomy support. Reflecting on the group sessions, 78% stated that they were always free to choose the kind of lifestyle changes they wanted to make (and were not being enforced by peer leaders). Seventy-two percent and 21% of the participants stated that their opinions were understood and appreciated in the group from ‘always’ to ‘most of the times’, respectively. More than 90% of participants stated that their peer leaders encouraged them to ask questions in group sessions, understood the way they see their lifestyle and acknowledged the way they wanted to make changes to their lifestyle, without being judgmental.
Adoption (provider-level)
Facilitators and barriers to intervention delivery
Participant-level factors
Reach
Participation
Effectiveness
Adoption (participant-level)
Goal | I have set this goal (N) | Since joining K-DPP, I have made lifestyle changes to achieve this goal (%) | I will continue to make these changes after the intervention | ||
---|---|---|---|---|---|
Very likely (%) | Likely (%) | Not sure (%) | |||
Improving diet | 346 | 99 | 83 | 15 | 2 |
Increasing physical activity | 306 | 96 | 67 | 32 | 1 |
Reducing smoking/tobacco | 51 | 76 | 82 | 18 | – |
Reducing alcohol consumption | 62 | 98 | 56 | 34 | 10 |
Intervention participant’s satisfaction from group sessions
Evaluation of control participants at 12 months
Goal | I have made changes (N) | I will continue to make these changes in future | ||
---|---|---|---|---|
Very likely (%) | Likely (%) | Not likely/not sure (%) | ||
Improving diet | 400 | 95.5 | 4 | 0.5 |
Increasing physical activity | 322 | 97 | 3 | – |
Reducing smoking/tobacco | 57 | 95 | 2 | 3 |
Reducing alcohol consumption | 75 | 81 | 11 | 9 |
Facilitators and barriers to participation
Community-level factors
Other community activities
Community support
Community-level facilitators and barriers
Discussion
Summary of key findings
Key success factors | Need to improve |
---|---|
• Home visits that guaranteed reasonably high reach, made by a trustworthy community-based organisation; • Peer leader training program that was feasible to deliver, easy enough to receive and relatively short but managed to provide skills needed, as perceived by peer leaders and participants; • Educational resource materials were perceived useful and actively used by peer leaders and participants; • Support provided by family and friends; • Involvement of experts to provide information that targeted knowledge gaps that peer leaders and participants also found salient; • K-DPP intervention team’s ongoing support to peer leaders; • Local resource person with a broad role to support peer leaders in practical arrangements as well as link with community; and • Engagement of community organisations and members to practical activities. | • Timing and venue for peer leaders training to increase accessibility; • Timing and location for group sessions, possibility to replace/complement face-to-face meeting with other delivery modes; • Inclusion of additional group activities such as arranging regular physical activity classes for group participants; and • Inclusion of additional sessions from diabetes experts. |