Publication:

Enhancing diabetes and hypertension management in rural India through a peer support program: evaluating a community-based intervention using RE-AIM framework

Background The health care system in India lacks an approach targeting individual risk behavior change and self-care practices. Thus, it is imperative to complement the healthcare system's efforts with alternative care management strategies at the grassroots. This paper aims to evaluate the utility of a community-based peer support program facilitated by trained volunteers to better manage diabetes and hypertension in rural areas of Karnataka state, India.

Methods A semi-structured peer support group approach called Swasthya Samithi (SS) and capacity-building activities empower patients with diabetes and/or hypertension, caregivers, and community health workers for better chronic care management through the ACE-ME program. Glasgow's RE-AIM framework assessed reach, feasibility, and effectiveness. A structured questionnaire based on WHO's STEPS tool, standardized scales, and qualitative checklists (Mixed-method approach) were used to collect data on program processes, output/outcome variables like lifestyle behavior, self-care practices, and clinical values.

Results The program reached 98% of the intended participants along with the non-patient community members. A total of 56 SS meetings were facilitated. Improved lifestyle behavior with reduction in use of tobacco, alcohol, consumption of processed food and significant improvement in self-care practices affirmed that the program was effective. Metabolic control of disease improved from 27% to 42% and 54% to 76% amongst the participants with diabetes and hypertension, respectively.

Conclusion The active engagement of participants and the capacity building of local health workers were key to the program's significant success, and the implementation experiences of the ACE-ME model provide pragmatic insights for its expansion in similar contexts.