A peer support program results in greater health benefits for peer leaders than other participants: evidence from the Kerala diabetes prevention program.

BACKGROUND: Peer support programs are promising approaches to diabetes prevention. However, there is still limited evidence on the health benefits of peer support programs for lay peer leaders. PURPOSE: To examine whether a peer support program designed for diabetes prevention resulted in greater improvements in health behaviors and outcomes for peer leaders as compared to other participants. METHODS: 51 lay peer leaders and 437 participants from the Kerala Diabetes Prevention Program were included. Data were collected at baseline, 12 months, and 24 months. We compared behavioral, clinical, biochemical, and health-related quality of life parameters between peer leaders and their peers at the three time-points. RESULTS: After 12 months, peer leaders showed significant improvements in leisure time physical activity (+ 17.7% vs. + 3.4%, P = 0.001) and health-related quality of life (0.0 vs. + 0.1, P = 0.004); and a significant reduction in alcohol use (-13.6% vs. -6.6%, P = 0.012) and 2-hour plasma glucose (-4.1 vs. + 9.9, P = 0.006), as compared to participants. After 24 months, relative to baseline, peer leaders had significant improvements in fruit and vegetable intake (+ 34.5% vs. + 26.5%, P = 0.017) and leisure time physical activity (+ 7.9% vs. -0.9%, P = 0.009); and a greater reduction in alcohol use (-13.6% vs. -4.9%, P = 0.008), and waist-to-hip ratio (-0.04 vs. -0.02, P = 0.014), as compared to participants. However, only the changes in fruit and vegetable intake and waist-to-hip ratio were maintained between 12 and 24 months. CONCLUSION: Being a peer leader in a diabetes prevention program was associated with greater health benefits during and after the intervention period. Further studies are needed to examine the long-term sustainability of these benefits.

The long-term effects of Kerala Diabetes Prevention Program on diabetes incidence and cardiometabolic risk: a study protocol.

INTRODUCTION: India currently has more than 74.2 million people with Type 2 Diabetes Mellitus (T2DM). This is predicted to increase to 124.9 million by 2045. In combination with controlling blood glucose levels among those with T2DM, preventing the onset of diabetes among those at high risk of developing it is essential. Although many diabetes prevention interventions have been implemented in resource-limited settings in recent years, there is limited evidence about their long-term effectiveness, cost-effectiveness, and sustainability. Moreover, evidence on the impact of a diabetes prevention program on cardiovascular risk over time is limited. OBJECTIVES: The overall aim of this study is to evaluate the long-term cardiometabolic effects of the Kerala Diabetes Prevention Program (K-DPP). Specific aims are 1) to measure the long-term effectiveness of K-DPP on diabetes incidence and cardiometabolic risk after nine years from participant recruitment; 2) to assess retinal microvasculature, microalbuminuria, and ECG abnormalities and their association with cardiometabolic risk factors over nine years of the intervention; 3) to evaluate the long-term cost-effectiveness and return on investment of the K-DPP; and 4) to assess the sustainability of community engagement, peer-support, and other related community activities after nine years. METHODS: The nine-year follow-up study aims to reach all 1007 study participants (500 intervention and 507 control) from 60 randomized polling areas recruited to the original trial. Data are being collected in two phases. In phase 1 (Survey), we are admintsering a structured questionnaire, undertake physical measurements, and collect blood and urine samples for biochemical analysis. In phase II, we are inviting participants to undergo retinal imaging, body composition measurements, and ECG. All data collection is being conducted by trained Nurses. The primary outcome is the incidence of T2DM. Secondary outcomes include behavioral, psychosocial, clinical, biochemical, and retinal vasculature measures. Data analysis strategies include a comparison of outcome indicators with baseline, and follow-up measurements conducted at 12 and 24 months. Analysis of the long-term cost-effectiveness of the intervention is planned. DISCUSSION: Findings from this follow-up study will contribute to improved policy and practice regarding the long-term effects of lifestyle interventions for diabetes prevention in India and other resource-limited settings. TRIAL REGISTRATION: Australia and New Zealand Clinical Trials Registry-(updated from the original trial)ACTRN12611000262909; India: CTRI/2021/10/037191.

Quality of COVID-19 information, education and communication materials in India: A content analysis.

Objective: This study examined the characteristics and quality of publicly available COVID-19 information education and communication (IEC) materials in India between March and December 2020. Design: An explanatory sequential mixed-method design was employed to examine the characteristics and quality of 265 purposefully selected IEC materials. Setting: The IEC materials analysed were those published between March and December 2020 on the Ministry of Health and Family Welfare website, Government of India. Methods: A checklist was utilised to examine the quality and characteristics of the materials. Thereafter, qualitative analysis provided insights into the contents of the materials with specific focus on the 'COVID-19 continuum of care'. Results: The majority (73.96%, n = 196) of the selected materials were directed towards the general public and had a focus on prevention (67.55 %, n = 179). Despite COVID-19-associated stigma, only 56 (21.13%) of the materials addressed this issue. However, most (95.47%, n = 253) of the materials adhered to quality standards for contents, readability and aesthetics. This qualitative analysis focused on the contents of selected IEC materials using the concept of 'continuum of care'. The analysis identified three important themes: prevention to early diagnosis and treatment; mitigation of stigma and discrimination surrounding COVID-19; and addressing the infodemic caused by COVID-19. Conclusion: The quality of materials was mostly satisfactory and appropriate to the emergent requirements. Strengthening audience engagement and attractiveness of the materials might enhance readability and actionability. A bottom-up approach to the development of future IEC materials, involving the community might widen the coverage of vulnerable populations in future crisis events.

Effects of a lifestyle intervention on depression and anxiety among adults at risk for diabetes in India: A secondary analysis of the Kerala Diabetes Prevention Program.

The impact of lifestyle interventions on diabetes and mental health conditions have been documented among people with diabetes. However, the mental health benefits of lifestyle interventions designed for diabetes prevention have not been systematically investigated among people at high risk of diabetes, particularly in low- and middle-income countries. We examined the effects of a 12-month peer support lifestyle intervention designed for diabetes prevention on depression and anxiety symptomology in the sample population of the Kerala Diabetes Prevention Program. Mixed-effects linear regression models were used to examine the effect of the intervention on depression and anxiety scores at 12 and 24 months in the total sample of 1007 adults at risk for diabetes and among those with mild-severe depressive or anxiety symptoms at baseline (n = 326 for depression; n = 203 for anxiety). Among all participants, the intervention group had a significantly higher reduction of depressive symptoms as compared to the control group at 12 months (mean diff score = -0.51; 95% CI: -0.95, -0.07; P = 0.02). This effect was not sustained at 24 months. There were no significant intervention effects for anxiety. Among those with mild-severe symptoms at baseline, the intervention group had a significantly higher reduction of depressive symptoms (mean diff score = -1.55; 95% CI -2.50, -0.6; P = 0.001) and anxiety symptoms (mean diff score = -1.64; 95% CI -2.76, -0.52; P = 0.004) at 12 months. The effect was sustained at 24 months for depression, but not anxiety. Lifestyle interventions designed for prevention of diabetes might improve depressive and anxiety symptoms in the short-term, particularly among those with mild-severe symptoms.

Effects of a lifestyle intervention on cardiovascular risk among high-risk individuals for diabetes in a low- and middle-income setting: Secondary analysis of the Kerala Diabetes Prevention Program.

We aimed to examine whether a lifestyle intervention was effective in reducing cardiovascular disease (CVD) risk in individuals at high-risk of developing diabetes in a low- and middle-income setting. The Kerala Diabetes Prevention Program was evaluated by a cluster-randomized controlled trial (2013-2016) of 1007 individuals (aged 30-60 years) at high-risk for diabetes (Indian Diabetes Risk Score ≥ 60 and without diabetes) in Kerala state, India. Sixty polling areas in Kerala were randomized to intervention or control groups by an independent statistician using a computer-generated randomization sequence. Participants from 30 intervention communities received a 12-month structured peer-support lifestyle intervention program involving 15 group sessions and linked community activities, aimed at supporting and maintaining lifestyle change. The primary outcome for this analysis was the predicted 10-year CVD risk at two years, assessed using the Framingham Risk Score. The mean age at baseline was 46.0 (SD: 7.5) years, and 47.2% were women. Baseline 10-year CVD risk was similar between study groups. The follow-up rate at two years was 95.7%. The absolute risk reduction in predicted 10-year CVD risk between study groups was 0.69% (95% CI: 0.09% to 1.29%, p=0.024) at one year and 0.69% (95% CI: 0.10% to 1.29%, p=0.023) at two years. The favorable change in CVD risk with the intervention condition was mainly due to the reduction in tobacco use (change index: -0.25, 95% CI: -0.42 to -0.09). Our findings suggest that a community-based peer-support lifestyle intervention could reduce CVD risk in individuals at high-risk of developing diabetes in India. TRIAL REGISTRATION: Australia and New Zealand Clinical Trials Registry ACTRN12611000262909.

Gender differences and barriers women face in relation to accessing type 2 diabetes care: A systematic review.

The objectives of this systematic review were to find out whether gender differences exist in the domain of access to type 2 diabetes care and to identify the barriers faced by women in accessing type 2 diabetes care. A PubMed search was conducted for English articles published between January 01, 2005, and April 30, 2017, that looked into the above-mentioned topics. The search showed 219 articles, which were scrutinized and 21 articles were chosen for final review. Five articles dealt with gender differences, 14 articles dealt with barriers faced by women in accessing type 2 diabetes care and two articles dealt with both aspects. To accomplish the first objective, major areas studied by articles dealing with gender differences in accessing type 2 diabetes care were identified. In each of those areas, articles which reported gender differences were noted. Six out of these seven articles which dealt with gender differences (87%) reported that gender differences were present in the areas of type 2 diabetes care they studied. These articles also reported that women faced more difficulty in accessing type 2 diabetes care. To accomplish the second objective, data from articles dealing with barriers faced by women in accessing type 2 diabetes care were carefully analyzed and potential themes and theme categories were identified. Results showed that women faced personal, sociocultural, health system, economic, psychological, and geographical barriers in accessing type 2 diabetes care. Since this systematic review could identify only limited studies, evidence from more studies would help to confirm and generalize our findings.

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

BACKGROUND: Type 2 diabetes mellitus (T2DM) is now one of the leading causes of disease-related deaths globally. India has the world's second largest number of individuals living with diabetes. Lifestyle change has been proven to be an effective means by which to reduce risk of T2DM and a number of "real world" diabetes prevention trials have been undertaken in high income countries. However, systematic efforts to adapt such interventions for T2DM prevention in low- and middle-income countries have been very limited to date. This research-to-action gap is now widely recognised as a major challenge to the prevention and control of diabetes. Reducing the gap is associated with reductions in morbidity and mortality and reduced health care costs. The aim of this article is to describe the adaptation, development and refinement of diabetes prevention programs from the USA, Finland and Australia to the State of Kerala, India. METHODS: The Kerala Diabetes Prevention Program (K-DPP) was adapted to Kerala, India from evidence-based lifestyle interventions implemented in high income countries, namely, Finland, United States and Australia. The adaptation process was undertaken in five phases: 1) needs assessment; 2) formulation of program objectives; 3) program adaptation and development; 4) piloting of the program and its delivery; and 5) program refinement and active implementation. RESULTS: The resulting program, K-DPP, includes four key components: 1) a group-based peer support program for participants; 2) a peer-leader training and support program for lay people to lead the groups; 3) resource materials; and 4) strategies to stimulate broader community engagement. The systematic approach to adaptation was underpinned by evidence-based behavior change techniques. CONCLUSION: K-DPP is the first well evaluated community-based, peer-led diabetes prevention program in India. Future refinement and utilization of this approach will promote translation of K-DPP to other contexts and population groups within India as well as other low- and middle-income countries. This same approach could also be applied more broadly to enable the translation of effective non-communicable disease prevention programs developed in high-income settings to create context-specific evidence in rapidly developing low- and middle-income countries. TRIAL REGISTRATION: Australia and New Zealand Clinical Trials Registry: ACTRN12611000262909 . Registered 10 March 2011.

Evaluation of a training program of hypertension for accredited social health activists (ASHA) in rural India.

BACKGROUND: Hypertension is a major risk factor for cardiovascular disease, a leading cause of premature death and disability in India. Since access to health services is poor in rural India and Accredited Social Health Activists (ASHAs) are available throughout India for maternal and child health, a potential solution for improving hypertension control is by utilising this available workforce. We aimed to develop and implement a training package for ASHAs to identify and control hypertension in the community, and evaluate the effectiveness of the training program using the Kirkpatrick Evaluation Model. METHODS: The training program was part of a cluster randomised feasibility trial of a 3-month intervention to improve hypertension outcomes in South India. Training materials incorporated details on managing hypertension, goal setting, facilitating group meetings, and how to measure blood pressure and weight. The 15 ASHAs attended a five-day training workshop that was delivered using interactive instructional strategies. ASHAs then led community-based education support groups for 3 months. Training was evaluated using Kirkpatrick's evaluation model for measuring reactions, learning, behaviour and results using tests on knowledge at baseline, post-training and post-intervention, observation of performance during meetings and post-intervention interviews. RESULTS: The ASHAs' knowledge of hypertension improved from a mean score of 64% at baseline to 76% post-training and 84% after the 3-month intervention. Research officers, who observed the community meetings, reported that ASHAs delivered the self-management content effectively without additional assistance. The ASHAs reported that the training materials were easy to understand and useful in educating community members. CONCLUSION: ASHAs can be trained to lead community-based group educational discussions and support individuals for the management of high blood pressure. TRIAL REGISTRATION: The feasibility trial is registered with the Clinical Trials Registry - India (CTRI) CTRI/2016/02/006678 (25/02/2016).

Adapting and Validating the Global Physical Activity Questionnaire (GPAQ) for Trivandrum, India, 2013.

INTRODUCTION: A limitation of the Global Physical Activity Questionnaire (GPAQ) in assessing physical activity in India is that it does not capture the diversity of activities across cultures and by sex. The purpose of this study was to culturally adapt and validate the GPAQ by using an accelerometer in Thiruvananthapuram City, India. METHODS: We developed a modified version of the GPAQ by adding a physical activity chart specific to the locale. We identified local physical activities through in-depth interviews, group discussions, and observation, and used Actigraph GT3X accelerometers to validate the modified GPAQ for a subsample of 47 women. Participants were drawn from a cross-sectional survey of 1,303 women aged 18 to 64 years, selected by multistage cluster sampling. Spearman rank correlation coefficients and intraclass correlation coefficients (ICC) were calculated to determine the correlation and level of agreement in moderate-to-vigorous physical activity (MVPA) on the basis of accelerometer measurement and the modified GPAQ. RESULTS: The correlation for MVPA between the modified GPAQ (overall) and the accelerometer (non-bouted MVPA) was 0.69 (95% confidence interval [CI], 0.39-0.85) with a moderately high ICC of 0.78 (95% CI, 0.56-0.90). The correlation for MVPA between the modified GPAQ and the accelerometer-based MVPA within bouts of at least 10 minutes was 0.60 (95% CI, 0.26-0.80) with an ICC of 0.55 (95% CI, 0.20-0.77) indicating a moderate level of agreement. CONCLUSION: The GPAQ can be used for assessing physical activity among women in India, and its adaptation and validation may be useful in other low-income or middle-income countries where activities are diverse in type and intensity.

Self-reported physical activity and its correlates among adult women in the expanded part of Thiruvananthapuram City, India.

Data on correlates of physical activity (PA) are limited in India. This study estimated the prevalence and correlates of PA among women. A cross-sectional survey was conducted among 1303 women (mean age 45 years) selected by multistage cluster sampling. Information was collected using a pretested interview schedule. Multivariate logistic regression analysis was used to determine the correlates of PA. Self-reported moderate or high level PA prevalence was 73.4% [95% confidence interval (CI); 71.1-75.9]. Women who perceived themselves as being underweight [odds ratio (OR) 3.68: 1.97-6.74]; had an exercising member in the household (OR 3.41: 2.52-4.66); had access to exercise facilities (OR 2.17: 1.63-2.95); were married (OR 2.14: 1.40-3.25), were in the age group of 35-54 years (OR 1.91: 1.32-2.63); reported having knowledge about the benefits of PA (OR 1.62: 1.13-2.25); and who reported having the support of friends and neighbors (OR 1.42: 1.05-2.01) were more likely to report PA than their counterparts.

Country actions to meet UN commitments on non-communicable diseases: a stepwise approach.

Strong leadership from heads of state is needed to meet national commitments to the UN political declaration on non-communicable diseases (NCDs) and to achieve the goal of a 25% reduction in premature NCD mortality by 2025 (the 25 by 25 goal). A simple, phased, national response to the political declaration is suggested, with three key steps: planning, implementation, and accountability. Planning entails mobilisation of a multisectoral response to develop and support the national action plan, and to build human, financial, and regulatory capacity for change. Implementation of a few priority and feasible cost-effective interventions for the prevention and treatment of NCDs will achieve the 25 by 25 goal and will need only few additional financial resources. Accountability incorporates three dimensions: monitoring of progress, reviewing of progress, and appropriate responses to accelerate progress. A national NCD commission or equivalent, which is independent of government, is needed to ensure that all relevant stakeholders are held accountable for the UN commitments to NCDs.

Voices of care: unveiling patient journeys in primary care for hypertension and diabetes management in Kerala, India.

Background: Diabetes and hypertension are leading public health problems, particularly affecting low- and middle-income countries, with considerable variations in the care continuum between different age, socio-economic, and rural and urban groups. In this qualitative study, examining the factors affecting access to healthcare in Kerala, we aim to explore the healthcare-seeking pathways of people living with diabetes and hypertension. Methods: We conducted 20 semi-structured interviews and one focus group discussion (FGD) on a purposive sample of people living with diabetes and hypertension. Participants were recruited at four primary care facilities in Malappuram district of Kerala. Interviews were transcribed and analyzed deductively and inductively using thematic analysis underpinned by Levesque et al.'s framework. Results: The patient journey in managing diabetes and hypertension is complex, involving multiple entry and exit points within the healthcare system. Patients did not perceive Primary Health Centres (PHCs) as their initial points of access to healthcare, despite recognizing their value for specific services. Numerous social, cultural, economic, and health system determinants underpinned access to healthcare. These included limited patient knowledge of their condition, self-medication practices, lack of trust/support, high out-of-pocket expenditure, unavailability of medicines, physical distance to health facilities, and attitude of healthcare providers. Conclusion: The study underscores the need to improve access to timely diagnosis, treatment, and ongoing care for diabetes and hypertension at the lower level of the healthcare system. Currently, primary healthcare services do not align with the "felt needs" of the community. Practical recommendations to address the social, cultural, economic, and health system determinants include enabling and empowering people with diabetes and hypertension and their families to engage in self-management, improving existing health information systems, ensuring the availability of diagnostics and first-line drug therapy for diabetes and hypertension, and encouraging the use of single-pill combination (SPC) medications to reduce pill burden. Ensuring equitable access to drugs may improve hypertension and diabetes control in most disadvantaged groups. Furthermore, a more comprehensive approach to healthcare policy that recognizes the interconnectedness of non-communicable diseases (NCDs) and their social determinants is essential.

The shifting roles of community health workers in the prevention and management of Noncommunicable disease during COVID-19 Pandemic: A scoping review.

Community Health Workers (CHWs) play a crucial role in the prevention and management of noncommunicable diseases (NCDs). The COVID-19 pandemic triggered the implementation of crisis-driven responses that involved shifts in the roles of CHWs in terms of delivering services for people with NCDs. Strategically aligning these shifts with health systems is crucial to improve NCD service delivery. The aim of this review was to identify and describe COVID-19-triggered shifting roles of CHWs that are promising in terms of NCD service delivery. We searched Ovid Medline, Embase, CINAHL, Web of Science, and CABI for Global Health for relevant articles published between Jan 1, 2020, and Feb 22, 2022. Studies that were conducted within a COVID-19 context and focused on the shifted roles of CHWs in NCD service delivery were included. We used PRISMA guidelines to report the findings. A total of 25 articles from 14 countries were included in this review. We identified 12 shifted roles of CHWs in NCD service delivery during COVID-19, which can be categorised in three dimensions: enhanced role of CHWs that include additional tasks such as medication delivery, extended roles such as the delivery of NCD services at household level and in remote communities; and enabled roles through the use of digital health technologies. Health and digital literacy of people with NCDs, access to internet connectivity for people with NCDs and the social and organizational context where CHWs work influenced the implementation of the shifted roles of CHWs. In conclusion, the roles of CHWs have shifted during COVID-19 pandemic to include the delivery additional NCD services at home and community levels, often supported by digital technologies. Given the importance of the shifting roles in the prevention and management of NCDs, adaptation and integration of these shifted roles into the routine activities of CHWs in the post-COVID period is recommended.

Prevalence of Brugada electrocardiographic pattern in adult population - A community-based study from Kerala, South India.

There is no data for Brugada electrocardiographic pattern (BrEP) from India. In a cross-sectional study of men and women between the ages 20-79 years, electrocardiograms were analyzed following the 2002 consensus. The overall prevalence of BrEP was 1.06 % (95 % CI 0.76, 1.35). There were two cases type I (0.04 %; 95 % CI 0.01, 0.06) and forty-seven type II/III (1.01 %; 95 % CI 1.02, 1.35); the pattern was markedly higher in men. In this study, BrEP was slightly less prevalent compared to South Asia but more than in the west.

Cluster randomised controlled trial of a peer-led lifestyle intervention program: study protocol for the Kerala diabetes prevention program.

BACKGROUND: India currently has more than 60 million people with Type 2 Diabetes Mellitus (T2DM) and this is predicted to increase by nearly two-thirds by 2030. While management of those with T2DM is important, preventing or delaying the onset of the disease, especially in those individuals at 'high risk' of developing T2DM, is urgently needed, particularly in resource-constrained settings. This paper describes the protocol for a cluster randomised controlled trial of a peer-led lifestyle intervention program to prevent diabetes in Kerala, India. METHODS/DESIGN: A total of 60 polling booths are randomised to the intervention arm or control arm in rural Kerala, India. Data collection is conducted in two steps. Step 1 (Home screening): Participants aged 30-60 years are administered a screening questionnaire. Those having no history of T2DM and other chronic illnesses with an Indian Diabetes Risk Score value of ≥60 are invited to attend a mobile clinic (Step 2). At the mobile clinic, participants complete questionnaires, undergo physical measurements, and provide blood samples for biochemical analysis. Participants identified with T2DM at Step 2 are excluded from further study participation. Participants in the control arm are provided with a health education booklet containing information on symptoms, complications, and risk factors of T2DM with the recommended levels for primary prevention. Participants in the intervention arm receive: (1) eleven peer-led small group sessions to motivate, guide and support in planning, initiation and maintenance of lifestyle changes; (2) two diabetes prevention education sessions led by experts to raise awareness on T2DM risk factors, prevention and management; (3) a participant handbook containing information primarily on peer support and its role in assisting with lifestyle modification; (4) a participant workbook to guide self-monitoring of lifestyle behaviours, goal setting and goal review; (5) the health education booklet that is given to the control arm. Follow-up assessments are conducted at 12 and 24 months. The primary outcome is incidence of T2DM. Secondary outcomes include behavioural, psychosocial, clinical, and biochemical measures. An economic evaluation is planned. DISCUSSION: Results from this trial will contribute to improved policy and practice regarding lifestyle intervention programs to prevent diabetes in India and other resource-constrained settings. TRIAL REGISTRATION: Australia and New Zealand Clinical Trials Registry: ACTRN12611000262909.

Screening performance of diabetes risk scores among Asians and whites in rural Kerala, India.

We compared the screening performance of risk scores for Asians and whites for diabetes, dysglycemia, and metabolic syndrome. Our subjects were 451 people aged 15 to 64 years who participated in a cohort study from May 2003 through September 2010 in a rural area of the Thiruvananthapuram district of Kerala, India. All outcome measures showed overlap in the range of area under the receiver operating characteristic curves of Asian and white diabetes risk scores (DRSs). Asian and white DRSs performed similarly in rural India.

Prevalence, awareness, treatment, control and correlates of prevalence and control of hypertension among older adults in Kerala: A mixed methods study.

INTRODUCTION: We conducted this study among older adults with the following objectives: (1) To find out the prevalence, awareness, treatment and control of hypertension, (2) To understand the factors associated with hypertension prevalence and control. METHODS: A mixed-methods study employing a sequential explanatory design was conducted with a survey of 300 participants aged ≥60 years, and 15 in-depth interviews. Blood Pressure (BP) and waist circumference were measured using standard protocol. Survey data were analysed using univariate and multivariate procedures. In-depth interviews were analysed employing thematic analysis. RESULTS: Hypertension prevalence was 72.3% (95% CI = 67.1-77.2), 68.2% (CI = 61.8-74.2) were aware, 65.4% (CI = 59.0-71.6) were treated and 24% (CI = 18.6-29.9) achieved adequate control. Inadequate physical activity [(adjusted odds ratio (AOR)] = 2.34; CI = 1.19-4.59), current alcohol use (AOR = 2.28; CI = 1.06-4.91) and self-reported diabetes (AOR = 2.02; CI = 1.15-3.52) were associated with hypertension prevalence. Those who reported diabetes (AOR = 2.72, CI = 1.34-5.55), with education level up to high school (AOR = 2.58, CI = 1.11-6.00) and who were in the age group 60-70 years (AOR = 2.14, CI = 1.09-4.20) were more likely to have controlled hypertension compared to their counterparts. From the in-depth interviews it was found that availability and accessibility of services, family support, financial wellbeing, habits and beliefs and conducive environment played a role in hypertension diagnosis and management. DISCUSSION: Prevalence of hypertension was high in this population along with poor control. Efforts are required to improve hypertension control focussing on older adults with low education and those who are aged 70 years and above.

Depressive Disorders and Associated Factors among Farmers in Andhra Pradesh: Results from a Cross-Sectional Study.

Background: In the two decades from 1995 to 2018, approximately 48 farmers committed suicide every day, accounting for over 0.4 million deaths. Despite farmer's mental health being a priority, studies on farmers' mental health in general and depressive disorders in particular are limited. Aim: This study was conducted to find out the prevalence and factors associated with depressive disorders among farmers in Andhra Pradesh. Materials and Methods: We conducted a cross-sectional survey among a random sample of 360 farmers. Depressive disorders were measured using the Patient Health Questionnaire (PHQ)-9. Mild-to-moderate depressive disorders were the outcome variable. Factors associated with depressive disorders were identified using binary logistic regression. Results: The overall prevalence of depressive disorders was 22.2% (95% CI = 18.0%-26.9%). Female farmers (AOR = 4.16; 95% CI = 1.19-14.57), farmers aged ≥57 years (AOR = 4.90; 95% CI = 1.44-16.63), and single farmers (AOR = 4.96; 95% CI = 2.08-11.80) have greater odds of having depressive disorders. Conclusion: Efforts are required to address depressive disorders among farmers focusing on females, older farmers, and households reporting hospitalization. Since depressive disorders are closely associated with suicide attempts, these efforts are essential to avoid suicides resulting from depressive disorders.

Chewing tobacco use among pregnant women in India: Analysis of national family health surveys.

BACKGROUND: India accounts for over 67% of chewing tobacco users globally and more than 50 million women in India chew tobacco. Chewing tobacco is documented to have negative effects on health of mother and foetus. This research was conducted to study the trends in chewing tobacco use among pregnant women in India, and identify factors associated with chewing tobacco use among pregnant women. METHODS: We analyzed micro-data from two representative national surveys i.e., National Family Health Survey (NFHS)-4 (2015-16) & NFHS-5 (2019-21). A sample of 32,428 & 28,408 pregnant women were extracted from NFHS-4 & NFHS-5 respectively. Weighted prevalence and 95% confidence levels of chewing tobacco use were computed. State wide comparisons in chewing tobacco use were made. Employing binary logistic regression, adjusted odds ratios (AOR) were computed to identify factors associated with chewing tobacco use. RESULTS: From NFHS-4 to 5 the prevalence of chewing tobacco use among pregnant women decreased from 4.0%(95% CI = 3.9-4.0) to 2.3%(95% CI = 2.2-2.4) respectively indicating a relative reduction of 42.5%. The highest prevalence remains to be in north-eastern India at 13.0%. Belonging to north-eastern region AOR = 7.0(95 %CI = 6.2-7.9), no-education AOR = 13.2(95 %CI = 10.5-16.5), poorest wealth index AOR = 6.7(95 %CI = 5.6-8.0) and belonging to scheduled tribe AOR = 2.6(95 %CI = 2.4-2.9) was significantly associated with chewing tobacco use among pregnant women. CONCLUSION: From NFHS-4 to 5, chewing tobacco use during pregnancy has shifted more towards socio-economically vulnerable population. Targeted approaches with accessible and affordable tobacco cessation advice integrated to primary healthcare system are needed.

How WhatsApp is transforming health communication among frontline health workers: a mixed-method study among midwives in India.

BACKGROUND: Limited literature exists in India on WhatsApp use for health communication among frontline health workers like Auxiliary Nurse Midwives (ANM). We conducted this study to assess the adoption of WhatsApp among ANMs and identify factors influencing its adoption. In addition, the study explored the perceptions of ANMs on WhatsApp use for sharing health information. METHODS: We employed a mixed-method sequential explanatory design. We surveyed 259 ANMs, followed by in-depth interviews with 19 purposively sampled ANMs. We conducted multinomial logistic regression to identify factors associated with WhatsApp adoption and employed thematic analysis to analyze interviews. RESULTS: 257 ANMs responded to the survey questionnaire, of which 18.3%, 48.2%, and 33.5% had low, mid, and high levels of WhatsApp adoption, respectively. Education (AOR = 2.87 [95% CI = 1.20-6.85]), motivation (AOR = 6.31 [95% CI = 1.43-27.80]), and technical awareness (AOR = 2.91 [95% CI = 1.11-7.62]) were significantly associated with WhatsApp adoption. Thematic analysis of the interviews resulted in six themes describing perceptions and experiences of ANMs on WhatsApp use. They are: (i) a way of instant communication, (ii) provision for multimedia messaging, (iii) a quick fix tool for queries and concerns, (iv) make attendance and reporting easy (v) a way of reaching higher officials, and (vi) a cost-saving mechanism. CONCLUSION: WhatsApp facilitated ANMs' communication and service delivery at the grassroots level. Measures to improve motivation, technical awareness, and digital education will likely improve WhatsApp adoption among health workers.