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Table 2 Major findings from the pilot phase and modifications made to the Kerala Diabetes Prevention Program

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

Identified challenge Strategies adopted Modifications made
Low education level of the participants. The majority of the participants (n = 18) had no formal education, with the highest level of education being 11 years of schooling. Simplify intervention materials to assist understanding of individuals with lower literacy levels. Intervention materials were modified with additional pictures to support understanding of text-based information. Additional group-based activities were planned to be incorporated into the sessions to facilitate story-telling and oral language based learning.
Low participation level of male participants. Recruit male peer-leaders that can encourage male participants to attend. Ensure sessions are run during convenient times for working males. Male peer-leaders were recruited in addition to the female peer-leaders. Sessions were organised during the evening and on weekends to enhance male participation.
Perceived relevance of T2DM prevention, with priority given to control and management of T2DM A strong link between prevention and disease management needed to be established to make the program relevant for the participants. Program content (intervention materials and sessions) needed to be modified to sensitize participants on the need for diabetes prevention amongst themselves and their families and to include information on diabetes management. More community awareness on prevention programs was required. An additional educational session, Diabetes Prevention Education Session (DPES 1), was incorporated into the program. DPES 1 provided an introduction to understanding Type 2 diabetes and its risk factors. This session stressed the similarity of strategies for primary and secondary prevention, and addressed misconceptions and role of lifestyle modification. The original diabetes education session became a sequel to DPES 1. This session, DPES 2, focused on the modifiable risk factors for diabetes prevention. The session took a deeper view on the specifics of healthy lifestyle behaviors, diet, physical inactivity, tobacco and importance of sleep. We also included “Diabetes Management” as an additional topic into the small group sessions to link diabetes management with prevention strategies, and thereby to increase perceived relevance of the program among participants.