Exploring Community Acceptability in Diabetes Prevention for South Asian Indians: A Qualitative Study Open Access

Abstract

Diabetes has been quietly raging the globe, affecting 415 million worldwide in 2015 – a number expected to rise to 642 million by 2040 (Unnikrishnan et al., 2017). With a snowballing prevalence rate, the threat of life-altering diabetic complications from undetected or untreated diabetes, and many unsolved healthcare access barriers for underserved and low-income populations, diabetes remains a key non-communicable disease of public health interest. Amid India’s increasingly industrialized economy and transitions in nutritional status, South Asians develop diabetes at younger ages and have increased glucose tolerance as well as lower criteria for central obesity compared to Europeans (Hu 2011) (Chowdhury et al., 2003). There is currently a lack of research on culturally relevant diabetes prevention for South Asian Indians. In 2016, clinically overweight South Asians in Chennai, India with prediabetes enrolled in the Diabetes Community Lifestyle Improvement Program (D-CLIP) study. A follow-up qualitative study was conducted with former D-CLIP participants to gain participant feedback and to gauge participants’ perceptions of D-CLIP. Findings from this study will pinpoint motivators, facilitators, and barriers to lifestyle change to help explore phenomena related to health behavior change and engagement with the D-CLIP intervention. This research will provide recommendations for fostering community acceptability, long-term dissemination, and sustainability for future lifestyle intervention programs for South Asian communities and future diabetes prevention efforts. Community-raised and -based recommendations for effective diabetes prevention is needed to fill the gap in diabetes burden for South Asian Indians. 

Table of Contents

INTRODUCTION 1 

PROBLEM STATEMENT 1 

SIGNIFICANCE OF THE STUDY 2 

AIMS OF THE STUDY 4 

Research Question 5 

Frequently Used Words 5 

II. BACKGROUND 6 

DIABETES AND PREDIABETES IN INDIA 6 

STUDIES EXAMINING DIABETES AWARENESS IN SOUTH INDIA 9 

PREVIOUS LIFESTYLE INTERVENTION PROGRAM (LIP) STUDIES 11 

U.S. Diabetes Prevention Program (DPP) 12 

Challenges Facing Lifestyle Intervention Studies 13 

THE PRESENT STUDY 16 

The Diabetes Community Lifestyle Improvement Program (D-CLIP) 16 

Gaps to Be Addressed 17 

III. METHODS 18 

POPULATION AND SAMPLE 18 

RESEARCH DESIGN 18 

PROCEDURES 18 

INSTRUMENTS 19 

DATA ANALYSIS 19 

Coding 19 

Preparing for Analysis 21 

Analysis 22 

ETHICAL CONSIDERATIONS 23 

LIMITATIONS 23 

IV. RESULTS 25 

FACTORS INFLUENCING DECISION TO ENROLL IN AND ENGAGE WITH D-CLIP 25 

Participant Acquisition 25 

Pre-D-CLIP Perceptions and Awareness about Health 29 

FACILITATORS AND BARRIERS TO MAKING INITIAL HEALTH BEHAVIOR CHANGES 31 

Perceptions about D-CLIP After Attending Intervention 31 

FACILITATORS AND BARRIERS TO MAINTAINING HEALTHY BEHAVIOR CHANGES 37 

Lifestyle Challenges 37 

Program Materials 40 

ADDITIONAL FINDINGS 41 

SUMMARY 44 

V. DISCUSSION 45 

OVERVIEW OF RESULTS 45 

DISCUSSION OF KEY RESULTS 46 

Population Misconceptions about Diabetes 46 

Benefits of Culture-Specific Recommendations for Behavior Change 48 

Relationship between Behavior Change and Feelings of Self-Efficacy, Empowerment, and Personal Responsibility 52 

Family Support 55 

Helpful When Intervention Cognizant of Time Burden 57 

STRENGTHS AND WEAKNESSES OF ANALYSIS 59 

Strengths 59 

Weaknesses 59 

PUBLIC HEALTH IMPLICATIONS 60 

Battle Population Misconceptions about Diabetes Through Community Initiatives 60 

Support Health Behavior Change by Promoting Positivity, Self-Efficacy, and Ownership over Behavior Change 62 

Provide Culturally Relevant Intervention Strategies 65 

Family Support is Helpful to Behavior Change 66 

FUTURE DIRECTIONS 67 

Innovate D&E Recommendations to Reduce Time Burden 67 

Address Barriers Unique to Women 68 

Account for Within-Group Differences 69 

Modify Public Infrastructure to Accommodate Moderate Walking 71 

CONCLUSION 72 

VI. REFERENCES 73 

About this Master's Thesis

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School	Rollins School of Public Health
Department	Hubert Department of Global Health
Degree	M.P.H.
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health
Keyword	empowerment community acceptability D-CLIP diabetes and diet diabetes and physical exercise barriers to healthy behavior facilitators to healthy behavior lifestyle intervention program South Asian Indians diabetes prevention health behavior change Chennai
Committee Chair / Thesis Advisor	Weber, Mary Beth, Emory University

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