Adapting and scaling a proven diabetes prevention program across 11 worksites in India: the INDIA-WORKS trial

• Type of Material: Article
• Authors: Mary Beth Weber, Emory University; Elizabeth Rhodes, Emory University; Harish Ranjani, Madras Diabetes Research Foundation; Panniyammakal Jeemon, Sree Chitra Tirunal Institute for Medical Sciences and Technology; Mohammed K Ali, Emory University; Monique Marcelle Hennink, Emory University; Ranjit M. Anjana, Madras Diabetes Research Foundation; Viswanathan Mohan, Madras Diabetes Research Foundation; K.M. Venkat Narayan, Emory University; Dorairaj Prabhakaran, Public Health Foundation of India
• Language: English
• Date: 2023-11-13
• Publisher: Springer Nature
• Publication Version: Final Published Version
• Copyright Statement: © 2023, The Author(s)
• License: Creative Commons Attribution 4.0 International
• Final Published Version (URL): https://doi.org/10.1186/s43058-023-00516-1
• Title of Journal or Parent Work: Implementation Science Communications
• Volume: 4
• Start Page: 134
• Grant/Funding Information: The study was supported by funding from the National Heart, Lung, and Blood Institute of the National Institutes of Health under grant R01HL125442. Additional support for ECR was provided by NIH grants D43TW009337 and R25TW009337. Additional support for PJ was provided by Wellcome Trust-DBT India Alliance intermediate (IA/CPHI/14/1/501497) and senior fellowships (IA/CPHS/20/1/505229).
• Keywords: India; Cardiometabolic disease; Prevention; Worksites; Implementation; Structured lifestyle modification; Adaptation; Diabetes; Qualitative research
• Research Categories: Health Sciences, Public Health

Abstract

Background Structured lifestyle change education reduces the burden of cardiometabolic diseases such as diabetes. Delivery of these programs at worksites could overcome barriers to program adoption and improve program sustainability and reach; however, tailoring to the worksite setting is essential. Methods The Integrating Diabetes Prevention in Workplaces (INDIA-WORKS) study tested the implementation and effectiveness of a multi-level program for reducing cardiometabolic disease risk factors at 11 large and diverse worksites across India. Herein, we describe and classify program adaptations reported during in-depth interviews and focus group discussions with worksite managers, program staff, and peer educators involved in program delivery, and program participants and drop-outs. We used thematic analysis to identify key themes in the data and classified reported program adaptations using the FRAME classification system. Results Adaptations were led by worksite managers, peer educators, and program staff members. They occurred both pre- and during program implementation and were both planned (proactive) and unplanned (proactive and reactive). The most frequently reported adaptations to the individual-level intervention were curriculum changes to tailor lessons to the local context, make the program more appealing to the workers at the site, or add a wider variety of exercise options. Other content adaptations included improvements to the screening protocol, intervention scheduling, and outreach plans to tailor participant recruitment and retention to the sites. Environment-level content adaptations included expanding or leveraging healthy food and exercise options at the worksites. Challenges to adaptation included scheduling and worksite-level challenges. Participants discussed the need to continue adapting the program in the future to continue making it relevant for worksite settings and engaging for employees. Conclusion This study describes and classifies site-specific modifications to a structured lifestyle change education program with worksite-wide health improvements in India. This adds to the literature on implementation adaptation in general and worksite wellness in India, a country with a large and growing workforce with, or at risk of, serious cardiometabolic diseases. This information is key for program scale-up, dissemination, and implementation in other settings.