The Community Health Assessment Program in the Philippines (CHAP-P) diabetes health promotion program for low- to middle-income countries: study protocol for a cluster randomized controlled trial

Gina Agarwal, Ricardo N Angeles, Lisa Dolovich, Janusz Kaczorowski, Jessica Gaber, Dale Guenter, Floro Dave Arnuco, Hilton Y Lam, Lehana Thabane, Daria O'Reilly, Rodelin M Agbulos, Rosemarie S Arciaga, Jerome Barrera, Elgie Gregorio, Servando Halili Jr, Norvie Jalani, Fortunato Cristobal, Gina Agarwal, Ricardo N Angeles, Lisa Dolovich, Janusz Kaczorowski, Jessica Gaber, Dale Guenter, Floro Dave Arnuco, Hilton Y Lam, Lehana Thabane, Daria O'Reilly, Rodelin M Agbulos, Rosemarie S Arciaga, Jerome Barrera, Elgie Gregorio, Servando Halili Jr, Norvie Jalani, Fortunato Cristobal

Abstract

Background: Type 2 diabetes is increasing globally, with the highest burden in low- to middle-income countries (LMICs) such as the Philippines. Developing effective interventions could improve detection, prevention, and treatment of diabetes. The Cardiovascular Health Awareness Program (CHAP), an evidence-based Canadian intervention, may be an appropriate model for LMICs due to its low cost, ease of implementation, and focus on health promotion and disease prevention. The primary aim of this study is to adapt the CHAP model to a Philippine context as the Community Health Assessment Program in the Philippines (CHAP-P) and evaluate the effect of CHAP-P on glycated hemoglobin (HbA1c) compared to a random sample of community residents in control communities.

Methods: Six-month, 26-community (13 intervention, 13 control) parallel cluster randomized controlled trial in Zamboanga Peninsula, an Administrative Region in the southern Philippines. Criteria for community selection include: adequate political stability, connection with local champions, travel feasibility, and refrigerated space for materials. The community-based intervention, CHAP-P sessions, are volunteer-led group sessions with chronic condition assessment, blood pressure monitoring, and health education. Three participant groups will be involved: 1) Random sample of community participants aged 40 or older, 100 per community (1300 control, 1300 intervention participants total); 2) Community members aged 40 years or older who attended at least one CHAP-P session; 3) Community health workers and staff facilitating sessions.

Primary outcome: mean difference in HbA1c at 6 months in intervention group individuals compared to control.

Secondary outcomes: modifiable risk factors, health utilization and access (individual); diabetes detection and management (cluster). Evaluation also includes community process evaluation and cost-effectiveness analysis.

Discussion: CHAP has been shown to be effective in a Canadian setting. Individual components of CHAP-P have been piloted locally and shown to be acceptable and feasible. This study will improve understanding of how best to adapt this model to an LMIC setting, in order to maximize prevention, detection, and management of diabetes. Results may inform policy and practice in the Philippines and have the potential to be applied to other LMICs.

Trial registration: ClinicalTrials.gov ( NCT03481335 ), registered March 29, 2018.

Keywords: Cluster randomized trial; Diabetes mellitus; Disease prevention; Health promotion; Hypertension; Low- to middle-income countries (LMICs); Philippines.

Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Overview of the CHAP-P Research Program
Fig. 2
Fig. 2
PRECIS Diagram
Fig. 3
Fig. 3
CHAP-P Intervention

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