Currently submitted to: JMIR Research Protocols
Date Submitted: Aug 4, 2026
Open Peer Review Period: Aug 4, 2026 - Sep 29, 2026
(currently open for review)
Warning: This is an author submission that is not peer-reviewed or edited. Preprints - unless they show as "accepted" - should not be relied on to guide clinical practice or health-related behavior and should not be reported in news media as established information.
Engagement of Community Through Participatory Learning and Action for the Prevention and Control of Type 2 Diabetes and Related Risk Factors in Rural Afghanistan (EMPOWER-D-Afg): Protocol for a Cluster Randomized Feasibility Trial
ABSTRACT
Background:
Type 2 Diabetes Mellitus (T2DM) is a rapidly growing global health challenge, disproportionately affecting low- and middle-income countries. In Afghanistan, an estimated 11–12% of adults live with diabetes, with a high proportion remaining undiagnosed and limited access to preventive and primary care services. Community-based, participatory approaches may offer a feasible strategy for prevention and early detection in fragile and resource-constrained settings. However, evidence on their applicability in Afghanistan is limited.
Objective:
This study aims to assess the feasibility and acceptability of implementing a culturally adapted Participatory Learning and Action (PLA) intervention for T2DM prevention and control in rural Afghanistan and to inform the design of a future definitive trial.
Methods:
The study is a two-arm cluster randomised feasibility trial conducted in rural districts of Kabul Province. Four village clusters will be randomised to intervention or control following baseline assessment. The intervention is a culturally adapted PLA approach and will be delivered over 10 months through monthly group and community sessions. The PLA cycle includes problem identification, strategy development, implementation, and reflection. Baseline surveys will be conducted prior to randomisation, with endline surveys approximately 10 months later among adults aged ≥30 years, while individuals aged ≥20 years will be eligible for participation in PLA sessions. Primary outcomes assess feasibility and acceptability, including recruitment, retention, fidelity, engagement, and data completeness. Secondary exploratory outcomes include prevalence of T2DMand intermediate hyperglycaemia. A mixed-methods process evaluation will explore implementation barriers and facilitators.
Results:
N/A
Conclusions:
The study will generate evidence on the feasibility, acceptability, and contextual adaptability of a culturally tailored PLA intervention in rural Afghanistan. Findings will guide refinement of the intervention and evaluation methods and inform the design of a future large-scale trial for community-based T2DM prevention in fragile settings. Clinical Trial: This study is registered at ClinicalTrials.gov (Identifier: NCT07350694), registered on 20 January 2026. Available at: https://clinicaltrials.gov/study/NCT07350694
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