JMIR Publications

ABSTRACT

Background:

Type II Diabetes Mellitus (TIIDM) is a critical global health issue, especially in low-and middle-income countries (LMICs) like Afghanistan and Pakistan, where many cases remain undiagnosed and specialized care is costly. Community Health Participatory Research (CHPR), which actively involves community members in addressing health issues, is increasingly recognized as effective approach to deliver sustainable and culturally relevant health solutions. Participatory Learning and Action (PLA), a method of CHPR, was implemented in the D-Magic trial in Bangladesh that empowered communities to identify challenges and develop locally relevant strategies to prevent and control TIIDM.

Objective:

This study aims to adapt the PLA-based D-Magic intervention for the prevention and control of TIIDM in rural and urban communities of Afghanistan and Pakistan.

Methods:

Under the Centre for Improving Mental and Physical Health Together (C4IMPACT) program, the EMPOWER-D Trial will systematically adapt the D-Magic intervention using the ADAPT Guidance framework. The study will be conducted across three sites: rural Afghanistan (Kabul), rural Pakistan (Peshawar and Swabi), and urban Pakistan (Karachi). Stakeholders and community members will be involved to ensure cultural relevance. The process includes identifying barriers and facilitators to the implementation of community-based interventions through a qualitative study and a scoping review, co-designing intervention materials, and piloting for feasibility and effectiveness.

Results:

EMPOWER-D was funded and launched in November 2022 by NIHR-UK (NIHR203248). Following a year-long development phase, the adaptation protocol was finalized, and a mock run of the interviews was conducted. Recruitment and qualitative data collection, including in-depth interviews and focus group discussions, began in July 2024 and have been completed in Peshawar, Swabi, and Karachi. As of January 2025, data collection has commenced in Afghanistan. Results are anticipated to be published in mid to late 2025 following the completion of data analysis.

Conclusions:

The EMPOWER-D adaptation will align the PLA-based intervention with local sociocultural context, ensuring health equity and participation. Building on the D-Magic trial's success, this adaptation will ensure the intervention's effectiveness and cost-effectiveness in preventing and managing TIIDM, not only in Afghanistan and Pakistan, but also other LMICs. Clinical Trial: The full version of the EMPOWER-D (Engagement of coMmunity through Participatory learning and action for cOntrol and preVEntion of type II Diabetes and its Risk factors ) trial is registered with clinicaltrials.gov. NCT06561126 for rural Pakistan; registered 23rd August 2024 and NCT06570057 for urban Pakistan; registered 26th August, 2024.