Accepted for/Published in: JMIR Research Protocols
Date Submitted: Jan 23, 2025
Date Accepted: Oct 16, 2025
Warning: This is an author submission that is not peer-reviewed or edited.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.
Adaptation of a Participatory Learning and Action (PLA) Community Intervention for the Prevention and Control of Type II Diabetes Mellitus in Urban and Rural Settings of Pakistan and Afghanistan: A Study Protocol
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) actively involves community members in addressing health issues, with Participatory Learning and Action (PLA) being one such CHPR approach. The D-Magic trial in Bangladesh utilized PLA through a group-based approach where communities identified their own problems and planned and implemented strategies to address these problems.
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:
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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 in Afghanistan, Pakistan, and other LMICs. Clinical Trial: The full version of the EMPOWER-D trial is registered with clinicaltrials.gov. NCT06561126 for rural Pakistan; registered 23rd August 2024 and NCT06570057 for urban Pakistan; registered 26th August, 2024.
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