JMIR Publications

ABSTRACT

Background:

Community-based interventions (CBIs) have emerged as a promising strategy for preventing and controlling non-communicable diseases, including Type 2 diabetes mellitus (T2DM). However, the success of such interventions depends on cultural and contextual factors that influence community mobilisation and participation.

Objective:

This qualitative study aimed to investigate the barriers and facilitators to community-based interventions for the prevention and control of T2DM in rural and urban Pakistan.

Methods:

We conducted a multi-site qualitative study involving 37 in-depth interviews and 12 focus group discussions with diverse stakeholders, including individuals with known and unknown status of T2DM, caregivers of people with T2DM, community elders, and healthcare providers. Data were collected from approximately 50 participants across both rural and urban Pakistan and were analysed thematically using the framework approach.

Results:

Three overarching themes emerged: familiarity with CBIs, barriers, and facilitators, mapped across the socioecological model. Participants displayed limited yet varied understanding of CBIs, with rural participants often equating them to research activities, while urban participants linked them to health education and moral responsibility. Barriers included low awareness, misconceptions, gender and cultural constraints, logistical challenges, economic hardship, and security concerns, differing by context. Facilitators encompassed engagement with community leaders, gender-sensitive approaches, incentives, accessible venues, mass mobilisation, religious spaces, and involvement of local healthcare workers for intervention delivery. Rural–urban contrasts highlighted the influence of social cohesion, prior exposure, and structural factors on CBI uptake.

Conclusions:

This study highlights that CBIs for T2DM prevention and control in Pakistan require contextually tailored, culturally sensitive, and gender-responsive approaches. Rural–urban contrasts underscore the role of social cohesion, prior exposure, and structural factors in shaping engagement. Integrating these insights can guide the design and implementation of scalable, sustainable, and participatory diabetes prevention programs across diverse Pakistani communities.