There is a need to decrease behavioural risk practices for cardiovascular disease, particularly in communities which are transitioning so rapidly. Interventions relying solely on health education to modify risk factors for chronic diseases have shown limited effectiveness, possibly because changes in individual behaviour are strongly constrained by social norms, economic resources, environmental and health system factors. Effective interventions therefore also need to address the community and structural dimensions of adverse risk behaviours. Evidence from social psychology, and across different fields of public health, suggests that engaging communities in the development and delivery of interventions yields more acceptable and effective programs. The closely networked and hierarchical structure of rural Indian communities, coupled with strong local governance, also lends itself to participatory approaches. There is an emerging body of evidence on the effectiveness of complex, community-based interventions for maternal and child health from rural communities in LMICs, but the evidence for chronic diseases is largely restricted to the urban poor, and there is limited data on India’s transitional communities.
Based on this, we are planning to develop a novel, complex community intervention which focuses on the community environment to address the growing burden of chronic diseases in transitional communities.
In November 2013, we began our exploratory work by conducting a number of focus group discussions to explore villagers’ views on ideas for interventions, with a particular focus on what factors influences nutritional behaviour and how these influences could be addressed through health promotion strategies. Other risk factors will be explored more fully in the future. We are currently conducting a systematic literature review on the effectiveness of community-engagement interventions, for primary prevention of chronic diseases in LMICs and will publish the results of these later in the year.