Adapting the Diabetes Prevention Program’s Power to Prevent for implementation: a Formative Research in peri-urban setting of Bamako, Mali

Abstract Background: Although type 2 diabetes and cardiovascular diseases are on the rise in Africa, there are few African community-level behavior change interventions for reducing diabetes and hypertension risk. We describe the process used to develop a pilot program adapting the evidence-based CDC Diabetes Prevention Program’s Power to Prevent (DPP-P2P) in two low-income urban communities in Bamako, Mali. Methods: The 12 DPP-P2P group sessions and handouts were converted into culturally appropriate, pictorial presentations including multiple role-plays and demonstrations. Nineteen community health workers and 45 diabetic and hypertensive patients were recruited to give feedback on the sessions delivered in one-month at two community health centers. Changes in activity levels and diet were assessed by pre- and post-tests. Feedback was given after each session, and at the end, by focus groups conducted with both sets of participants. We performed a content analysis of the focus group discussion data and assessed pre and posttest differences in activity and diet using the Chi-square test, using Stata v. 15.1. Results: Participants were very enthusiastic about the program. They suggested more emphasis on involving the family, verifying the low-cost of healthy eating, and including exercise guides. The level of inactivity (less than 1 weekly) dropped from 35.3% to 12.1% (P=0.026), while engaging in some form of physical activity 3 or more times in the previous week rose from 32.3% to 75.8% (P<0.001). Limitation of fat intake rose from 70.6.3% to 97.0% (P= 0.004). Conclusion: This pilot study demonstrates the feasibility and high acceptability of adapting the DPP-P2P delivered through community health workers in a low-income periurban setting of Africa . The high attendance to different sessions, adhesion to physical activities encourage for further effectiveness studies of DPP-P2P adaptation.