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BMJ Open. 2019 Nov 11;9(11):e031400. doi: 10.1136/bmjopen-2019-031400.

Adapting the Diabetes Prevention Program for low and middle-income countries: protocol for a cluster randomised trial to evaluate 'Lifestyle Africa'.

Author information

Center for Children's Healthy Lifestyles and Nutrition, Children's Mercy Hospitals and Clinics, Kansas City, Missouri, USA
Department of Pediatrics, University of Missouri Kansas City School of Medicine, Kansas City, Missouri, USA.
University of the Western Cape School of Public Health, Cape Town, South Africa.
Department of Heatlh Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, Michigan, USA.
Life Span Institute, University of Kansas, Lawrence, Kansas, USA.
Health Services and Outcomes Research, Children's Mercy Kansas City, Kansas City, Missouri, USA.
Department of Biobehavioral Health, Penn State College of Health and Human Development, Hershey, Pennsylvania, USA.
Department of Epidemiology and Prevention, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA.
Research Centre for Health through Physical Activity, Lifestyle and Sport (HPALS), Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.
Department of Medicine and Chronic Disease Initiative for Africa, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.
University of Missouri Kansas City School of Pharmacy, Kansas City, Missouri, USA.



Low and middle-income countries like South Africa are experiencing major increases in burden of non-communicable diseases such as diabetes and cardiovascular conditions. However, evidence-based interventions to address behavioural factors related to these diseases are lacking. Our study aims to adapt the CDC's National Diabetes Prevention Program (DPP) within the context of an under-resourced urban community in Cape Town, South Africa.


The new intervention (Lifestyle Africa) consists of 17 weekly sessions delivered by trained community health workers (CHWs). In addition to educational and cultural adaptations of DPP content, the programme adds novel components of text messaging and CHW training in Motivational Interviewing. We will recruit overweight and obese participants (body mass index ≥25 kg/m2) who are members of 28 existing community health clubs served by CHWs. In a 2-year cluster randomised control trial, clubs will be randomly allocated to receive the intervention or usual care. After year 1, usual care participants will also receive the intervention and both groups will be followed for another year. The primary outcome analysis will compare percentage of baseline weight loss at year 1. Secondary outcomes will include diabetes and cardiovascular risk indicators (blood pressure, haemoglobin A1C, lipids), changes in self-reported medication use, diet (fat and fruit and vegetable intake), physical activity and health-related quality of life. We will also assess potential psychosocial mediators/moderators as well as cost-effectiveness of the programme.


Ethical approval was obtained from the University of Cape Town and Children's Mercy. Results will be submitted for publication in peer-reviewed journals and training curricula will be disseminated to local stakeholders.




Diabetes Prevention Program; community health workers; low and middle-income countries; obesity

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