Table 3.
Contextualization of implementation strategies of the CoCo-HD program
| Implementation strategies | Tamil Nadu | Kerala |
|---|---|---|
| Training of CHWs | ||
| The actor | ICMR-NIE team and District Program Officers/ Medical Officers | SCTIMST team and District Programme Officers + ToT by selected MLSPs for further training under supervision. |
| The action | Face-to-face training | Face-to-face + online |
| Action target | MLSP and WHV | MLSPs in the entire state of Kerala |
| Temporality | August 2023 – Sept 2023 | December 2023 – March 2024 |
| Dose | 2 days (1 + 1); 6 h/ day | 1.5 days; 6 + 3 h |
| Outcome | Improved knowledge and skills in conducting PSG sessions | Empowered MLSPs in leading Peer group sessions in a structured and organized manner. |
| Justification | Training of the trainers and cascading to CHWs has been proven to be effective | A hybrid approach of face-to-face and online training mode is the preferred approach of the state health department. |
| PSG Sessions | ||
| The actor | MLHP and WHV | MLSPs |
| The action |
Conducting PSG sessions and activities: Repetitive slogan Special topic Activities Measurements |
Conducting PSG Sessions and activities: Set and review of goals Discussion on the core topics Initiate activities specific to the concerned sessions Plan for the forthcoming session Conduct study-specific measurements |
| Action target | People with diabetes and hypertension | People with diabetes and hypertension |
| Temporality | Oct 2023 – Sept 2024 | December 2023 – March 2025 (As the implementation is conceived in a phased manner across the state, with concurrent training and initiation of implementation overlapping). |
| Dose | 12 sessions; 60–90 min | 12 sessions; 60–90 min |
| Outcome | Medication compliance, Achieve treatment targets of hypertension (Blood pressure control) and diabetes (Blood sugar control) |
Improved adoption of self-care practices. Improved medication adherence. Weight and waist circumference reduction. Improvement in consumption of fruits and vegetables. Reduction in daily salt use. Improved control rates of hypertension and diabetes. |
| Justification | Monthly sessions have been used and proven to be effective in other settings. | Monthly sessions have been used and proven to be effective in other settings. |
| Community engagement activities | ||
| The actor | MLHP and WHV | MLSPs, Medical Officers and Supervisors |
| The action | Community Mobilisation during outreach activities, Information, Education, Communication (IEC) Provisions, Advertisements such as announcements, elevation of banners/posters, Peer Selection, and Reminders | Activities to engage and ensure more community participation in building awareness of the need for lifestyle modifications. |
| Action target | People with diabetes and hypertension and the community | Adults of all age groups |
| Temporality | 18 months | 18 months |
| Dose | Monthly once | One session: In a phased manner |
| Outcome | Community sessions conducted | Improved community awareness. Improved readiness to participate in structured lifestyle modification intervention sessions. |
| Justification | Community engagement is critical for effectively implementing PSG sessions and activities. | Community engagement will improve the acceptability of MLSPs and PSG in managing hypertension and diabetes. |