Contextual Awareness, Response and Evaluation: Diabetes in Ghana

Type 2 diabetes (T2D) affects approximately 6% of adults in Ghana resulting in poor mental and physical health, premature death, and increased costs for individuals, families and healthcare services. The CARE:Diabetes project represents a research collaboration between public health specialists, historians, social scientists, economists, political scientists, psychologists, pharmacists and engineers to understand the contextual drivers and consequences of T2D in three urban communities in Accra, Ghana. This will include research into the historical, political and physical context of T2D, giving us insights into how environmental, economic and social factors have shaped T2D risk in this urban setting. Information on individual, household and community burdens of disease and risk factors will be gathered through community surveys while social science methods will provide deep understanding of contextual determinants and perceptions of disease. Assessment of digital infrastructure and development capacity will identify opportunities for digital strategies to raise awareness of T2D, prevent disease, and strengthen health systems. We will also map available formal and informal health care providers and work with these, community groups and policy makers to co-create intervention strategies to reduce T2D risk in the study area. In particular, we will adapt and test a specific community mobilisation intervention that has proven successful in reducing diabetes risk in other settings.

Ghana is a lower middle income country where type 2 diabetes (T2D) affects approximately 6% of adults and prevalence is increasing, resulting in poor mental and physical health, premature mortality, and increased costs for individuals, families and healthcare services. There is an urgent need for cost-effective T2D prevention programmes designed specifically for Ghanaian populations. Any such intervention must address the broad socio-cultural and economic determinants and consequences of T2D that include traditions and customs, gender norms, urbanisation, living conditions and housing arrangements, rural-urban migration cycles, health service provision and market forces and regulation.

We will conduct truly interdisciplinary research to understand the history, epidemiology, narratives, socio-ecological drivers, consequences and responses to T2D. We will use this contextual understanding to identify specific strategies and recommendations for intervention. This will include community, health system, market and policy level solutions and will recognise the emergent potential of appropriate digital interventions such as mHealth education and behaviour change, electronic decision support, and enhanced peer-to-peer communication and consultation systems.

Further, we will adapt and test a Participatory Learning and Action (PLA) community mobilisation intervention for T2D. The PLA intervention, proven to reduce T2D prevalence and risk in Bangladesh by over 60%, works by facilitating community discussion, mutual learning to raise critical consciousness and foster collective action to reducing disease risk in general populations. With appropriate contextual adaptation, we hypothesise that PLA community mobilisation has the potential for substantial impact on reducing the T2D burden in urban Ghana.

Through a holistic, integrated approach to examining the contextual factors related to T2DM we will build awareness, tools and capacity to address the issues from a communities, systems, research and policy level.

The beneficiaries of the research will be:
- People with type two diabetes or at risk of developing type two diabetes and their families
- Health professionals
- Policymakers
- Civil society organizations
- Industry
- Researchers

Overall impact will be:
- Increased understanding of diabetes, healthy lifestyles and ways to address it within communities in Accra
- A better equipped health system to deal with T2DM and well-developed local models for community interventions
- At a policy and civil society level the profile of diabetes will be raised, and specific recommendations for an integrated approach to tackling T2DM available
- Increased capacity of researchers in the UK and Ghana through mutual learning