Participatory Engagement for City Communities Against NCD Risk in Bangladesh and Nepal (The PECAN Project)

There is a high burden of non-communicable diseases (NCDs) in South Asian cities, driven by key 'modifiable' risk exposures across the life course. Adults in Nepal and Bangladesh are estimated to have on average at least two NCD risk factors, and this is expected to be more in cities. Risk exposure is driven by individual-, household-, community- and environmental-level factors, e.g. access to safe and supportive 'healthy spaces' for physical activity. Therefore, 'modifying' these exposures is rarely a personal choice, rather it is determined by wider sociocultural, sociopolitical and economic factors (customs, gender norms, living conditions and housing, rural-urban migration, health service provision, and market forces and regulation). Interventions are needed that raise individual and collective awareness and understanding of risk and that foster and facilitate broad community action to reduce risk. Such responses must go beyond individual behaviour change and single diseases or risks to also address structural, political and economic factors common to multiple risks and diseases.

We have shown that community mobilisation using Participatory Learning and Action (PLA) tackles higher-level drivers of health by empowering individuals and enabling communities to understand and overcome barriers to health. With a whole-population focus on NCD risks, our 42-month implementation research will provide a comparative case study on adaptation, application and evaluation of PLA in cities in Nepal and Bangladesh to address risk determinants and consequences. We will study outcomes of common NCD risk, including diet, physical activity, tobacco and alcohol use, blood glucose, blood pressure and BMI in representative population samples of adults aged 18+. The PLA model will be complemented by co-developed, evidence-based strategies including group-based physical activity, digital (mHealth) health promotion and arts-based methods. We have shown these lead to contextually appropriate strategies of awareness raising, information sharing and collective community action to address broad determinants of health threats and improve population health. We will also focus specifically on physical activity outcomes among women aged 50+. Physical activity has well-established and multifaceted benefits, including for blood pressure, diabetes and cancer risk, mental health, locomotor activity and metabolism, and inflammation. Combined, this specific population (older women) and this specific outcome (physical activity) is an exemplar of a neglected group in NCD intervention research and an outcome that reflects social interactions, environment and gender norms. Our previous work aligns with global literature, showing that physical inactivity is highest among those migrating from rural to urban areas, older populations and women. Success in increasing physical activity among older women will illustrate our intervention's ability to tackle broad determinants of NCD risk, with likely positive impacts across genders, generations and environments.

There is a high burden of non-communicable diseases (NCDs) in South Asian cities. We have shown that community mobilisation using Participatory Learning and Action (PLA) tackles higher-level drivers of health by empowering individuals and enabling communities to understand and overcome barriers to health. With a whole-population focus on NCD risks, our 42-month implementation research will provide a comparative case study on adaptation, application and evaluation of PLA in cities in Kathmandu, Nepal and Faridpur, Bangladesh to address risk determinants and consequences. We will study outcomes of common NCD risk, including diet, physical activity, tobacco and alcohol use, blood glucose, blood pressure and BMI in representative population samples of adults aged 18+. The PLA model will be complemented by codeveloped, evidence-based strategies including group-based physical activity, digital (mHealth) health promotion and arts-based methods. Through mixed methods implementation science methods, including participatory research methods, population based surveys, an interrupted-time series analysis, and economic evaluation we will describe the implementation and impact of our intervention approach.