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

孟加拉国和尼泊尔城市社区参与应对非传染性疾病风险（PECAN 项目）

• 批准号: MR/Z000475/1
• 负责人: Edward Fottrell
• 金额: $ 207.26万
• 依托单位: University College London
• 依托单位国家: 英国
• 项目类别: Research Grant
• 财政年份: 2024
• 资助国家: 英国
• 起止时间: 2024 至 无数据
• 项目状态: 未结题
• 来源: https://gtr.ukri.org/projects?ref=MR%2FZ000475%2F1
• 关键词: Participatory; Engagement; City; Communities; Against

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.

在南亚城市，非传染性疾病(NCDs)的负担很高，这是由生命过程中关键的“可改变的”风险暴露推动的。据估计，尼泊尔和孟加拉国的成年人平均至少有两种非传染性疾病的风险因素，预计城市中的风险因素会更多。风险暴露是由个人、家庭、社区和环境层面的因素驱动的，例如获得安全和支持性的身体活动“健康空间”。因此，“修改”这些风险敞口很少是个人选择，而是由更广泛的社会文化、社会政治和经济因素(习俗、性别规范、生活条件和住房、城乡移徙、医疗服务提供以及市场力量和监管)决定的。需要采取干预措施，提高个人和集体对风险的认识和了解，促进和促进广泛的社区行动，以减少风险。这种应对措施必须超越个人行为变化和单一疾病或风险，还必须解决多种风险和疾病所共有的结构、政治和经济因素。我们已经表明，使用参与性学习和行动(解放军)的社区动员通过赋予个人权力并使社区能够理解和克服健康方面的障碍，来解决更高层次的健康驱动因素。随着全民对非传染性疾病风险的关注，我们为期42个月的实施研究将提供一个关于尼泊尔和孟加拉国城市适应、应用和评估解放军以应对风险决定因素和后果的比较案例研究。我们将在18岁以上成年人的代表性人群样本中研究常见非传染性疾病风险的结果，包括饮食、体力活动、烟酒使用、血糖、血压和BMI。解放军模式将得到共同开发的、基于证据的战略的补充，包括基于群体的体力活动、数字(MHealth)健康促进和基于艺术的方法。我们已经表明，这些导致了提高认识、信息共享和社区集体行动的适当战略，以解决健康威胁的广泛决定因素，并改善人口健康。我们还将特别关注50岁以上女性的体力活动结果。体力活动具有公认的多方面好处，包括对血压、糖尿病和癌症风险、心理健康、运动活动和新陈代谢以及炎症。这一特定人群(老年妇女)和这一特定结果(体力活动)结合在一起，是非传染性疾病干预研究中被忽视群体的典范，也是反映社会互动、环境和性别规范的结果。我们之前的工作与全球文献一致，表明从农村迁移到城市地区的人、老年人口和妇女中，缺乏体力活动的人最多。增加老年妇女体力活动的成功将说明我们的干预措施有能力应对非传染性疾病风险的广泛决定因素，并可能对性别、世代和环境产生积极影响。