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

南亚城市的非传染性疾病负担很高，这是由于整个生命过程中主要的“可改变的”风险暴露所致。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风险因素，预计城市中的风险因素会更多。风险暴露受到个人、家庭、社区和环境层面因素的影响，例如能否获得安全和支持性的“健康空间”进行身体活动。因此，“改变”这些暴露很少是个人的选择，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、卫生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理解，并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改变和单一疾病或风险，还必须处理多种风险和疾病共有的结构、政治和经济因素。我们已经证明，利用参与式学习和行动（PLA）的社区动员，通过赋予个人权力和使社区能够理解和克服健康障碍，解决了更高层次的健康驱动因素。在全民关注非传染性疾病风险的情况下，我们为期42个月的实施研究将为尼泊尔和孟加拉国城市的解放军适应、应用和评估提供比较案例研究，以解决风险决定因素和后果。我们将研究常见非传染性疾病风险的结果，包括18岁以上成年人代表性人群样本中的饮食、身体活动、吸烟和饮酒、血糖、血压和BMI。解放军模式将辅以共同开发的循证战略，包括基于群体的体育活动、数字（移动健康）健康促进和基于艺术的方法。我们已经表明，这些导致了适合具体情况的提高认识、信息共享和集体社区行动战略，以解决健康威胁的广泛决定因素和改善人口健康。我们还将特别关注50岁以上女性的体育活动结果。体育锻炼有多方面的好处，包括血压、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（身体活动）结合起来，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、老年人口和妇女中缺乏身体活动的比例最高。成功增加老年妇女的身体活动将说明我们的干预措施有能力解决非传染性疾病风险的广泛决定因素，并可能对性别、代际和环境产生积极影响。

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.