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.

由于整个生命过程中关键的“可改变”风险暴露，南亚城市的非传染性疾病（NCD）负担很重。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，预计城市中这一比例会更高。风险暴露是由个人、家庭、社区和环境因素驱动的，例如获得安全和支持性的“健康空间”进行体育活动。因此，“改变”这些风险很少是个人选择，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、城乡迁移、医疗服务提供以及市场力量和监管）决定。 ）。需要采取干预措施来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降低风险。此类应对措施必须超越个人行为改变和单一疾病或风险，还应解决多种风险和疾病常见的结构、政治和经济因素。我们已经证明，利用参与式学习和行动 (PLA) 进行社区动员可以通过赋予个人权力并使社区了解和克服健康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尼泊尔和孟加拉国城市 PLA 的适应、应用和评估的比较案例研究，以解决风险决定因素和后果。我们将研究 18 岁以上成年人代表性人群样本中常见非传染性疾病风险的结果，包括饮食、体力活动、吸烟和饮酒、血糖、血压和体重指数。 PLA 模式将得到共同开发的循证策略的补充，包括基于团体的体育活动、数字（移动健康）健康促进和基于艺术的方法。我们已经表明，这些可以导致提高认识、信息共享和集体社区行动等适合具体情况的战略，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 岁以上女性的身体活动结果。体育活动具有公认的多方面益处，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。结合起来，这一特定人群（老年女性）和这一特定结果（体力活动）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口、老年人口和女性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表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。