A cluster randomised controlled trial of community groups using Participatory Learning and Action to prevent and...

Community mobilisation through Participatory Learning and Action (PLA) has been shown to be effective for a range of health outcomes, including diabetes. Using a cluster randomised controlled trial we evaluated the impact of a PLA community mobilisation intervention for diabetes prevention and control when implemented in rural Bangladesh in 2021-2022 and adapted to the evolving context of the COVID-19 pandemic. 108 PLA groups held a minimum of 13 meetings over a total implementation period of 20 months. Random cross-sectional samples of adults (aged ≥30 years) at baseline (pre-intervention, n = 1392) and at endline (post-intervention, n = 1343) were selected to evaluate intervention impact on the primary outcome of prevalence of intermediate hyperglycaemia and diabetes assessed through fasting blood glucose concentrations and two-hour oral glucose tolerance tests. Secondary outcomes included blood pressure, knowledge of diabetes, and behavioural outcomes, including diet, physical activity, and care-seeking. Results showed no evidence of an intervention effect on prevalence of intermediate hyperglycaemia and diabetes between study arms (adjusted difference -1.19% (95% CI -10.74, 8.36), p = 0.784). Large increases in diabetes knowledge were recorded and the intervention was associated with a significant reduction in mean diastolic blood pressure (-2.98 (-5.55, -0.41), p = 0.028) and possible reductions in the prevalence of hypertension (-7.40% (-16.03, 1.24), p = 0.0845) and abdominal obesity (-15.23% (-33.02, 2.56), p = 0.085). Although COVID-related interruptions and adaptations to implementation of PLA may have impacted effectiveness, the PLA approach to non-communicable disease prevention and control continues to show promise in resource-poor settings. Trial registration: ISRCTN42219712 - registered 31st October 2019. Status: complete.