Enhancing diabetes and hypertension management in rural India through a peer support program: evaluating a community-based intervention using RE-AIM framework

Background: The health care system in India lacks an approach targeting individual risk behavior change and self-care practices. Thus, it is imperative to complement the healthcare system's efforts with alternative care management strategies at the grassroots. This paper aims to evaluate the utility of a community-based peer support program facilitated by trained volunteers to better manage diabetes and hypertension in rural areas of Karnataka state, India. Methods: A semi-structured peer support group approach called Swasthya Samithi (SS) and capacity-building activities empower patients with diabetes and/or hypertension, caregivers, and community health workers for better chronic care management through the ACE-ME program. Glasgow's RE-AIM framework assessed reach, feasibility, and effectiveness. A structured questionnaire based on WHO's STEPS tool, standardized scales, and qualitative checklists (Mixed-method approach) were used to collect data on program processes, output/outcome variables like lifestyle behavior, self-care practices, and clinical values. Results: The program reached 98% of the intended participants along with the non-patient community members. A total of 56 SS meetings were facilitated. Improved lifestyle behavior with reduction in use of tobacco, alcohol, consumption of processed food and significant improvement in self-care practices affirmed that the program was effective. Metabolic control of disease improved from 27% to 42% and 54% to 76% amongst the participants with diabetes and hypertension, respectively. Conclusion: The active engagement of participants and the capacity building of local health workers were key to the program's significant success, and the implementation experiences of the ACE-ME model provide pragmatic insights for its expansion in similar contexts.