Towards the Development of an Intervention to Address Social Determinants of Non-Communicable Disease in Kerala, India: A Mixed Methods Study
Abstract
:1. Introduction
1.1. Non-Communicable Disease in India
1.2. Complexity of Social Determinants of NCDs
1.3. Social Intervention Design Considerations
1.4. Literature Review
- Studies that examined effectiveness of social interventions that targeted social risk factors of Diabetes, hypertension and CVD;
- Randomised controlled trials;
- Conducted in India;
- Population aged over 30 years;
- Peer-reviewed journal articles;
- Written in English language.
2. Materials and Methods
2.1. Design
2.2. Qualitative Interviews
2.2.1. Community Members
2.2.2. Health Practitioners and ASHAs
2.3. Expert Workshop
2.4. Ethical Approval
3. Results
3.1. Qualitative Interviews
3.1.1. Community Members
3.1.2. Health Practitioners and ASHAs
3.2. Stakeholder Workshop
3.3. Mapping Resources in the Community
- Health: religious organisations provide nursing care services for older people, home care for those unable to reach health facilities, postnatal maternal and infant care; NGO’s provide regular medical camps, community-based palliative care and free medications based on need.
- Psychological and social support: at the community level, friends, neighbours and family members provide much social support.
- Economic: private organizations provide medication, medical kits, and a monetary support to the caregivers of people who require home assistance. Financial support is also provided to some in need through religious organisations.
4. Discussion
Limitations
5. Conclusions
Author Contributions
Funding
Acknowledgments
Conflicts of Interest
Appendix A
References
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Basic Themes | Organising Themes | Global Theme |
---|---|---|
Group 1—Low Risk | Social Risk and Chronic Disease Management | |
Individuals are unaware of the health risks and complications Incorrect diet and lack of awareness | Lifestyle | |
Financial Stability opens way for better choices and accessing quality services | Finance | |
Lack of immediate family support to buy medicines Community support through health education Support of friends in the form of checking in, buying medicines, etc. | Relationships | |
Trusting, friendly and positive attitude of healthcare professionals Economic stability results in accessing better quality services and informal support | Access to services | |
Group 2—Behavioural Risk | ||
Job and busy routine leading to non-adherence to following healthy diet Lack of education or knowledge leads to ignorance which, in turn, affects adherence | Lifestyle | |
Unemployment with lack of stable income Choosing to meet the needs of family over buying medicines for self | Finance | |
Physical and emotional support from immediate family members Networking by extended family members in the form of referrals and community linkages Positive doctor–patient relationship and involvement of health care professionals | Relationships | |
Opting for alternative treatments (Ayurveda/homeopathy/naturopathy) Lack of trust towards government doctors Wrong notions such as one gets addicted to medicines together with forgetfulness leads to non-adherence Frequent travel as a barrier to non-adherence | Access to services | |
Group 3—Social Risk | ||
Awareness about the significance of the illness and complications resulting from non-adherence Spiritual beliefs and ventilation as a source of coping mechanism and restoring hope | Lifestyle | |
Lack of finances as a reason to settle for government hospitals over private ones Lack of finances leading to inability to follow healthy, balanced diet and to buy medicines Informal support from churches or mosques | Finance | |
Belief that own children won’t provide support because of financial constraints or conflicting relationships Life events like death of spouse Lack of neighbours and social isolation | Relationships | |
Lack of transport to reach long distance resources Rude approach from healthcare professionals | Access to services |
Challenges | Needs |
---|---|
Health care providers focus on medical treatment with little time or resources for care The community workforce is grassroots, reaching those in need, but extremely overloaded Assessment and intervention with social relationships a priority of family agencies employing social workers, however links between these agencies and health care providers is not always strong Systematic challenges: little time and resources for care Many government services are being provided but some lack awareness in the community, issues of accessibility for vulnerable populations Challenge for government services is the myth that free medicines or treatment are inadequate | Health care context Move from curative to preventive interventions Increased access to already existing mental health services like the District Mental Health Programme. Health volunteers exist for mental and neurological care, potential for other chronic conditions |
Community care Strengthen lower-cost parts of this system, leaving clinical as it is but increasing access to ASHAs and social workers. Systems where patients are able get their medicines at their home Systems for coordination across workforce and services | |
Family support and self-care Generate feasible systems through existing self-help groups to enhance social and emotional support Links are needed between community workers and supportive community programmes such as Kudumbasree, a trusted system of neighbourhood groups for poverty alleviation | |
Awareness raising Sensitization about the services that are currently available (government services like free medicines, NCD clinics, etc.) Awareness of medication compliance is lacking |
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Webber, M.; Joubert, J.; Fendt-Newlin, M.; Madavanakadu Devassy, S.; Scaria, L.; Benny, A.M.; Joubert, L. Towards the Development of an Intervention to Address Social Determinants of Non-Communicable Disease in Kerala, India: A Mixed Methods Study. Int. J. Environ. Res. Public Health 2020, 17, 8636. https://doi.org/10.3390/ijerph17228636
Webber M, Joubert J, Fendt-Newlin M, Madavanakadu Devassy S, Scaria L, Benny AM, Joubert L. Towards the Development of an Intervention to Address Social Determinants of Non-Communicable Disease in Kerala, India: A Mixed Methods Study. International Journal of Environmental Research and Public Health. 2020; 17(22):8636. https://doi.org/10.3390/ijerph17228636
Chicago/Turabian StyleWebber, Martin, Jacques Joubert, Meredith Fendt-Newlin, Saju Madavanakadu Devassy, Lorane Scaria, Anuja Maria Benny, and Lynette Joubert. 2020. "Towards the Development of an Intervention to Address Social Determinants of Non-Communicable Disease in Kerala, India: A Mixed Methods Study" International Journal of Environmental Research and Public Health 17, no. 22: 8636. https://doi.org/10.3390/ijerph17228636