Joanna Morrison

Background: Non-communicable diseases (NCDs) are a leading cause of premature mortality in South Asia, with urban populations experiencing rapidly rising risk due to demographic transition, environmental change, and widening social inequalities. While community participation is increasingly recognised as essential for effective NCD prevention, the nature, scope, and effectiveness of community-driven interventions in urban South Asia remain less synthesised. This scoping review aimed to systematically map community-driven interventions targeting NCD prevention in urban South Asian settings. We sought to examine how these interventions were implemented, the mechanisms through which they operated, and the contextual factors shaping their outcomes. Methods: To conduct the scoping review MEDLINE, Embase, Scopus, and Web of Science databases were searched from inception to July 28, 2026, alongside grey literature. Eligible studies reported community-driven interventions targeting NCDs or related risk factors among urban populations in South Asia. Data were charted and synthesised descriptively and thematically. Modes of community engagement were classified using Gram et al.’s “classroom–club–collective” typology. Results: 14 studies met the inclusion criteria: eleven from India, two from Nepal, and one from Sri Lanka. Interventions primarily targeted type 2 diabetes, hypertension, cardiovascular risk, mental health and tobacco use, with limited attention to chronic respiratory diseases and cancers. All studies reported positive short-term behavioural, psychosocial, or intermediate clinical outcomes. Communities were engaged in design, delivery, adaptation or mobilisation through peer educators, women’s self-help groups, mothers’ groups, trained community volunteers, and youth clubs/advocates. Community involvement in evaluation was rare. Implementation success was shaped by contextual constraints such as urban poverty, time scarcity, gender norms, and limited infrastructure. Contextual enablers included using trusted social networks, cultural adaptation, and local leadership. Most interventions were small-scale, short-term, and weakly integrated into health systems. Conclusion: The literature suggests potential for community-driven approaches to support NCD-related interventions in urban South Asia by mobilising local communities; however, current evidence remains insufficient to establish effectiveness. Scaling and sustaining such approaches will require greater institutional support, integration with urban health systems, and investment in longitudinal, mixed-methods implementation research that centres community leadership as a core component of NCD prevention and control strategies.

BACKGROUND In Bangladesh, more than 50% of deaths among children and adolescents (up to 18 years of age) are due to injury, with drowning being the leading cause. Most childhood unintentional injuries are preventable, as they are often a result of a lack of education, knowledge, or supervision in addition to structural causes. Therefore, many interventions to prevent injuries apply behavioural science to improve caregivers' knowledge and change their behaviour. Among them, mobile health (mHealth) interventions have proven effective, but most evidence comes from high-income settings. Little is known about how to design and evaluate mHealth injury-prevention interventions in low-resource, rural contexts such as Bangladesh. OBJECTIVE This study aims to develop and assess the feasibility, acceptability and potential effectiveness of mHealth messages to prevent childhood unintentional injuries in rural Bangladesh. METHODS This is a cluster randomised pilot and feasibility study using a delayed-intervention design, taking place in two rural villages in south-central Faridpur district, Bangladesh. One village was randomly allocated to receive the mHealth intervention immediately, while caregivers in the second village will act as a control group before receiving the same intervention following completion of the endline evaluation of the initial phase. All participants in the intervention village who care for children aged 15 or younger will receive the mHealth (voice and text) messages on childhood unintentional injury risk factors, prevention strategies and post-injury management and care over a period of 24 weeks. A mixed-methods approach, combining pre- and post-intervention surveys with a qualitative process evaluation, will be used to assess feasibility, acceptability and potential effectiveness of the intervention. RESULTS Ethical approval has been granted by the University College London Research Ethics Committee (27763.001) and by the Ethical Review Committee of the Diabetic Association of Bangladesh (BADAS-ERC/EC/24/25). Baseline data collection was completed in August 2025. The intervention implemented in the intervention village between September 2025 and February 2026. Intervention is being delivered to the control village from June to mid-November 2026. Endline surveys and qualitative process evaluation data collections in both villages will be completed by December 2026. CONCLUSIONS This pilot and feasibility study will generate evidence on the feasibility, acceptability, and preliminary effectiveness of a theory-driven mHealth intervention to prevent childhood unintentional injuries in rural Bangladesh, informing the design of a future, adequately powered trial. CLINICALTRIAL ISRCTN16988204. https://doi.org/10.1186/ISRCTN16988204

In 2022, nearly a third of the global adult population did not meet the recommended levels of physical activity [1]. The number of people failing to meet the recommended physical activity guideline...

Introduction: Bangladesh has a high burden of type two diabetes mellitus (T2DM) and hypertension. To better target non-communicable disease (NCD) programmes, populations with unmet care needs must be identified. We describe the unmet care needs for people living with T2DM and hypertension in rural Bangladesh at a subregional level. Methods: We conducted a secondary analysis of cross-sectional surveys conducted in 2021 and 2022 in Alfadanga Upazila, Faridpur District. Surveys were conducted among random samples of non-pregnant adults aged >30 years, including questions about demographics, NCD diagnoses, care-seeking and treatment. Study staff conducted blood pressure measurements to determine hypertension and 2-hour oral glucose tolerance tests to determine T2DM status. We calculated the prevalence of T2DM and hypertension and the unmet need for care, defined as the prevalence minus the proportion screened (T2DM only), diagnosed, treated and controlled, following the cascade of care (COC). We present the COC for 12 subregional geographical clusters and sex. Results: 1982 participants (62.9% women) were analysed. The prevalence of T2DM was 19.0%, and the unmet need for care was 90.7%. The prevalence of hypertension was 37.9%, and the unmet need for care was 81.4%. For both T2DM and hypertension, women had a higher prevalence of disease, but there was a wider gap in the COC for hypertension, with 22.4% of women achieving good control compared with 10.9% of men. At the subregional level, the prevalence of T2DM ranged from 12.4% to 26.5%, and the unmet need for care from 85.0% to 95.6%. Variations in the prevalence and unmet need for care were also seen for hypertension but with different subregional distribution patterns. Conclusions: In this rural Bangladesh setting, the unmet care need was high for T2DM and hypertension, with subregional and sex differences. Understanding hyper-local factors driving NCD risks and access to care could support more effective programme delivery.

Participatory approaches to research with adolescents are often seen as inherently superior to other qualitative methods because of their potential to redress power imbalances and enhance engagement. In reality, implementing participatory approaches is resource intensive and a complex balancing act where compromises have to be made. In this article, we share our experiences of using participatory approaches for intervention development with adolescents in Samoa and Nepal as part of two independent research projects. We reflect critically on the challenges we faced in relation to ethics, power dynamics, logistics, data quality, and benefits to participants, and how they shaped the meaningful participation of adolescents. We argue that encouraging reflexivity and discussion about the challenges and compromises we make in our research not only provides a space to learn from each other, but can enable more impactful and transformative participatory research with adolescents.

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.

Objectives Research indicates the effectiveness of participatory interventions to address rapid rises in type 2 diabetes in low-income countries. Understanding their transferability to different contexts is a priority. We aimed to analyse how the COVID-19 post-lockdown context and adjustments to a participatory learning and action intervention affected theorised mechanisms of effect in rural Bangladesh and to examine the broader implications of this context and intervention adjustments for developing optimal contexts for participatory interventions. Design Mixed methods using longitudinal qualitative and quantitative observation data, focus group discussions and interviews with group and community members and project personnel. We used descriptive content analysis, guided by realist evaluation research questions about context, implementation and mechanisms. We used team reflection to enhance the rigour of our analysis. Setting Cluster-randomised trial in Alfadanga upazila, Faridpur district, in the central region of Bangladesh. The intervention was implemented between January 2020 and December 2022, during the COVID-19 pandemic. Participants Participatory group members, community members and project personnel (n=32). Structured observations of participatory groups (n=1820) and unstructured observations of groups and their environments (n=15). Interventions Participatory learning and action community groups of men and women implemented by community-based facilitators. Results Due to COVID-19, the participatory learning and action (PLA) intervention was not implemented as planned, which had major effects on the time available to develop the intervention with communities. Communities learnt about diabetes and were motivated to address its causes at an individual level, but community action was a more challenging mechanism to trigger. The post-pandemic context made it difficult to build community rapport, and strategies to engage communities through home visits were challenging. Communities’ prior negative experience in working together and in working with non-governmental organisations led to low community cohesion and low motivation to address diabetes collectively. This also resulted in expectations that the implementing organisation would implement community actions and incentivise attendance at meetings. This misalignment of expectations further disabled relationship building, and community strategies addressing the social causes of diabetes were largely not enacted. Conclusion PLA has optimal effects when time is available to build trust and social cohesion. These are contextual elements and mechanisms that need to be activated to enable critical reflection and community action to develop an enabling environment to address type 2 diabetes. Trial registration number ISRCTN42219712.

Background: Disparities in vaccination coverage exist in Somalia with Internally Displaced Persons (IDPs) being among the groups with the lowest coverage. We implemented an adapted Participatory Learning and Action (PLA) intervention, which focused on routine vaccinations among displaced populations living in Mogadishu IDP camps. The intervention was successful in improving maternal knowledge and vaccination coverage but unsuccessful in improving timely vaccination. We conducted a qualitative study to understand this result and analyze the multi-level barriers to routine childhood immunization uptake. Method: In this qualitative study we used observation data from 40 PLA group discussions with female caregivers and purposively sampled nine vaccination service providers and six policy makers for interview. We also reviewed national-level vaccine policy documents and assessed the quality of health facilities in the study area. We used the socioecological framework to structure our analysis and analyzed the data in NVivo. Results: The barriers to childhood vaccination among IDPs at the individual level were fear due to lack of knowledge, mistrust of vaccines, concerns about side effects and misinformation; opportunity costs; and costs of transportation. At the interpersonal level, family members played an important role as did the extent of decision-making autonomy. Community factors such as cultural practices, gender roles, and household evictions influenced vaccination. Organizational issues at health facilities such as waiting times, vaccine stock-outs, distance to the facility, language differences, and hesitancy of health workers to open multi-dose vials affected vaccination. At the policy level, confusion about the eligible age for routine vaccination and age restrictions for catch-up vaccination and certain antigens such as BCG were important barriers. Conclusion: Complex and interrelated factors affect childhood vaccination uptake among IDPs in Somalia. Interventions that address multiple barriers simultaneously will have the greatest impact given the complex nature of vulnerabilities in this population. There is a need to strengthen the health system and connect it with existing community structures to increase demand for services. Our research highlights the importance of formative research before implementing interventions. Further research on the integration of health service strengthening with PLA to improve childhood vaccination among IDPs is recommended. Trial registration number: ISRCTN-83,172,390. Date of registration: 03/08/2021.

Access to adequate and nutritious food is important for the current and future health of adolescent girls. Interventions often focus on the individual as responsible for their own health ignoring the complex structural issues that underlie optimal nutrition. In South Asia gender inequalities have been noted as an important determinant of poor nutrition among women and their young children, but analysis of adolescent girls’ diets and what influences these are rarely undertaken. Therefore, we sought to analyse the factors affecting what and where girls’ eat and what affects their behaviour in the plains of Nepal, using a cultural-ecological approach. We analysed a secondary qualitative dataset of focus group discussions with adolescent girls aged 12–19 years old, young mothers, mothers-in-law, and older female key informants. Eating was heavily influenced by patriarchal norms. Boys had preferential access to food, money, and freedom of movement to appreciate their future role in providing for the family. Food was an investment, and boys were perceived to have more nutritional need than girls. Girls were not perceived to be a good return on investment of food, and eating practices sought to prepare them for life as a subservient daughter-in-law and wife. Obedience and sacrifice were valued in girls, and they were expected to eat less and do more housework than boys. Girls’ eating and behaviour was constrained to maintain self and family honour. Interventions should acknowledge cultural influences on eating and engage multiple actors in addressing harmful gender norms which limit eating and prevent girls from reaching their potential.