Mediation and Moderation of an Educational Intervention for Improving Intention to Practise Pneumoconiosis Prevention Among South Asian Construction Workers

Developing and assessing the "MultiLife" intervention: a mobile health-based lifestyle toolkit for cardiometabolic multimorbidity in diabetes and hypertension management - a type 1 hybrid effectiveness-implementation trial protocol

BACKGROUND

Cardiometabolic multimorbidity (CMM), characterized by the coexistence of diabetes, hypertension, and cardiovascular disease, poses a major health challenge in India, particularly in rural areas with limited healthcare resources. Lifestyle interventions can manage cardiometabolic risk factors, yet adherence remains suboptimal. Mobile health (mHealth) interventions offer a scalable approach for managing CMM by promoting behaviour change and medication adherence. We will develop and evaluate the MultiLife intervention, a mHealth-based lifestyle toolkit aimed at improving CMM management among individuals receiving primary care in Eastern India in the year 2025.

METHODS

This study is a two-arm, cluster-randomized controlled trial with a hybrid Type 1 design involving 840 participants across 18 primary health centres in Odisha and Jharkhand. Using the Health Belief Model as a conceptual framework, the MultiLife intervention will deliver daily digital reminders, weekly health education broadcasts, and ongoing primary care support in the intervention arm, while the control group will receive the standard ongoing primary care support care. The trained healthcare workers will recruit 50 CMM patients, with a 6-month intervention period, during routine visits in each cluster. Primary outcomes include changes in HbA1c from baseline (T0) to end-line (T6). Secondary outcomes include blood pressure, body mass index, physical activity, and dietary habits. Qualitative assessments will explore intervention barriers and facilitators. Implementation outcomes, assessed through the RE-AIM QuEST framework, will evaluate MultiFrame's acceptability, adoption, fidelity, and maintenance. A random-effects regression model will be used for difference-in-difference analysis, adjusting for covariates and within-cluster correlations.

DISCUSSION

The MultiLife trial may provide valuable insights into how mHealth-enabled primary care can enhance patient engagement, adherence, and cardiovascular risk reduction in resource-constrained settings. By integrating patient perspectives, this study could inform scalable digital health strategies for comprehensive CMM management, providing a model for future interventions in similar contexts.

TRIAL REGISTRATION

CTRI.nic.in, CTRI/2024/10/074559, Registered on 1 October 2024.

Implementing a tailored communication intervention to increase colonoscopy screening rates among first-degree relatives of people with colorectal cancer: Lessons learned

PURPOSE

To report the process evaluation of a tailored communication intervention for first-degree relatives of colorectal cancer patients in a randomized controlled trial.

METHOD

Based on the MRC process evaluation framework, the process of delivering a two-arm RCT intervention were evaluated on 3 themes: (1) implementation, (2) mechanism, and (3) contextual factors. Implementation data were collected through a logbook, online tool platform feedback, and questionnaire surveys. Subgroup analysis was conducted for implementation outcomes. The mechanism and contextual factors were analyzed by mediation and moderation analysis.

RESULTS

From March 2019 to May 2019, 188 (57%) eligible participants were recruited to participate in this study in Shenzhen, China. In the intervention group, 68 (72.3%) participants received written and verbal sessions. Relatively high satisfaction rates (77.6%-100%) were achieved. The mediating effect was found for perceived barriers (95%CI = -0.880, -0.133) and cues to action (95%CI = 0.043, 0.679). No moderators were identified. People who received the first two sessions are more likely to receive a colonoscopy, whereas the time spent on intervention did not influence the colonoscopy uptake.

CONCLUSIONS

Potential strategies to enlarge the tailored effect were identified, including tailoring communication on the perceived barriers and cues to action and reinforcing patients' compliance in the first written and verbal sessions. To accomplish the difficult task of recruiting at-risk family members, direct approaches and adequate records on contact information of at-risk family members are suggested when the cancer cases were identified for the first time.

Development of a multimedia intervention to improve pneumoconiosis prevention in construction workers using RE-AIM framework

Pneumoconiosis is a common occupational lung disease among construction workers. Educational interventions targeting specific ethnic groups of construction workers are of benefit for pneumoconiosis prevention. The aim of this study was to develop a multimedia educational intervention for pneumoconiosis prevention for South Asian construction workers, and to evaluate its feasibility, acceptability and effectiveness in increasing knowledge of pneumoconiosis, modifying beliefs about pneumoconiosis, and enhancing intention to implement measures for its prevention among the workers. This evaluation was performed using the Reach-Effectiveness-Adoption-Implementation-Maintenance framework. A one-group design was adopted and intervention mapping was used to guide the process of intervention development, while the Health Belief Model guided the development of intervention content. The intervention was delivered at construction sites, ethnic minority associations and South Asian community centres. Data were collected via surveys completed at pre-intervention, post-intervention and 3 months after the intervention. A total of 1002 South Asian construction workers participated in the intervention. The participants reported a moderate-to-large increase in knowledge, perceived susceptibility, perceived severity, perceived benefits, cues to action and self-efficacy (Cohen's d: 0.37-0.89), a small reduction in perceived barriers (Cohen's d = 0.12) and a moderate improvement in attitudes and intention to practice (Cohen's d: 0.45, 0.51) at post-intervention. A follow-up survey of 121 participants found that the implementation of preventive measures appeared to increase. Overall, the findings demonstrate that the implementation of a culturally adapted multimedia educational intervention could be an effective approach to improving knowledge, self-efficacy and intention regarding pneumoconiosis prevention among South Asian construction workers.