Case Study 1

Situational analysis – Diabetes prevention, India

Carrying out a situational analysis for the implementation of NCD prevention and control policies and interventions

Why this case study?

This illustrates how a situational analysis was carried out in the state of Kerala, India in order to assess the need to implement a diabetes prevention programme.

The situational analysis laid the foundation for the adaptation of diabetes prevention programmes from Europe, the USA and Australia to the local context.


Carrying out a situational analysis for the implementation of NCD prevention and control policies and interventions


Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India

Health issue

Type 2 diabetes mellitus


Trivandrum region in Kerala, India

Target population

Men and women at high risk of developing diabetes


India has approximately 65 million individuals with type 2 diabetes mellitus (T2DM) – the second-largest number for a single country in the world. This number is expected to double by 2030.(26, 27) Studies estimate that T2DM affects between 9% and 20% of the country’s adult population.(28, 29)

Kerala has the highest prevalence of T2DM, with up to 20% of adults estimated to have the disease in parts of the state.(30, 31)

Description of policy or intervention

The Kerala Diabetes Prevention Program (KDPP) is a lifestyle intervention aimed at individuals in rural areas of Kerala at high risk of developing diabetes. The programme is designed to reduce the risk of developing diabetes through a series of peer-led sessions held within local communities. Following training on diabetes prevention and group facilitation, peer leaders identified from within the community conduct small group sessions focused on increasing knowledge about diabetes and on prevention strategies. Sessions are supplemented with community-wide activities such as yoga, walking and gardening which help participants to put into practice the learning from the group sessions.

What took place?

A situational analysis was carried out prior to the development of the KDPP by triangulating evidence from:

  1. previous research on the prevalence and control of diabetes in India and elsewhere;
  2. policy and other programme documents relevant to diabetes prevention specific to Kerala or India and
  3. a collection of novel qualitative data in Kerala through engagement with local stakeholders (including consumers).(32)

Relevant published research was retrieved following PubMed searches using medical subject heading (MeSH) terms related to diet, physical activity, tobacco and health pro-motion interventions conducted in India.

The search engines of relevant government department websites (e.g. of the Ministry of Health & Family Welfare) were used to retrieve relevant policy and programme documents (including guidelines at both the state and national level on NCD prevention and control, diet, physical activity and tobacco and alcohol use).

The qualitative research component consisted of focus groups (with pre-diabetic individuals from rural areas of Kerala, identified from the database of an earlier survey(33) that explored perceptions and attitudes towards T2DM and its prevention). These group discussions helped to identify specific needs for cultural adaptation and for delivery of the programme to target communities.

What was learnt?

The National Programme for Prevention and Control of Diabetes Cardiovascular Dis- eases and Stroke (NPDCS) – with recommendations on diet and physical activity – only launched recently in India. This contrasts to the situation in high income countries (HICs), where most diabetes prevention programmes were implemented almost a decade ago.

Despite the large burden of NCDs in the state and across the country, the situational analysis revealed gaps in NCD research and policy in Kerala/India. A review of epidemiological studies revealed a higher prevalence of risk factors for T2DM in Kerala than in the rest of the country,(29) with some risk behaviours (such as smoking) higher than the national average. Adult physical inactivity during leisure time was also high (34).

The focus groups highlighted the important role of families and cultural norms in making lifestyle choices in India. This underpinned the importance of developing a more integrated approach to behaviour change interventions than used in HICs. Multiple strategies involving family and community empowerment were called for – as corroborated by other studies in India.(32, 35-36)