Engaging city communities in Bangladesh and Nepal for non-communicable disease prevention and control
| ISRCTN | ISRCTN76741197 |
|---|---|
| DOI | https://doi.org/10.1186/ISRCTN76741197 |
| Sponsor | University College London |
| Funder | Medical Research Council |
- Submission date
- 27/02/2026
- Registration date
- 04/03/2026
- Last edited
- 04/03/2026
- Recruitment status
- Not yet recruiting
- Overall study status
- Ongoing
- Condition category
- Other
Plain English summary of protocol
Background and study aims
There is a high burden of non-communicable diseases (NCDs) in South Asian cities. Adults in Nepal and Bangladesh are estimated to have on average at least two NCD risk factors and this is expected to be more in the cities. Risk exposure is driven by individual, household, community and environmental-level factors, such as access to safe and supportive ‘healthy spaces’ for physical activity. These exposures are rarely a personal choice, rather they are determined by wider sociocultural, sociopolitical and economic factors (such as customs, gender norms, living conditions and housing, rural-urban migration, health service provision, market forces and regulation). Interventions are needed that raise individual and collective awareness and understanding of risk and that foster and facilitate broad community action to reduce risk. Such responses must go beyond individual behaviour change and single diseases or risks to also address structural, political and economic factors common to multiple risks and diseases. We have previously shown that community mobilisation using Participatory Learning and Action (PLA) tackles higher-level drivers of health by empowering individuals and enabling communities to understand and overcome barriers to health. This implementation research aims to provide a comparative case study on the adaptation, application and evaluation of PLA in urban cities in Nepal and Bangladesh to address NCD risk determinants and consequences.
Who can participate?
Adults aged 18 years and over who are permanent residents of the study areas in Faridpur, Bangladesh, and Kathmandu and Nagarjun in Nepal
What does the study involve?
We will focus our research on common NCDs and NCD risk factors. The PLA model will be complemented by co-developed, evidence-based strategies including group-based physical activity, digital health promotion, and creative engagement of NCD action groups. We will also focus specifically on physical activity outcomes among women aged 40 years and older. Physical activity has well-established and multifaceted benefits, including on blood pressure, diabetes and cancer risk, and mental health. Combined, this specific population (older women) and this specific outcome (physical activity) is an example of a neglected group in NCD intervention research and an outcome that reflects social interactions, environment and gender norms.
What are the possible benefits and risks of participating?
All individuals participating in household surveys will be told their blood glucose and blood pressure results and will receive information on healthy levels and how to access appropriate care-seeking and further testing. The risks involved with taking part in the study are minimal.
Where is the study run from?
1. Centre for Health Research & Implementation, Diabetic Association of Bangladesh (CHRI-BADAS) (Bangladesh)
2. HERD International (Nepal)
3. UCL Institute for Global Health (UK)
When is the study starting and how long is it expected to run for?
November 2026 to February 2028
Who is funding the study?
UK Medical Research Council under the Global Alliance of Chronic Diseases cities initiative
Who is the main contact?
1. Prof. Edward Fottrell, e.fottrell@ucl.ac.uk
2. Dr Joanna Morrison, joanna.morrison@ucl.ac.uk
Contact information
Principal investigator, Public, Scientific
UCL Institute for Global Health
30 Guilford Street
London
WC1N 1DP
United Kingdom
| Phone | +44 (0)203108 51663 |
|---|---|
| e.fottrell@ucl.ac.uk |
Principal investigator
UCL Institute for Global Health
30 Guilford Street
London
WC1N 1DP
United Kingdom
| Phone | +44 (0)207905 2646 |
|---|---|
| joanna.morrison@ucl.ac.uk |
Study information
| Primary study design | Interventional |
|---|---|
| Allocation | N/A: single arm study |
| Masking | Open (masking not used) |
| Control | Uncontrolled |
| Assignment | Single |
| Purpose | Prevention |
| Scientific title | Participatory Engagement for City Communities Against Non-Communicable Disease (NCD) Risk in Bangladesh and Nepal (PECAN) |
| Study acronym | PECAN |
| Study objectives | To implement and evaluate a Participatory Learning and Action (PLA) strategy, working with urban communities to co-develop evidence-based interventions for non-communicable disease (NCD) awareness raising, information sharing and collective community action to address the broad determinants of health and advance our understanding of how co-production can be used to tackle the drivers of NCD risk. |
| Ethics approval(s) |
1. Approved 02/01/2025, University College London Life and Medical Sciences Research Ethics Committee (University College London, 2 Taviton Street, London, WC1E 6BT, United Kingdom; +44 (0)20 7679 8717; ethics@ucl.ac.uk), ref: 4766/004 2. Approved 03/02/2025, Ethical Review Committee of the Diabetic Association of Bangladesh (122 Kazi Nazrul Islam Avenue, Shahbagh, Dhaka-1000, n/a, Bangladesh; +880 (0)58616641-50; info@dab-bd.org), ref: BADAS-ERC/EC/25/39 3. Approved 24/12/2024, Nepal Health Research Council (NHRC) (Ramshah Path, Kathmandu, PO Box 7626, Nepal; +977 (1)5354220; nhrc@nhrc.org.up), ref: 1336 |
| Health condition(s) or problem(s) studied | Non-communicable diseases (NCDs) and NCD risks in adults living in urban communities in Nepal and Bangladesh |
| Intervention | Community mobilisation through Participatory Learning and Action (PLA) is a specific approach to community interventions that has four phases: phase 1 focuses on problem identification, whereby participants themselves identify and prioritise factors that affect their health; phase 2 involves the collective design of strategies that communities can implement to address the problems and health threats identified in phase 1; during phase 3, the communities implement these strategies; in phase 4 communities reflect on and evaluate the success of the strategies they have implemented. This is done at a community grassroots level. This research will work with co-production groups of citizen scientists from city communities in Faridpur, Bangladesh and Kathmandu and Nagarjun, Nepal, to adjust and expand existing theories of how PLA interventions create enabling contexts to reduce NCD risk in urban environments and hypothesise how the context and different components of context need to adapt favourably to the components of the intervention for it to be effective. Based on this participatory analysis, we will develop the content and format of at least three evidence-based strategies with co-production groups. 1. NCD action groups: There is potential to engage civil society organisations to address the challenge of NCDs. We will employ and train local facilitators to mobilise and build the capacity of community members who have been identified as having bridging social capital (those who have networks and ties with individuals, groups or corporate actors represented in public agencies, schools, business interests, legal institutions and religious/political groups) and linking social capital (relations between individuals and groups in different social strata to access power, social status and wealth) and who have political efficacy (i.e., influence over decisions affecting their local area). We expect these groups to meet and engage with powerful individuals and groups (such as politicians and religious leaders) throughout the implementation phase to facilitate action to address the structural drivers of NCDs. 2. Group-based physical activity: We will develop and implement group-based physical activity to be implemented by skilled coaches recruited and paid locally. The form, content, venue and scheduling of this activity will be designed based on our collaboration with the co-production groups. It has been shown that women prefer exercising with those of similar age and gender; therefore, we anticipate running both mixed-gender and women-only activities. Group-based physical activity will be implemented for a duration of 12 months. 3. Digital health intervention: PLA interventions usually contain a component which responds to community demands for more information. We will work with co-production group members to iteratively develop a digital health intervention to provide information about environmental, commercial, and behavioural risk factors of NCDs, how to prevent NCDs, and how to identify symptoms. The intervention will also model ‘ideal’ type behaviours such as care-seeking, healthy eating, and physical activity. Information will be shared via participating households' mobile phones over a period of 12 months. Voluntary sign-up to receive this information will be encouraged by facilitators through household visits and intervention launch events in each city. Co-production groups will be supported to implement other strategies beyond these if they decide to do so. |
| Intervention type | Behavioural |
| Primary outcome measure(s) |
|
| Key secondary outcome measure(s) | |
| Completion date | 01/02/2028 |
Eligibility
| Participant type(s) | |
|---|---|
| Age group | Mixed |
| Lower age limit | 18 Years |
| Upper age limit | 100 Years |
| Sex | All |
| Target sample size at registration | 1362 |
| Key inclusion criteria | Population cross-sectional evaluation sample: 1. Aged 18 years and above 2. Permanent residents in one of the study areas during the study period Adult female evaluation cohort: 1. Female 2. Aged 40 years and above 3. Permanent residents in one of the study areas during the study period |
| Key exclusion criteria | Population cross-sectional evaluation sample: 1. Aged under 18 years 2. Temporary residents in the study areas 3. Individuals who decline to participate in the survey 4. Individuals who lack the capacity to consent to study participation Adult female evaluation cohort: 1. Not female 2. Aged under 40 years 3. Temporary residents in the study areas 4. Individuals who decline to participate in the survey 5. Individuals who lack the capacity to consent to study participation |
| Date of first enrolment | 01/11/2026 |
| Date of final enrolment | 31/10/2027 |
Locations
Countries of recruitment
- Bangladesh
- Nepal
Study participating centres
Avenue Shahbagh
Dhaka
01000
Bangladesh
Bhaisepati
Lalitpur
Kathmandu
PO Box 24144
Nepal
Results and Publications
| Individual participant data (IPD) Intention to share | No |
|---|
Editorial Notes
03/03/2026: Study's existence confirmed by the Medical Research Council.
