Empowering Accredited Social Health Activist (ASHA) in a rural communities of Pune (Maharashtra): Process evaluation of a community-based intervention for diabetes care

Background: Diabetes is quickly reaching the status of a potential epidemic, with more than 74.2 million Indians diagnosed with the disease. With the majority of India's population residing in rural areas, the potential burden of diabetes is compounded by rising healthcare expenses, lower literacy, lack of awareness, limited access, and availability of healthcare. Objective: The process evaluation of project diabetes with dignity (DWD) aimed to test the feasibility and effectiveness of a model of enhanced diabetes care for adults, empowering Accredited Social Health Activists (ASHAs) in rural communities of Pune, Maharashtra. Methods: A community-based, quasi-experimental study was conducted with high-risk identified adults with Type 2 diabetes (n = 431, 30–70 years), in two Primary Health Centers of Baramati block of Pune district. ASHAs implemented six months' DWD intervention, including screening of subjects at risk of Type 2 diabetes using Indian diabetes risk score questionnaire, random blood glucose testing using glucometer, counseling, monthly house-to-house visits, and community-based awareness-raising activities about diabetes care-related issues. Results: Results indicated that the delivery, and reach of DWD intervention were favorable. The intervention was delivered as intended with a high degree of fidelity with dosage delivery, high attendance, and good participation rates. The participants were satisfied with intervention strategies activities and recognized to scale it up further. The engagement of ASHAs as a protagonist in the successful project implementation was emphasized. Conclusions: The findings on DWD intervention satisfaction, reach, and participation favored the capacity-building of ASHAs for diabetes screening, prevention, management, and referrals in rural Indian settings.