Project Abstract As African countries rapidly urbanize, they face new service delivery challenges to address the rapid rise of non- communicable diseases in cities, where women bear an exceptional portion of this burden. While access to medical management of these conditions is receiving attention, culturally appropriate approaches are needed to address the behavioral components including changes to diet and physical activity habits. We propose an innovative adaptation of the Centers for Disease Control and Prevention’s Diabetes Prevention Program “Power to Prevent” program, which we will develop and pilot in the low-income peri-urban neighborhoods of Bamako, Mali. This program is well-suited to delivery by the city’s community health workers already supporting families in improving maternal and child health outcomes. First, we will use participatory research methods to engage them and community residents in making adaptations to the community health worker’s guidelines and tools for recommended activities so that they are linguistically and culturally appropriate, including guidelines for food consumption using locally available foods. These adaptations will use more graphics and photographs, so they are appropriate for low-literacy participants. Second, another key innovation is the explicit orientation to couples, where only one may have a diagnosed cardiovascular disease. Our adaptation will provide tools the women can use in negotiating for changes to the family’s meals and her daily routine. Third, we will conduct a comparative effectiveness study at 6 community health centers with high rates of CVD, recruiting adults recently diagnosed with diabetes or hypertension. Based on the random allocation of their community health center, participants will be assigned to one of three groups of 150 each: Couples, with at least one meeting the eligibility criteria; Individuals, men and women, both eligible; Comparison, men and women with CVD. Trained community health workers and diabetic peer educators will use the adapted DPP materials with the Couples and Individuals groups over a period of 12 months. At the conclusion of this pilot we will assess the levels of adoption of recommended cardiovascular risk reduction behaviors and changes in obesity, hypertension, and diabetes control, comparing differences in outcomes between the three groups. Our work will enable Mali to incorporate diabetes and hypertension risk reduction into their already deployed networks of community health workers. A successful pilot will be followed by a larger scale study with full integration into the Malian health care system, potentially then reaching women and their families. The Malian DPP adaptation will also be suitable for Francophone West Africa, where customs and lifestyles are similar among the millions of families confronting the burdens of cardiovascular disease.

Project Narrative This project uses participatory and locally informed research to adapt an evidence-based diabetes prevention program for use in urban Bamako in West Africa, where the risk for diabetes and cardiovascular diseases is significantly rising. Because low-income women living in peripheral neighborhoods experience a disproportionate burden of these diseases, the adaptation will specifically address the need for women to be able to communicate effectively in order to gain the support of their spouses and family for making recommended dietary and daily activity changes. By identifying barriers and solutions to implementing the DPP program, this socio-culturally adapted research program will generate critical data for integration of Diabetes, CVD and other NCDs in primary health in low-income resource communities of Africa.