Title: Evaluating the Impact of Digital Intervention versus the WHO PEN Approach in

Non-Communicable
Disease Prevention and Control in Resource-Limited Settings: A Quasi-Experimental Study

Phase I
KAP Questionnaire on diabetes and cardiovascular diseases(CVD)
This study aims to learn about knowledge, attitudes, and practices toward the adaptability of digital
intervention related to diabetes and heart disease,/Hypertension.

To assist in implementing digital intervention for diabetes and heart disease/, and Hypertension.

A. Socio-demographic profile, Medical history, and Anthropometric status

A1. Date ……………………. (d) ……………………. (m) ……………………. (y)

A2. Name of the respondent ……………………

S. No. Question Response

​ Male
A3. Gender ​ Female
​ Others
A4. Age of the respondent …………. Years
​ Hindu
​ Sikh
​ Christian
A5 Religion
​ Muslim
​ Other, please specify___________
​ Not willing to tell
​ Married
​ Unmarried
A6. Marital status ​ Separated
​ Divorced
​ Others
​ Uneducated/Illiterate
​ Primary school (I-V standard)
​ Middle school (VI-X standard)
A7. Educational qualification ​ High school (XI-XII standard)
​ Intermediate or diploma
​ Graduate
​ Profession or Honours
A8. Occupation ​ Unemployed

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 ​ Elementary occupation
​ Plant and machine operators and assemblers
​ Craft and related trade workers
​ Skilled agricultural and fishery workers
​ Skilled workers and shops and market sales
workers
​ Clerks
​ Technicians and associated professionals
​ Professionals
​ Legislators, senior officials and managers
​ Rural
Place of origin and how long have you been ​ Urban
A9
residing in the current location? Duration-______________________

A10. Total family members

​ 2,13,814 and above
​ 1,06,850-2,13,813
​ 80,110-1,06,849
A11. Monthly household income (Rupees) ​ 53,361-80,109
​ 31,978-53,360
​ 10,703-31,977
​ <10,702
​ Yes. _____________
A12. Do you have a family history of diabetes? ​ No
​ Not sure

​ Yes. _____________
​ No
A13.
Do you have a family history of heart ​ Not sure
disease/Hypertension? ​ Any other heart disease. Please
specify_________

B. Anthropometric measurements of the respondent

Measurement Reading 1 Reading 2

B.1 Weight (Kg)
B.2 Height (cm)
B.3 Waist Circumference (cm)
B.4 Hip circumference(cm)
B.5 BMI(kg/m2)

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 C. Familiarity with technology

C.1 Do you use a mobile phone? 1.​ Yes

2.​ No
C.2 Do you have Internet access? 1.​ Yes
2.​ No
C.3 Do you know how to read a text message? 1.​ Yes
2.​ No
C.4 Do you know how to send a text message? 1.​ Yes
2.​ No

D. Clinical Assessment

Measurement Reading
D.1 Fasting/Random Blood Glucose
D.2 HbA1c
D.3 Blood Pressure Systolic
Diastolic
Pulse
D.4 Lipid profile a. Total cholesterol
b. LDL
c. VLDL
d. HDL

*HbA1c reference range:

Normoglycemia(mg/dl)(WHO/ADA): < 5.7%

Prediabetes (mg/dl)(WHO/ADA): 5.7-6.4%

Diabetes (mg/dl): ≥ 6.5%

E. Questionnaire on diabetes and heart disease,/Hypertension.

S. Questions
No
Knowledge and Screening-based questions
1. Have you heard about disease conditions, ​ Yes, heard about diabetes If No, skip Q2 and
diabetes and heart disease,/Hypertension? ​ Yes, heard about heart 3, and Q4
disease/Hypertension
​ Both
​ Heard about heart disease,
please specify _______

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2. Have you been screened for diabetes? ​ Yes
​ No
3. Have you been screened for ​ Yes
Hypertension/heart-related conditions? ​ No
4 Have you been diagnosed with diabetes or heart ​ Yes(diabetes) If No, skip Q5 and
disease,/Hypertension? ​ Yes (heart Q6, proceed to
disease/Hypertension) Q7.
​ No
​ Both
4a. How long since diagnosis?
​ <1 year,
​ 1-3 years,
​ 4-6 years,
​ >6 years

5 Do you have regular medical check-ups? ​ Yes

​ No
5a. How frequently do you get yourself tested for a. Blood pressure:
the following? ​ Monthly,
​ 3 – 6 Months,
​ Once a year,
​ Twice a year ____
​ Never

b. Blood sugar:
​ Monthly,
​ 3 – 6 Months,
​ Once a year,
​ Twice a year
​ Never

c. Type of testing for blood sugar

​ Random blood sugar
​ Fasting blood sugar
​ HbA1C
​ Don’t test

[Link]:
​ Monthly,
​ 3 – 6 Months,
​ Once a year,

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 ​ Twice a year
​ Never

Risk factors and symptoms:

6a. According to you, how did you acquire _____________

diabetes? _____________
Not sure
(Prompts: genetic predisposition [family
history], decreased physical activity, unhealthy
diet, stress).

6b. According to you, how did you acquire heart _____________

disease/Hypertension? _____________
Not sure
7. a.​ What do you think causes diabetes? ​ Obesity/overweight
​ Unhealthy diet
​ Sedentary lifestyle
​ Stress
​ Smoking
​ Alcohol abuse
​ Certain medications?
​ Medical history
​ Others_________

b.​ What, in your perception, could cause ​ Obesity/overweight

Hypertension/heart disease? ​ Unhealthy diet
​ Sedentary lifestyle
​ Stress
​ Smoking
​ Alcohol abuse
​ Certain medications?
​ Medical history
​ Others_________
8. Do you believe diabetes/heart ​ Yes- Diabetes/heart
disease,/Hypertension are a serious health risk? disease/Hypertension
​ No

Management and treatment

9. Have you received health education/awareness ​ Yes

on your condition? ​ No
If yes, who provided it? ​ Doctor
​ Dietician

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 ​ Anganwadi worker
​ Medical camp
​ Friends or family
​ Others…..

a.​ If yes, what type of education did you receive? ​ dietary modification
​ weight management/reduction
​ physical activity
​ others….

c. Have you followed the given medical advice? ​ Yes

​ No

d. If not, what challenges did you face?

10. Have you received medical treatment since your ​ Yes​ - Diabetes/heart If No, Skip Q10a
diagnosis? From whom did you get this disease/Hypertension
treatment- formal/informal physicians( local ​ No
healing practitioners)? ​ Not willing to tell
_______________________________
__________________________

10a. If yes. Specify the treatment type:

1.​ Name:
2.​ Duration of the treatment:
3.​ Frequency:
4.​ Dose of the medication, if any:
5.​ Where are you getting this treatment?
11. Have you experienced any treatment side ​ Yes If No, Skip to
effects? ​ No Q11a
​ Not sure
11a. If yes, what are the side effects you faced during
and after treatment, please specify
_____________________
12. Has the treatment changed over a period of ​ Yes
time? ​ No

13. Do you self-manage these conditions at home? ​ Yes If No, Skip Q13a
​ No
13a. If so, please describe the type of
self-management you have modified for
diabetes/heart disease/Hypertension at home.
Specify……………….
a. Type of self-management

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 b. Frequency
(like increased walking, healthy eating,
avoiding junk food, restricting salt and/or sugar
in diet, medication, increased sleep, alternative
treatment)
14. Have you had any challenges with If No, skip 14a.
self-management?
14a If yes, please specify what type of challenges
you have faced

Behaviour modification and lifestyle choices

15. How do you maintain your dietary habits in

day-to-day life? (Prompt: What factors shape
your Dietary habits daily? Is it fixed
work/school lunch hours, work timings, fasting,
etc?

16. Do you consume alcohol? ​ Yes If No, skip Q16a.

​ No
16a. How frequently do you consume alcohol? ​ Daily
​ Occasionally
​ Weekly
​ Monthly
17. Do you smoke? ​ Yes If No, skip to 18a
​ No
17a. How frequently do you smoke? ​ Daily
​ Occasionally
17b How many cigarettes/bidis do you smoke? ……..
.
18a Do you find it necessary to add sugar to your ​ Yes If No, skip Q18b.
beverages (juice/tea/coffee)? ​ No
18b State the reason you add additional sugar
.
19. Do you find it necessary to add additional salt ​ Yes If No, skip to 19a.
into your meals (Prompt: Sprinkle table ​ No
salt/pickle/papad)
19a. State the reason you add additional salt

20. Do you always end a meal with a sweet dish? ​ Always

​ Very often
​ Sometimes
​ Rarely
​ Never

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21 Do you consume food from outside? ​ Yes If No, Skip to
​ No Q21a.
21a. How frequently do you consume outside food? ​ Once a week
​ Twice a week
​ Thrice a week
​ More than 3 times a week
​ daily
21b What motivates you to eat outside food?
. (Prompt: Time/Cost/get together)
22. Do you think these dietary choices and changes ​ Yes
you are making influence your diabetes/heart ​ No
disease,/Hypertension Conditions? ​ Not sure
​ Do not know
23. Do you consume unhealthy food when you are
bored or stressed, or upset? How often do you
do it? ​

24. Have you made any changes in the way you ​ Yes
shop at a supermarket or through online food ​ No
grocery apps(Intentionally adding less
pre-packaged foods, Avoiding processed food)
25. Do you engage in any physical activity? ​ Yes If No, Skip to
​ No Q25a & Q25b
25a. How often do you exercise? ​ Everyday
​ 4-6 times/week
​ 1-3 times/week
​ Once a month
25b What type of exercise do you do? ​ Walking
. ​ Jogging
​ Swimming
​ If any other, please
specify……………
26. Do you track your steps using an app? ​ Yes If No, skip to
​ No Q27
26a. How often do you use it per week? Frequency of use__________

27. How often do you do aerobic exercise if you are ​ Likely

diagnosed with any of these conditions? ​ Neutral
(Aerobic exercises are: heavy yard work, ​ Unlikely
walking, swimming, running, cycling, dancing)
28. How does physical activity help with diabetes
and hypertension/and heart disease? (Improve
overall fitness or maintain the clinical reading, _______________________

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 or improve the well-being of individuals with
metabolic syndrome)
29. How has your condition affected your daily life? ​ Increased stress
​ Disrupted sleep
​ Financial burden
​ Medication difficulties
​ Lethargy
​ Others
_____________________________

Digital intervention and awareness

30. Do you use any mobile apps to manage your ​ Yes If no, skip Q 31
conditions? ​ No and 32
31a Have you taken advice from any Media source? ​ Yes If No, skip to
​ No Q31b
31b Preferred mode of information delivery? ​ SMS
​ Phone call
​ Video message
​ WhatsApp message
​ Others ……..

31c Topic of advice/education ​ Diet

​ Physical activity
​ Sleep
​ Stress reduction
​ Weight management
​ others

31d Were you able to implement the advice you ​ Yes If yes, skip 33d
sought? ​ No

31e. If not, what are the challenges you faced in

implementing?
32a Do you want to know more about ​ Yes
self-management of diabetes/heart ​ No
disease,/Hypertension?
32b How frequently would you like to receive the ​ Daily
information? ​ Weekly
​ Twice a week
​ Bi-weekly
​ Others

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32c If yes, on what topic do you like to obtain the ​ Diet
information? ​ Physical activity
​ Sleep
​ Stress reduction
​ Weight management
​ others

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