# A type 2 hybrid effectiveness-implementation trial of Community Health Workers to improve screening for postpartum diabetes in urban slums of India

> **NIH NIH R01** · WEILL MEDICAL COLL OF CORNELL UNIV · 2024 · $606,840

## Abstract

PROJECT SUMMARY & ABSTRACT
By 2045, most of the new cases of diabetes will occur in low- and middle- income countries (LMIC) like India,
but 50% of those afflicted will not know. Improving postpartum diabetes screening for women with gestational
diabetes (GDM) – a marker of high risk for progression to type 2 diabetes (T2DM) – can help close this
diagnostic gap. This is particularly important in India, where few women with GDM receive postpartum T2DM
screening, even though 25% of women with GDM develop T2DM within the first year postpartum. Improving
T2DM screening during the critical life stages of pregnancy and postpartum will help prevent the sequelae
of untreated diabetes, including cardiovascular disease, the leading cause of death among Indian women.
In partnership with the Deep Griha Society and King Edward Memorial Hospital Research Center, we propose
a hybrid type II effectiveness-implementation cluster randomized trial to evaluate if community health workers
(CHW) can improve postpartum T2DM screening in the urban slums of Pune, India. We will screen pregnant
women living in slum communities in India for GDM during pregnancy. The slum communities will be
randomized in equal number to one of two study arms: (1) the home-based testing arm, where women with
GDM will be offered the WHO-recommended oral glucose tolerance test for T2DM screening in their homes;
and (2) the referral arm, where women with GDM will be referred for clinic-based postpartum T2DM screening.
Through a mixed-methods approach, we will determine the impact of CHW-delivered services on the uptake of
postpartum T2DM testing as well as factors pertaining to intervention implementation. Our specific aims are to:
1. Determine the uptake of postpartum T2DM screening in home testing versus referral arms
 among women with GDM in Pune, India. The primary outcome is uptake of postpartum T2DM
 screening in women with GDM. We hypothesize that 70% of women in the home testing arm will accept
 screening for T2DM within one-year postpartum compared to 45% in the referral arm
2. Evaluate implementation of the CHW-delivered programs using a convergent, mixed methods study
 design and the Consolidated Framework for Implementation Research (CFIR). We will collect
 qualitative and quantitative data from Aim 1 participants with GDM in both study arms, as well as from
 CHW, clinical staff, and Ministry of Health Officials to systematically evaluate CFIR Domains.
This will be the first study to determine if trained CHW can improve postpartum T2DM screening in urban
Indian slums. The results of this study will improve uptake of postpartum T2DM screening, identify low-income
women at the highest risk of postpartum T2DM in India, and potentially identify novel approaches for improving
postpartum screening for other diseases in low- and middle-income countries, in line with the NIH PAR-22-132.

## Key facts

- **NIH application ID:** 10930835
- **Project number:** 5R01HD112141-02
- **Recipient organization:** WEILL MEDICAL COLL OF CORNELL UNIV
- **Principal Investigator:** Jyoti S Mathad
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2024
- **Award amount:** $606,840
- **Award type:** 5
- **Project period:** 2023-09-18 → 2028-08-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10930835

## Citation

> US National Institutes of Health, RePORTER application 10930835, A type 2 hybrid effectiveness-implementation trial of Community Health Workers to improve screening for postpartum diabetes in urban slums of India (5R01HD112141-02). Retrieved via AI Analytics 2026-05-27 from https://api.ai-analytics.org/grant/nih/10930835. Licensed CC0.

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