INTRODUCTION:Evidence regarding the linkage between intimate partner violence (IPV) and suicidality among males is limited. This gap contributes to a siloed approach to prevention of these important public health concerns. OBJECTIVES:To examine the cross-sectional and longitudinal associations between IPV use, exposure and suicidality (suicidal ideation and attempts) among Australian adult males. METHODS:Data were drawn from the Australian Longitudinal Study on Male Health (n = 13,898), spanning baseline, two-year, and six-year follow-ups. IPV exposure and use were assessed at Wave 1. Cross-sectional associations with lifetime suicidal ideation and attempts were examined at baseline, and prospective associations with suicidal ideation and attempts in the preceding 12 months were assessed at Waves 2 and 3. Modified Poisson and logistic regression models were applied. RESULTS:At baseline, 30.3% reported IPV exposure and 23.7% reported IPV use. Both IPV exposure (RR = 1.85; 95% CI: 1.69-2.02) and IPV use (RR = 1.96; 95% CI: 1.79-2.14) were associated with lifetime suicidal ideation; each was also linked with more than twice the odds of lifetime suicide attempts. IPV exposure and use at Wave 1 prospectively predicted suicidal ideation and attempts two years later, but these associations were no longer evident at the six-year follow-up. Males reporting both IPV exposure and use had the highest risk, though combined effects were less than multiplicative. CONCLUSION:Findings highlight the need for integrated IPV and suicide-prevention approaches and suggest that targeted mental-health assessment and early intervention is needed. Addressing male suicidality needs to therefore complement, rather than compete with, IPV-prevention efforts.

IntroductionLow fruit and vegetable (FV) consumption is a major contributor to the rising burden of non-communicable diseases, yet intake in India remains far below recommended levels. Although structural barriers to healthy eating are widely documented, little is known about how perceived barriers and dietary self-efficacy influence FV intake in high-risk populations, especially in a country like India.MethodsThis study analyzed longitudinal data from 1,007 Indian adults participating in the Kerala Diabetes Prevention Program (K-DPP) in order to examine the effects of perceived barriers and dietary self-efficacy on FV intake over 9 years. Linear mixed-effects models were used to evaluate five perceived barrier domains and four dietary self-efficacy items in relation to FV intake (g/day) across four waves. Predictors were modeled categorically using the lowest-barrier and highest-efficacy groups as reference groups, with adjustment for demographic and behavioral covariates.ResultsHigher perceived barriers related to availability (β = −53.9 g/day, 95% CI [−80.7, −27.3], p < 0.001) and cost (β = −25.3 g/day, 95% CI [−46.6, −4.0], p < 0.02), along with low dietary self-efficacy in adapting to different tastes (β = −43.0 g/day, 95% CI [−76.6, −9.4], p = 0.01) were significantly associated with lower FV intake.DiscussionThese findings highlight that perceived structural constraints, particularly limited availability and affordability, are key correlates of low FV intake in this population, and may inform interventions that prioritize improving access to FVs as a foundation for sustainable dietary improvement.

OBJECTIVES:This study examined the geographical distribution, study designs, methodological quality, and key findings of research on suicide-related media content in low- and middle-income countries (LMICs). METHODS:A systematic review, narrative synthesis, and meta-analysis were conducted following PRISMA guidelines. Seven databases (MEDLINE, PsycINFO, Scopus, ProQuest, Web of Science, PubMed, and CINAHL) were searched to August 12, 2025. Eligible studies used LMIC data and addressed media reporting quality, the impact of media on behaviours or attitudes, stakeholder perspectives, or evaluation of guidelines and campaigns. Risk of bias was assessed using adapted JBI checklists and ROBINS-I. Studies examining adherence to international guidelines were meta-analysed to generate pooled estimates and heterogeneity measures by country and guideline. RESULTS:Eighty-two papers from 19 countries were included, most from South-East Asia (n =50). Research covered newspapers, online news, social media, and television, using quantitative, qualitative, and mixed methods. The majority (80%) were quantitative content analyses of newspaper reporting, others included qualitative interviews, interrupted time series, pre-post studies, and analyses of social media or internet search trends. About 65% were rated at moderate or high risk of bias. Pooled analyses of 57 studies analysing newspaper content showed high rates of harmful reporting, such as specifying the suicide method (86%), and extremely low rates of protective practices, such as including help-seeking information (<2%). CONCLUSION:Evidence on suicide and media in LMICs is expanding but remains concentrated in few countries and dominated by newspaper analyses. High levels of potentially harmful reporting and scarce helpful practices highlight urgent needs for interventions promoting more responsible media coverage.

Research on chronic suicidal thoughts and behaviors (STB) in Australia is limited. This study aimed to determine the prevalence and identify predictors of chronic STB among Australian males. A nine-year retrospective cohort study was conducted, analysing data from the first four waves of the Ten to Men Study. The study included 3,070 males who reported lifetime STB at Wave 1. Chronic STB was defined as the presence suicidal thoughts, plans, or attempts over subsequent waves. Modified Poisson and mixed-effects Poisson regression models were used to identify predictors. The prevalence of chronic suicidal thoughts and attempts were 34.5

BACKGROUND:Evidence on the long-term effectiveness of lifestyle interventions for diabetes prevention in low-income and middle-income countries is scarce. We aimed to evaluate the 9-year effect of a peer-support lifestyle intervention on the incidence of diabetes in India. METHODS:The Kerala Diabetes Prevention Program (K-DPP) was a cluster-randomised, controlled trial of a peer-support, group-based lifestyle intervention conducted in a community setting in adults aged 30-60 years at high risk for diabetes (with an Indian Diabetes Risk score ≥60 and without diabetes on an oral glucose tolerance test) in Kerala, India. Clusters (polling areas) were randomly assigned (1:1) to the intervention group or the control group. The intervention consisted of a 12-month peer-support programme delivered by trained lay peer leaders through monthly sessions. The control group received an education booklet with lifestyle change advice at baseline. Participants were followed up at 1 year, 2 years, and 9 years. Diabetes was diagnosed using American Diabetes Association criteria (fasting plasma glucose [FPG] ≥126 mg/dL [7·0 mmol/L] or glycated haemoglobin [HbA1c] ≥6·5% [48 mmol/mol]). We considered both physician-diagnosed diabetes and individuals who were initiated on antidiabetic medications during the follow-up period in the calculation of diabetes incidence. The primary outcome of the follow-up study was the cumulative incidence of diabetes at 9 years. Long-term effects were assessed using generalised linear models and generalised estimating equations. The trial was registered with the Australia and New Zealand Clinical Trials Registry (updated from the original trial, number ACTRN12611000262909) and the Clinical Trial Registry of India (CTRI/2021/10/037191), and follow-up is ongoing. FINDINGS:Between Jan 20 and Oct 27, 2013, 60 polling areas were randomly assigned to the intervention group (n=30) or the control group (n=30). 500 participants were enrolled in the intervention group and 507 were enrolled in the control group. 475 (47%) participants were female and 532 (53%) were male. 863 (86%) participants were followed up at 9 years. The cumulative incidence of diabetes was 125 (30%) of 419 in the intervention group and 142 (34%) of 422 in the control group (relative risk [RR] 0·88 [95% CI 0·73-1·08]; p=0·24). When assessed using FPG criteria alone, the incidence of diabetes was 28% lower in the intervention group than in the control group (RR 0·72 [0·53-0·98]; p=0·036). No significant subgroup differences were observed in terms of age, sex, or baseline glycaemic status. INTERPRETATION:K-DPP achieved a modest overall reduction in diabetes incidence over a 9-year period. However, the overall decrease in diabetes incidence based on FPG and HbA1c criteria was not statistically significant compared with the control group. The consistency of effects based on incidence of diabetes across subgroups supports the broad preventive potential of community-based, peer-led lifestyle interventions. FUNDING:The Australian National Health and Medical Research Council. TRANSLATION:For the Malayalam translation of the abstract see Supplementary Materials section.

BACKGROUND:Male suicide is a long-standing, inequitable health issue in Australia, with key prevention strategies based on increasing mental health services use. There is little research of the intersection of service use and men exhibiting suicidal thoughts and behaviours (STBs); we examined patterns and factors influencing service use amongst males with STBs. METHODS:Data from the Australian Longitudinal Study on Male Health was used. Our sample was males who responded to questionnaires regarding STBs and consented with sharing linked service use records (N = 8793). Chi-square tests analysed prevalence of mental health service use between males with/without experiences of lifetime STBs. Multivariate Poisson regression models analysed associations between no STBs/suicidal thoughts/suicide attempts and use/predictors of services. RESULTS:1749 (19.7 %) and 492 (5.5 %) males reported lifetime suicidal thoughts and suicide attempts respectively. Males with STBs had higher prevalences of mental health service use for 'at least once' and median number of service uses. Approximately half of males with lifetime STBs had never accessed mental health services. Males with suicidal thoughts versus attempts access services at similar rates. Factors associated with decreased service use were regional/rural locations, sexual minorities, disability, depressive symptoms and older age. LIMITATIONS:We utilised a cross-sectional analysis; further study would benefit from analysing longitudinal service use patterns. CONCLUSIONS:Males with lifetime STBs demonstrate increased mental health service use in the Australian adult male population. Large numbers of males with STBs have not engaged with mental health services. Targeted interventions should be considered to increase ensure engagement and equity of access.

INTRODUCTION:While Australian studies explore suicidal thoughts' prevalence and correlates, little is known about their first onset in unaffected individuals or the predictors and rates of remission in the general population. OBJECTIVE:The objective of the study is to determine the rates of first-onset suicidal thought and remission of suicidal thoughts among Australian males over a 9-year period and to identify predictors of these rates. METHODS:This retrospective cohort study analysed 6035 participants from the Ten to Men study over four waves spanning 9 years. Outcomes included the first onset and remission of suicidal thoughts, with predictors encompassing sociodemographic, lifestyle, substance use, mental health and social factors. Modified Poisson regression with robust errors was used to identify predictors. RESULTS:The rate of first-onset suicidal thoughts over the 9-year study period was 19.2% (95% confidence interval = [18.1%, 20.4%]). The remission rate for suicidal thoughts over the same period was 65.5% (95% confidence interval = [62.5%, 68.4%]). The onset of suicidal thoughts was linked to lower education, depressive symptoms, disability, financial stress, homosexual orientation and history of partner violence. Depressive symptoms and disability were also associated with reduced remission rates. CONCLUSION:One-fifth of males reported a first onset of suicidal thoughts, while nearly two-thirds with a history of such thoughts experienced remission over the 9-year period. Suicide prevention interventions need to prioritize males with a disability and mental health problems, as these factors both predict the first onset of suicidal ideation and reduce the rate of remission.

Introduction Cardiometabolic diseases (CMDs), the leading causes of death in low-income and middle-income countries (LMICs), are proven to be mitigated through structured lifestyle interventions (SLIs—dietary changes, physical activity, tobacco cessation and alcohol intake), but the challenge lies in scaling them up in LMICs. Therefore, we undertook a systematic review to identify the strategies, methods and outcomes used in scaling up SLI programmes to improve cardiometabolic outcomes in LMICs.Methods We searched studies implementing scale-up strategies (delivery approaches enhancing an intervention’s adoption, implementation and sustainability), methods (theories, models and frameworks) and present outcomes (feasibility, fidelity, etc) following the Proctor E framework. We searched six databases to identify studies published in English with no time restriction, guided by the Setting, Perspective, Intervention, Comparison and Evaluation framework. Quality assessment was performed using the Cochrane risk-of-bias, National Institutes of Health and Joanna Briggs Institute tools. Given the heterogeneity of the outcome measures, we conducted a narrative synthesis of the extracted information.Results Out of the 26 studies included, 18 (69%) adapted SLI interventions to suit local contexts. Strategies such as system integration, strengthening facility services and training led to up to 100% attendance of participants. Notably, only four studies (15%) used theories, models and frameworks for the full scale-up process, which is crucial for large-scale implementation in resource-limited settings. 15 (58%) studies reported the feasibility of scale-up, whereas 7 (27%) reported no significant differences in lifestyle behaviours or CMD biomarkers.Conclusions Early community and local stakeholders’ engagement is crucial for codeveloping strategies for the scale-up of SLIs. Conducting readiness assessments and system integration are all essential considerations for improving scale-up outcomes. Additionally, we strongly recommend using suitable frameworks to guide the scale-up of SLIs to maximise the benefit for the population.

Introduction and Objective: The aim of this study was to examine the 9-year effects of structured lifestyle interventions on predicted 10-year CVD risk in Asian Indians with high risk for type 2 diabetes. Methods: The Kerala Diabetes Prevention Program (K-DPP) is a cluster-randomized controlled trial conducted in Kerala, India. The study involved 1,007 individuals at high risk for type 2 diabetes, based on Indian Diabetes Risk Score of ≥60. The intervention group participated in a 12-month lifestyle education program. The primary outcome of this study was the predicted 10-year cardiovascular disease (CVD) risk, assessed using the Framingham Risk Score. Results: The mean age at baseline was 46 years and 47.2% were female. The 10-year CVD risk at baseline was similar between study arms. The follow-up rate at 9 years was 85.5%. The difference in mean changes in predicted 10-year CVD risk between the intervention and control groups at 1 year was -0.64% (95% CI: -1.23, -0.04; P=0.030) and at 2 years was -0.68% (95% CI: -1.36, -0.01; P=0.050). However, at the 9 years, there was no difference in CVD risk between the intervention and the control group; 0.16% (95% CI: -1.17, 1.48; P=0.810). Conclusion: A community-based structured lifestyle intervention program reduced CVD risk among individuals at high risk for type 2 diabetes at 1 and 2 years but this was not maintained at 9 years. This was likely due to the profound effects of serious floods and the COVID-19 pandemic in this part of India in the intervening period. G.D. Demissie: None. A. Shrestha: None. T. Haregu: None. S. Thirunavukkarasu: None. B. Oldenburg: None. National Health and Medical Research Council (Grant ID: 1160283)

Improving the sustainability of public health interventions is a priority for policymakers and program implementers. However, existing theories, models, and frameworks focus on describing constructs, processes, and measures of sustainability. Models to guide the improvement of sustainability of public health interventions are currently lacking. To develop an evidence-based model that can systematically guide the improvement of the sustainability of public health interventions. We used a systematic and multi-stage approach to iteratively develop the model. A narrative review of the sustainability literature identified key constructs relevant to the improvement mechanisms of sustainability. Identified constructs were then developed into stages and activities. We applied the resulting model to guide development of improvement strategies in four public health interventions in Southeast Asia, verifying the applicability of the model to real-life contexts. Evidence from 8 systematic reviews; 60 theories, models, and frameworks of sustainability; and 24 measures of sustainability, were used to develop the model. Expert review and real-world evaluation further refined the model. The resulting INNOVATE model has eight stages: Identify the mechanisms; Narrate determinants; Navigate strategies; Optimize the acquisition of resources; Validate strategies; Apply strategies; Tailor evaluation of the strategies; and Enhance the applied strategies and their implementation. Within each stage, there are five activities (IDEAL): Inform with quality evidence; Dedicate efforts to nurture local leaders/champions; Engage relevant stakeholders; Adapt to the local context; and Leverage tacit and local knowledge. The initial model was used to identify practical strategies for improving the sustainability of four public health interventions in Southeast Asia. By applying the five activities within each of the eight stages, the INNOVATE model can systematically guide the improvement of the sustainability of public health interventions.

The Suicide Stigma Assessment Scale is a 44-item measure of three components of public suicide stigma: stereotypes, prejudice, and discrimination. We examined the validity and reliability of the Suicide Stigma Assessment Scale for use with young adults in the Indian context. The study comprised translation and back-translation, cognitive interviews, and assessments of content validity. Scale reliability and confirmatory factor analyses were undertaken using a sample of 375 participants aged 18-29 years drawn from the general population in Chennai, India. Cronbach alpha scores indicated that the three scales (stereotypes [.76], prejudice [.71], and discrimination [.88]) each had acceptable internal consistency. All three scales had acceptable scale-level content validity ratings, and the majority of individual items (n = 33, 75%) were rated as "quite relevant" or "very relevant" by at least four of the five panel members. However, 11 items had poor item-level content validity ratings. Confirmatory factor analyses yielded mediocre model fit parameters for each of the three scales, indicating a poor fit. Further examination of internal consistency and confirmatory factor analyses at the subscale level indicated that the most promising subscales were the Weak, Distressed, Anger, and Avoidance subscales. The Suicide Stigma Assessment Scale is a novel scale developed in the United States for measuring public suicide stigma. While some of the subscales were promising, our results suggest the current full scale in its current form requires further investigation and adaptation to be a good cultural fit for use in India.

Background: Youth suicide represents a significant public health problem in India. This paper reports on the results of a large survey examining the correlates of suicidal ideation and attempts among college students in India, adopting an ideation-to-action framework. Methods: Participants (n = 8,542) were recruited from 30 universities spanning nine states of India, and they completed a self-administered questionnaire assessing the 12-month prevalence of suicidal thoughts and attempts, symptoms of depression and anxiety, non-suicidal self-injury, exposure to suicidality in others, as well as a suite of other health and social indicators. Generalised linear models were used to examine the correlates of suicidal ideation, and the correlates of suicide attempts among ideators. Results: Just over one-in-ten (12.3 %) reported suicidal ideation in the preceding 12 months, 5.2 % reported a suicide attempt and 12.2 % reported non-suicidal self-injury. Just over one-third (34.8 %) of ideators reported a suicide attempt in the past 12 months. Higher odds of a suicide attempt among ideators were observed among those who: had bad/very bad quality family relationships, were consuming greater amounts of alcohol, had used cannabis, had been exposed to suicidal ideation in others, had been exposed to the suicide death of people they had personally known, and those who had been engaging in non-suicidal self-injury. Conclusions: Our study revealed a suite of important factors that correlate with suicidality among college students in India, and our analytical approach highlights those factors that are associated with the progression from suicidal ideation to suicide attempts.

RESEARCH QUESTION:Are women who receive fertility treatment at increased risk of cardiovascular disease (CVD) hospitalization compared with women who do not? DESIGN:A retrospective cohort study of all women registered for fertility treatment at Monash IVF between 1998 and 2014. This cohort was linked to the Victorian Admitted Episodes Dataset, which contains records of all hospital admissions in the Australian state of Victoria. Age- and Index of Relative Socioeconomic Disadvantage (IRSD)-adjusted relative risks of CVD hospitalization for women who did or did not undergo fertility treatment were determined using Poisson regression. Risks were calculated overall by CVD subtype and stratified by area-based social disadvantage using IRSD fifths, number of stimulated cycles and mean oocytes per cycle. RESULTS:Of 27,262 women registered for fertility treatment, 24,131 underwent treatment and 3131 did not. No significant difference was found in risk of CVD hospitalization between treated and untreated women overall (adjusted RR 0.93, 95% 0.82 to 1.05) or by CVD subtype. The admission risk for CVD was significantly lower in treated women who had a mean of fewer than five oocytes per cycle (adjusted RR 0.80, 95% CI 0.70 to 0.92) compared with untreated women. Treated women residing in areas within the second IRSD fifth were less likely to be hospitalized for CVD compared with untreated women (age-adjusted RR 0.66, 95% CI 0.49 to 0.89). CONCLUSIONS:Fertility treatment is not associated with increased risk of CVD hospitalization. Lower risk among some subgroups of treated women may be explained by social disadvantage.

Background: The prevalence of mental health issues among youth is significantly high globally. This article presents findings from a survey that examined psychological distress, suicidal thoughts and behaviors, and health and social indicators among college students in India. Methods: The study recruited 8,542 students from 30 universities spanning nine Indian states, utilizing a questionnaire that included the Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder-7 (GAD-7) to measure depression and anxiety symptoms. It also examined the prevalence of suicidal thoughts, attempts, non-suicidal self-injury, and other health and social factors. Results: Findings indicate that 18.8% and 12.4% of students had considered suicide over their lifetime and in the past year, respectively, with 6.7% having attempted it at some point in their lives. Among those with lifetime suicidal thoughts, more than one-third (38.1%) reported having previously disclosed these thoughts to someone, with friends being the most common confidants. Furthermore, one-third (33.6%) of participants reported moderate to severe symptoms of depression, and one-quarter (23.2%) reported moderate to severe symptoms of anxiety. Conclusions: The study revealed a significant prevalence of depressive and anxiety symptoms, as well as suicidal thoughts and attempts among college students in India. The study underscores the critical need for interventions aimed at improving mental health and supporting this demographic.

BackgroundSuicide is the 10th leading cause of death among Australian males. Despite the cultural diversity in Australia, there is a significant research gap in knowledge of suicidal behavior among Australian males from ethnically and culturally diverse backgrounds. The study aimed to estimate the prevalence and risk of suicidal behaviors among Australian males based on ethnicity, with an emphasis on those from ethnic-minority backgrounds.MethodsWe used data from the first wave of the Australian Longitudinal Study on Male Health. Multiple logistic regression models were used to determine the risk of suicidal behavior (lifetime suicide attempt, lifetime suicidal ideation, recent suicidal ideation) by ethnicity.ResultsAmong ethnic minority males, Pacific Islander males also had the highest prevalence of lifetime suicide attempts (12.2%), while Middle Eastern (2.3%) and South-/North-East Asian males (2.9%) had the lowest rates. South American males had the highest recent suicidal ideation (18.2%), followed by Pacific Islanders (14.2%). The highest prevalence of lifetime suicidal thoughts was reported among males of mixed ethnicity (23.0%), followed by South American (14.6%) and Pacific Islander (13.5%) males. Most ethnic-minority groups had a lower risk of lifetime suicidal ideation compared with Australian males. Evidence regarding differences in recent suicidal ideation and lifetime suicide attempts between ethnic-minority and Australian-background males was inconclusive.ConclusionEvidence was found of differences in suicidal behaviors among Australian males based on ethnicity. Future research should use inclusive methodologies to confirm these associations and explore the underlying factors contributing to higher rates of suicidal behavior in specific populations.

India grapples with a formidable health challenge, with an estimated 315 million adults afflicted with hypertension and 100 million living with diabetes mellitus. Alarming statistics reveal rates for poor treatment and control of hypertension and diabetes. In response to these pressing needs, the Community Control of Hypertension and Diabetes (CoCo-HD) program aims to implement structured lifestyle interventions at scale in the southern Indian states of Kerala and Tamil Nadu. This research is designed to evaluate the implementation outcomes of peer support programs and community mobilisation strategies in overcoming barriers and maximising enablers for effective diabetes and hypertension prevention and control. Furthermore, it will identify contextual factors that influence intervention scalability and it will also evaluate the program’s value and return on investment through economic evaluation. The CoCo-HD program is underpinned by a longstanding collaborative effort, engaging stakeholders to co-design comprehensive solutions that will be scalable in the two states. This entails equipping community health workers with tailored training and fostering community engagement, with a primary focus on leveraging peer supportat scale in these communities. The evaluation will undertake a hybrid type III trial in, Kerala and Tamil Nadu states, guided by the Institute for Health Improvement framework. The evaluation framework is underpinned by the application of three frameworks, RE-AIM, Normalisation Process Theory, and the Consolidated Framework for Implementation Research. Evaluation metrics include clinical outcomes: diabetes and hypertension control rates, as well as behavioural, physical, and biochemical measurements and treatment adherence. The anticipated outcomes of this study hold immense promise, offering important learnings into effective scaling up of lifestyle interventions for hypertension and diabetes control in low- and middle-income countries (LMICs). By identifying effective implementation strategies and contextual determinants, this research has the potential to lead to important changes in healthcare delivery systems. The project will provide valuable evidence for the scaling-up of structured lifestyle interventions within the healthcare systems of Kerala and Tamil Nadu, thus facilitating their future adaptation to diverse settings in India and other LMICs.

Community Health Workers (CHWs) play a crucial role in the prevention and management of noncommunicable diseases (NCDs). The COVID-19 pandemic triggered the implementation of crisis-driven responses that involved shifts in the roles of CHWs in terms of delivering services for people with NCDs. Strategically aligning these shifts with health systems is crucial to improve NCD service delivery. The aim of this review was to identify and describe COVID-19-triggered shifting roles of CHWs that are promising in terms of NCD service delivery. We searched Ovid Medline, Embase, CINAHL, Web of Science and CABI for Global Health for relevant articles published between 1 January 2020 and 22 February 2022. Studies that were conducted within a COVID-19 context and focused on the shifted roles of CHWs in NCD service delivery were included. We used Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines to report the findings. A total of 25 articles from 14 countries were included in this review. We identified 12 shifted roles of CHWs in NCD service delivery during COVID-19, which can be categorized in three dimensions: 'enhanced' role of CHWs that includes additional tasks such as medication delivery; 'extended' roles such as the delivery of NCD services at household level and in remote communities; and 'enabled' roles through the use of digital health technologies. Health and digital literacy of people with NCDs, access to internet connectivity for people with NCDs, and the social and organizational context where CHWs work influenced the implementation of the shifted roles of CHWs. In conclusion, the roles of CHWs have shifted during the COVID-19 pandemic to include the delivery of additional NCD services at home and community levels, often supported by digital technologies. Given the importance of the shifting roles in the prevention and management of NCDs, adaptation and integration of these shifted roles into the routine activities of CHWs in the post-COVID period is recommended.

Background Individuals at high risk for type 2 diabetes are also at an increased risk for developing cardiovascular disease (CVD). Although there are separate trials examining the effects of lifestyle interventions on absolute CVD risk among people at high risk for type 2 diabetes, a comprehensive evidence synthesis of these trials is lacking. Objective We will systematically synthesize the evidence on the effects of lifestyle interventions in reducing absolute CVD risk and CVD risk factors among people at high risk for type 2 diabetes. Methods We adhered to the PRISMA-P (Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols) statement in reporting the details of this protocol. Randomized controlled trials of diabetes prevention that examined the effects of lifestyle interventions for at least 6 months on absolute CVD risk and CVD risk factors among individuals at high risk for type 2 diabetes will be eligible. We will systematically search the MEDLINE, Embase, PsycINFO, CENTRAL, and Scopus databases and ClinicalTrials.gov using a mix of Medical Subject Headings and text words. Two authors will independently screen the abstract and title of the articles retrieved from the search, followed by full-text reviews using the inclusion and exclusion criteria and data extraction from the eligible studies. Article screening and data extraction will be performed in the Covidence software. The primary outcome will be the changes in absolute 10-year CVD risk, as estimated by risk prediction models. The secondary outcomes are the changes in CVD risk factors, including behavioral, clinical, biochemical, and psychosocial risk factors, and incidence of type 2 diabetes. Results An initial database search was conducted in July 2023. After screening 1935 articles identified through the database search, 42 articles were considered eligible for inclusion. It is anticipated that the study findings will be submitted for publication in a peer-reviewed journal by the end of 2024. Conclusions This study will provide up-to-date, systematically synthesized evidence on the effects of lifestyle interventions on absolute CVD risk and CVD risk factors among individuals at high risk for type 2 diabetes. Trial Registration PROSPERO CRD42023429869; https://tinyurl.com/59ajy7rw International Registered Report Identifier (IRRID) DERR1-10.2196/53517