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Family Medicine

Community Health Assessment Program in the Philippines (CHAP-P)

Diabetes is increasing dramatically in low- to middle-income countries (LMICs), much more than it is in high-income countries. It has reached epic proportions and poses a huge burden on healthcare systems worldwide. Effective interventions need to be developed to address this issue.

The Community Health Assessment Program in the Philippines (CHAP-P) adapted the Cardiovascular Health Awareness Program (CHAP), a Canadian program, to an LMIC setting, with the inclusion of a community diabetes prevention and early detection component. This intervention was trialled in the Philippines through a 5-year study and is currently being scaled up in one large region of the country. The adaptability to similar LMIC settings is also being explored.

The CHAP-P intervention is a drop-in diabetes and cardiovascular risk assessment, health promotion, and disease prevention program. Like the Canadian CHAP, CHAP-P community-based, primary care-centred, volunteer-led, and free of charge for participants. In CHAP-P, lay community health workers assess residents attending the program in community-based locations. The assessment uses a digital questionnaire, validated tools, and an automated blood pressure device. Residents at risk of developing diabetes or with elevated blood pressure are given health education, access to community resources, or referrals to local health offices to help decrease their risk factors and detect the presence of diabetes and hypertension early.

A multi-phased study (2014-2021) to adapt the intervention to the local context and evaluate its effectiveness started with understanding the adaptation to the Philippines setting through a qualitative research approach bringing in varied stakeholders. This work was followed by a series of pilot studies testing individual elements of the intervention and culminated in a 26-community cluster randomized controlled trial testing the effectiveness of the intervention and its cost-effectiveness. Results will be shared soon through publications and presentations.

The current Scale-Up study (2019-2025) aims to spread CHAP-P throughout the entire Zamboanga Peninsula, Philippines (with a population of 3.6 million), with the intervention aimed at early detection and risk management of diabetes and hypertension for adults aged 40+. We will evaluate scale-up outcomes using an implementation approach, and also include a nested trial of selected communities to see whether CHAP-P is still effective as it scales up.

CHAP-P is based on a formal partnership between the McMaster University Department of Family Medicine and the Ateneo de Zamboanga University School of Medicine (Philippines), with guidance from a Project Advisory Group of international collaborators and researchers.

Notable publications

Agarwal G, Angeles RN, Dolovich L, Kaczorowski J, Gaber J, Guenter D, Arnuco FD, Lam HY, Thabane L, O’Reilly D, Agbulos RM, Arciaga RS, Barrera J, Gregorio E, Halili S, Jalani N, Cristobal F. The Community Health Assessment Program in the Philippines (CHAP-P) diabetes health promotion program for low- to middle-income countries: study protocol for a cluster randomized controlled trial. BMC Public Health 2019; 19:682

Investigators

Nominated Principal Investigators

  • Gina Agarwal, MBBS, PhD, Department of Family Medicine, McMaster University, Canada
  • Fortunato Cristobal, MD, MPH, MHPEd, School of Medicine, Ateneo de Zamboanga University, Philippines

Principal Investigators

  • Ricardo Angeles, MD, MPH, MHPEd, PhD, Department of Family Medicine, McMaster University, Canada
  • Lisa Dolovich, PharmD, MSc, Department of Family Medicine, McMaster University, Canada
  • Janusz Kaczorowski, PhD, Department of Family and Emergency Medicine, University of Montreal, Canada

Co-Investigators

  • Rosemarie Arciaga, MD, MSc , Zamboanga Medical Research Foundation
  • Jerome Barrera, MD, School of Medicine, Ateneo de Zamboanga University
  • Elgie Gregorio, MD, MPH, School of Medicine, Ateneo de Zamboanga University
  • Dale Guenter, MD, MSc, Department of Family Medicine, McMaster University
  • Servando Halili Jr., PhD, Graduate School, Ateneo de Zamboanga University
  • Norvie Jalani, MD, MPH, Department of Health, Zamboanga Peninsula
  • Hilton Lam, PhD, Institute of Health Policy and Development Studies, University of the Philippines Manila
  • Daria O’Reilly (Health Economics), PhD, Department of Health Research Methods, Evidence, and Impact , McMaster University
  • Karl Stobbe,MD, Department of Family Medicine, McMaster University
  • Lehana Thabane (Statistics), PhD, Department of Health Research Methods, Evidence, and Impact,, McMaster University

Project Advisory Group

  • Ichsan, MD, MSc, Syiah Kuala University, Banda Aceh, Indonesia
  • Faiçal Jarraya, MD, Faculté de Médecine de Sfax, Sfax, Tunisia
  • Nusaraporn Kessomboon, Khon Kaen University, Thailand 
  • Pattapong Kessomboon, MD, Khon Kaen University, Thailand
  • Germán Málaga, MD, MSc, Universidad Peruana Cayetano Heredia, Lima, Perú
  • Lynda Redwood-Campbell, MD, MPH, Department of Family Medicine, McMaster University, Canada

Project Partners

  • Ateneo de Zamboanga University – School of Medicine; Graduate School
  • Global Alliance for Chronic Disease
  • Khon Kaen University
  • McMaster University – Department of Family Medicine; Department of Health Research Methods, Evidence, and Impact
  • Republic of the Philippines Department of Health
  • Zamboanga City Health Office
  • Zamboanga Medical Research Foundation