Co-designing school-based diabetes prevention in Karnataka, India: A qualitative multistakeholder study of adolescent health behaviors
Tejaswini B. Darukaradhya, Krishnamurthy Jayanna, Sony Sequeira, D. V. Sampreetha, G. Hari Prakash, N. S. Shivaraj, A. R. SomashekarABSTRACT
Background:
The rising burden of type 2 diabetes among adolescents underscores the need for contextually relevant prevention strategies. Schools provide a key platform for health promotion, yet qualitative insights from low-and middle-income settings remain limited. This study explored stakeholder perceptions of factors influencing adolescent health behaviors associated with diabetes risk to inform a comprehensive school-based prevention program.
Methods:
An exploratory qualitative study was conducted in three districts of Karnataka, India. A total of 26 in-depth interviews and 14 focus group discussions were conducted with purposively sampled adolescents (12–16 years), parents, teachers, a school administrator, and an education official. Data were analyzed thematically using Braun and Clarke’s framework, with themes organized across micro, meso, and macro levels.
Results:
A total of 132 participants contributed through interviews and focus group discussions. Micro-level factors included limited health literacy, low motivation, inadequate life skills, and misconceptions. Meso-level factors encompassed the requirements for age-appropriate content, peer norms, and supportive school infrastructure. Macro-level factors reflected the lack of physical activity opportunities, local food environments, pervasive availability of unhealthy foods, and inconsistent institutional support. These determinants aligned with social cognitive theory (SCT) constructs such as behavioral capability, self-efficacy, outcome expectations, observational learning, reciprocal determinism, reinforcement, and environmental influences. These insights guided the development of a multicomponent intervention package.
Conclusion:
Stakeholder insights reveal that adolescent behaviors are shaped by individual misconceptions, peer and school influences, and broader environmental barriers. A school-based program that integrates knowledge, skills, peer support, and institutional reinforcement, guided by SCT, may offer a structured pathway for sustainable prevention.