Lifestyle interventions to reduce non-communicable disease risk in female secondary school teachers of Islamabad; a quasi-experimental mixed-methods protocol.

Background: Non-Communicable Diseases (NCDs) are rapidly increasing globally, including Pakistan. Female school teachers form a vital yet often ignored population sub-group in terms of NCDs prevalence and risk factor clustering. Despite growing burden of lifestyle associated NCDs, there is limited data on workplace based lifestyle interventions, particularly in school settings. Objective: The proposed study aims to evaluate the effectiveness of a lifestyle intervention on NCDs risk factors and their awareness in female secondary school teachers, as well as to identify the barriers and facilitators to its adoption. Methods: A quasi-experimental mixed methods study will be conducted in public secondary schools of Islamabad city, Pakistan, including both an intervention and control group. The study will be divided into three phases; baseline assessment, intervention development and implementation, and an end-line assessment. Comparisons will be made between control group and intervention groups, as well as pre and post intervention. Following the end-line assessment, in-depth interviews will be conducted on a sample of teachers to explore the barriers and facilitators to adoption of lifestyle changes. A total of 130 teachers, recruited through purposive sampling, will be divided into 2 groups of 65 in intervention and control groups each. The intervention will span 9 months, and consist of bi-weekly education and training sessions on lifestyle modifications. The sessions will include topics relevant to nutrition and physical activity, and take home resources such as sample menus, list of healthy food options etc. Primary outcomes of the study include anthropometric measurements including weight, body mass index (BMI), waist and hip circumference (WHC), waist to hip ratio (WHR). Secondary outcomes will include knowledge and awareness of NCDs and their associated risk factors. Discussion: The study aims to reduce NCDs risk factors among female teachers by incorporating tailored lifestyle interventions including both nutrition and physical activity. This study intervention can help promote overall health of working females, improve workplace wellness and foster a culture of health promotion and disease prevention in educational settings. The findings will facilitate policy-makers to generate sustainable health strategies to empower teachers to take control of their health, and build a healthier educational workforce.