Implementing a lifestyle toolkit in individuals with cardiometabolic multimorbidity: study protocol for a cluster randomised, type III effectiveness–implementation trial (SHRADDHA-CMM)

Lifestyle modification, including dietary interventions, physical activity, and stress management, has proven crucial in the non-pharmacological management of cardiometabolic diseases. However, the implementation of these interventions in the context of cardiometabolic multimorbidity (CMM) within the unique demographic and cultural milieu of India is inadequately explored, despite Indians exhibiting distinct susceptibility to cardiovascular diseases. This community-based study aims to address existing knowledge gaps by implementing a culturally tailored lifestyle toolkit based on the WHO-HEARTS framework among individuals with CMM and exploring the intergenerational preventive dimension. The study adopts a two-arm non-blinded cluster randomised controlled trial (c-RCT) design to include adults diagnosed with CMM, defined by the presence of two or more of diabetes mellitus, hypertension, stroke, or coronary heart disease, aged 18 years and above, providing informed consent, and agreeing to follow-up. The trial spans the ‘Epidemiology of Non-communicable Diseases In Rural Areas’ (ENDIRA) cohort in Ernakulam, Kerala. The intervention, ‘SHRADDHA lifestyle toolkit’, integrates guidance on diet, physical activity, stress management, tobacco and alcohol cessation, and drug adherence. It leverages frontline health workers and a digital health platform for implementation. Measurements involve use of point-of-care devices and digital tools. The study duration is 24 months, with a sample size of 2000 participants distributed across 18 clusters. Statistical analysis includes repeated-measures ANOVA and multilevel models, employing an intention-to-treat approach. The study’s novelty lies in its holistic approach, addressing various facets of CMM comprehensively. Trial registration: The trial has been registered with the Clinical Trial Registry of India (CTRI) Reference Number—CTRI/2025/08/092529.