Three-I framework for health promotion of lifestyle disorders

Lifestyle disorders are health conditions that are linked with the way people live their life. These are non-communicable and pose a formidable challenge to healthcare systems despite being potentially preventable. The role of interns thus extends beyond therapeutic management to encompass health promotion, prevention, and community engagement.¹ Unfortunately, there is lack of comprehensive and structured training curricula tailored for interns focused on preventive aspects of lifestyle disorders in India.

A needs assessment was undertaken among interns using Google Forms. After analysing the responses, a structured health promotion training module using a 3-I framework was created for lifestyle disorders: Inquire (ask about health problems); Identify (risk factors for lifestyle disorders); and Intervene (Counsel the patient appropriately). Content validity was assessed using the Delphi method with five external subject-matter experts, and a training module was built with the intention of capacity building to improve interns' skill in health promotion, which focused on hypertension, type 2 diabetes mellitus and obesity, under the following domains: understanding lifestyle disorders; physical activity promotion; substance use; nutrition education; stress management, mental well-being; behaviour change communication; individual risk-assessment and counselling; and community engagement.

A three-day training programme was then conducted with interns during the first week of their posting in the Community Medicine Department. Two batches, totalling N = 62, were trained. A pre- and post-test six-station OSCE with standardised patients was used to assess trainees. Furthermore, during interns' 3-month posting in urban and rural health and training centres, weekly random prescription audits were done to assess interns' prescribing of lifestyle modification. Feedback from the interns and faculty was also gathered using a questionnaire.

Baseline OSCE scores confirmed students' inadequate communication skills (mean = 11.5/30 ± 3.25). After training there was significant increase (mean = 19.9/30 ± 5.72; p < 0.001). Random prescription audits showed that 83% of interns were prescribing lifestyle modifications for all adult patients attending health centres. Interns accepted the training using the 3-I framework well and felt that learning was useful for real-patient encounters. They also suggested conducting training program during the third phase of MBBS degree with refresher training offered at the start of internship. Faculty also expressed interest in incorporating training sessions into MBBS as the training and OSCEs were thought to fit well in the existing curriculum. In sum, the 3-I framework appears to have provided a useful tool to improve students' communication skills regarding health promotion.

The study emphasises the pivotal role of integrating such comprehensive training programs into medical curricula for combating lifestyle disorders, thereby fostering future physicians as effective change agents committed to proactive health promotion who advocate for healthier lifestyles.

Prateek Bobhate: Conceptualization; methodology; data curation; formal analysis; project administration; writing – original draft; validation; investigation; software; visualization; supervision; resources. Swarupa Bhagwat: Conceptualization; methodology; validation; supervision; project administration; visualization. Saurabh Shrivastava: Methodology; investigation; validation; formal analysis; data curation; software.