Effectiveness of a female community health volunteer-led physical activity education intervention on accelerometer-derived outcomes in semi-urban Nepal: an open-label, cluster randomised controlled trial

Abstract

Physical inactivity is a growing public health challenge in low- and middle-income countries (LMICs), yet evidence on scalable, community-based interventions remains limited. We evaluated the effectiveness of a Female Community Health Volunteers (FCHVs)-led, home-based educational programme in promoting physical activity in semi-urban Nepal. We conducted a six-month, open-label, cluster-randomised controlled trial among adults in 14 wards of Pokhara, Nepal, with seven clusters each assigned to intervention or control. Trained FCHVs made three home visits, one per month, delivering two-hour sessions promoting physical activity, using materials co-designed with guidance from the Theory of Planned Behaviour. The main outcome was the change in daily device-measured moderate-to-vigorous physical activity (MVPA) from baseline to follow-up. Among 264 participants (132 in the intervention arm and 132 in the control arm; mean age 49.6 years; 67.5% women) in intention-to-treat analysis, device-measured MVPA declined over six months. However, compared with the control group, the intervention group had a 9.80 min/day smaller decline in non-bout MVPA (95% CI: 0.41–19.18; p = 0.041) and a 4.53 min/day smaller decline in MVPA accumulated in ≥ 10-min bouts (95% CI: 0.29–8.77; p = 0.036). Positive effects were observed in between-group average acceleration (+ 1.84 mg, p = 0.035). Although MVPA declined in both groups over six months, the FCHV-led, home-based educational intervention attenuated this decline compared to usual care. These findings suggest that existing health volunteer-led education may contribute to maintaining physical activity levels in semi-urban populations. Trial registration clinicaltrials.gov Identifier: NCT06386692.