It was a cross-sectional evaluative study to assess the implementation of the performance of the communication plan developed by the PreDiBe project for behaviour change in people at risk of Type 2 diabetes. This performance was evaluated by combining the elements of two health assessment models. The New public Management model [13] which takes into account the effect, effectiveness, efficiency and satisfaction of all stakeholders of an programme and the Donabedian Model [14] includes the sub variables which are: the structure, process and results, the evolution of the political, economic, cultural and social environment.

· At the structure level

The study focuses on the resources used for the programme implementation:

- Financial resources;

- Human Resources;

- Infrastructure;

- Management material;

- Technical tools was described in Table 1;

- Communication tools;

- Technical equipment.

· At the process level

The study focused on the activities carried out, the beneficiaries of the study and the collaboration between the participants and the beneficiaries:

1)Management activities

They concerned:

- The research team setting up;

- The management team setting up;

- The technical team setting up;

- The resource mobilization;

- The drafting of activity reports.

2)Technical activities

Its consist to:

- The training of participants;

- The monitoring of participants;

- The nutritional education for Target groups by nutritionists (the use of educational fact sheets and activity monitoring sheets);

- The culinary demonstrations that were carried out for the target groups by nutritionists (technical diagrams and activity tracker);

- The physical activity practice that was carried out for the target groups by the sports teachers (physical activity program sheet and Activity Monitoring Sheet);

- The coaching of the beneficiaries that was carried out by nutritionists and peer educators (Activity Monitoring Sheet).

3) The beneficiaries of the programme are people at risk of Type 2 diabetes who are sensitized and trained to participate in the programme package (follow-up sheet of participants at the beginning and at the end of each activity session).

4)Collaboration between participants and beneficiaries

The relationship between the project participants and the beneficiaries was also considered.

· Results level

The study focuses on the level of improvement in the knowledge of the participants and the project targets, the motivation of the leaders, the evolution of the number of participants in the sessions, the percentage of targets that participated in all the activity sessions, then the changes achieved in the level of nutrition education and physical activity activities, the effectiveness of the implementation of the communication plan, the efficiency of the implementation of the communication plan, and then the satisfaction of the beneficiaries, participants, political-administrative authorities and taxpayers.

· At the level of the political and socio-cultural environment

The political and administrative actors of the Tchaourou commune were involved in the implementation of the communication plan. These are the communal development committee and the communal Development Council, the Kings and traditional Chiefs.

Sampling method

The choice of target populations for the study was based on the probabilistic method.

Sampling Technique

Exhaustive selection was used for the financial resources, technical tools, and communication tools. For Human Resources, the choice of the participants in the programme was reasoned while the convenience choice was used to select the beneficiaries of the programme package. The comprehensive choice was used for all programme activities.

Sample size

*For structure

The process evaluation sample consisted of:

- Three sources of funding (World Diabetes Foundation, Comlan Alfred Quenum Regional Institute of Public Health, Community of Tchaourou);

- The research team of five researchers;

- Three project managers (one project manager, one project coordinator);

- 15 political-administrative and religious authorities (the mayor of the commune, the first Deputy Mayor, the second Deputy Mayor, the General Secretary of the Commune, the coordinator of social promotion, four village chiefs, one King, four religious Chiefs);

- 52 participants in the programme (four nutritionists, two sports teachers, 35 health workers, a social worker, ten peer educators);

- Two infrastructures (an office at the town hall, a housing for nutritionists);

- One project document, 12 activity reports;

- 212 technical tools (4 growth charts, 4 scales, 4 tensiometers, 4 impedance meters, 4 feelers, 6 kitchen utensils - 10 fireplaces, 10 sets of pans, 10 buckets, 10 ladles, 10 skimmers - 4 sports grounds, 9 tape recorders, 90 sports outfits, 9 popular local music keys/USB);

- 20 communication tools (ten picture boxes, six fact sheets of nutritional education sessions, three technical diagrams of culinary demonstration, a physical activity program sheet);

- A follow-up sheet of the beneficiaries for each type of activity (nutritional education, culinary demonstration, physical activity practice).

*For the process:

The process assessment sample consisted of:

- The establishment of three teams (research team, management team and technical team);

- The mobilization of financial resources by the WDF, the IRS and the community of Tchaourou;

- Drafting of reports;

- Training of actors (four nutritionists, two sports teachers, two health workers, one social worker, ten peer educators);

- The formation of political-administrative and religious authorities (the mayor of the commune, the first deputy mayor, the General Secretary of the town hall, four village chiefs, a king, four religious Chiefs);

- Training of the 90 beneficiaries of the programme (subjects at risk of Type 2 diabetes);

- Six quarterly nutrition education sessions and 48 weekly sessions;

- Six quarterly culinary demonstration sessions and 48 weekly sessions;

- 240 sessions of 30 minutes of individual daily physical activity;

- 52 one-hour sessions of physical activity (aerobic and abdominal movements) weekly group;

- 12 one-hour sessions (collective Walk) of monthly physical activity;

- A tracking card of beneficiaries at home;

- Supervision of participants.

*For results

For the evaluation of the results, the sample consisted of:

- 90 subjects at risk, beneficiaries of the program;

- Four nutritionists;

- Two sports teachers;

- 35 health workers;

- A social worker;

-10 pairs-educators;

-12 political-administrative and religious authorities.

The Variables study

The main variable in this study was the performance of the communication plan implementation for the behaviour change based on the identified modifiable behaviours. It consisted of the following sub-variables:

- The structure performance;

- The process performance;

- The Results performance.

The sub-variable “the structure performance” is made up of the following components: financial support, human resources (the participants of the programme), infrastructures, management materials, technical tools, communication tools and their elements and the monitoring sheets of the different activities (Table 2).

The sub-variable “the process performance” components are: the management process quality, the technical process quality and the quality of collaboration between the project participants and beneficiaries and the elements resulting from it (Table 3).

The sub-variable “Results Performance” includes the following components and it derived elements: the competence level of: nutritionists sports teachers, peer educators, health workers, beneficiaries, the evolution of the participants number in the different activities, the obtained changes (new culinary demonstration practices,

reduction of high-calorie meals in favour of vegetables, the practice of at least 150 minutes of physical activity, per week, reduction of tobacco use and alcohol consumption) the effectiveness and efficiency of the communication plan implementation and the satisfaction of all stakeholders (Table 5). Tables 2-4 present the criteria for assessing the performance components of the communication plan implementation for behaviour change based on the identified changeable behaviours.

The process performance sub-variables of the implementation of the behaviour change communication plan (Figure 1) were operationalized through the scores assignment. Two score scales were used. A score of “1” is assigned when the criterion is present and “0” when the criterion is absent. The sum of the scores of the each component elements determines the total of each sub-variable. The assessment of the sub-variables was made according to the Varkevisser rating scale: “good” (if the score is above 80% of the highest score); “acceptable” (if the score is between 80% and 60% of the highest score) and “poor” (if the score is below 60% of the maximum score) [15]. The implementation performance of the behaviour change communication plan was obtained by summing the scores of the three sub-variables. Thus, the total score for the “structure performance” sub-variable is 0 to 26 (Table 2); 0 to 34 for the “process performance” sub-variable (Table 3) and 0 to 20 for the “outcome performance” sub-variable (Table 4).

The guideline was approved by the ethics committee of the Benin Ministry of Health, the authorization of the coordinator of the Tchaourou Regional hospital and the communal administrative authorities.

The observation of the analysis document, transcription of semi-structured interviews and group discussions helped for the development of a detailed programme account. The implementation performance of the communication plan was assessed by summing the scores of the three sub-variables of the main variable. The activities achievement level was assessed by Varkevisser standards.

Commentary on the Conceptual Framework

The implementation performance of the communication plan for behaviour change communication in subjects at risk of type 2 diabetes was achieved through structure performance, process performance and outcome performance while taking into account the political, economic, social and cultural environment.

· Improving health well-being: “Ms. Kochoni Marthe is a support group leader called Iwossan (which means Healing in ‘Nago’ a local language) from the Tchalla district of the village of Tchaourou centre. Before the project started in May 2015, she was overweight and unwell, and was taking medication to help her recover. During the activity sessions, explanations and advice were given on the disease and its management. So she committed herself to mobilizing the group members for the effective implementation of the lessons learned during the educational and physical activity sessions. Since then, she has been organizing herself and the others to play sports on the basketball court of the Tchaourou stadium every day. She feels lighter every time she comes back from sport. I have stopped taking my medication since then and my weight has gone down; I’m very happy.” she says!

· Changing cooking habits: “Mrs. CODO Prisca is a member of the group called Fifamè (which means in Peace) from Sinankpassor district of the village Tchatchou centre. She says: before the project arrived, she used to prepare the sauce with a lot of oil. Moreover, she supported the idea that it is the oil that makes a good vegetable sauce. She also used enough salt. ‘I noticed that a spoonful of oil was added to the sauce at the end of cooking. Also the onion was used to precook the leaves. The cube (sodium glutamate) was replaced by mustard, shrimp and small fish as well as garlic. I repeated the same way of cooking at home and to a group of teachers. The teachers liked it and it saves me money. I’ll adopt this way of cooking forever because my whole family will be healthy.’”

The commitment of the mayor of the commune and his council to work for social mobilization for the diabetes prevention activities: “I commit,” said the Mayor of Tchaourou during the advocacy workshop, “to make funds available from the communal budget to organize an awareness session for the commune’s 2000relays and village nutrition committees on the signs, risk factors of diabetes and means of prevention, in order to support mobilization; I support this project 100%”.

“I’m General Secretary of the Commune. I didn’t know the risk factors for diabetes. Following the screening organised by Dr AZANDJEME at the beginning of the project, I was classified as a high-risk subject for diabetes. I was also hypertensive. I had been prescribed bundles of medication. But I started to review my diet and balance it by eating vegetables and fruits. I started dancing early in the morning from midnight to two o’clock or sometimes from two to four o’clock in the morning. My big belly started to shrink. I haven’t taken any medication since then. I have been saved by the coming of this project.”

I am Mrs. Suzanne OLEJAS, Project Coordinator of the World Diabetes Foundation for West Africa.

In 2016 when I visited the four programme villages after the project was set up in the department of Borgou in the commune of Tchaourou “I was very satisfied with the implementation of all the elements planned by the PreDiBe project. I did not expect such a good implementation of the project, the involvement of the local authorities and such a great commitment of the beneficiaries. I am convinced that the project will bear satisfactory fruit.”