Effectiveness of a scalable group-based education and monitoring program, delivered by health workers, to improve control of hypertension in rural India : a cluster randomised controlled trial

Background: New methods are required to manage hypertension in resource-poor settings. We hypothesised that a community health worker (CHW)-led group-based education and monitoring intervention would improve control of blood pressure (BP). Methods and findings: We conducted a baseline community-bas...

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Main Authors: Gamage, Dilan Giguruwa, Riddell, Michaela A., Joshi, Rohina, Thankappan, Kavumpurathu R., Chow, Clara K., Oldenburg, Brian, Evans, Roger G., Mahal, Ajay S., Kalyanram, Kartik, Kartik, Kamakshi, Suresh, Oduru, Thomas, Nihal, Mini, Gomathyamma K., Maulik, Pallab K., Srikanth, Velandai K., Arabshahi, Simin, Varma, Ravi P., Guggilla, Rama K., D'Esposito, Fabrizio, Sathish, Thirunavukkarasu, Alim, Mohammed, Thrift, Amanda G.
Other Authors: Lee Kong Chian School of Medicine (LKCMedicine)
Format: Article
Language:English
Published: 2021
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Online Access:https://hdl.handle.net/10356/146854
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Institution: Nanyang Technological University
Language: English
id sg-ntu-dr.10356-146854
record_format dspace
institution Nanyang Technological University
building NTU Library
continent Asia
country Singapore
Singapore
content_provider NTU Library
collection DR-NTU
language English
topic Science::Medicine
Hypertension
Antihypertensives
spellingShingle Science::Medicine
Hypertension
Antihypertensives
Gamage, Dilan Giguruwa
Riddell, Michaela A.
Joshi, Rohina
Thankappan, Kavumpurathu R.
Chow, Clara K.
Oldenburg, Brian
Evans, Roger G.
Mahal, Ajay S.
Kalyanram, Kartik
Kartik, Kamakshi
Suresh, Oduru
Thomas, Nihal
Mini, Gomathyamma K.
Maulik, Pallab K.
Srikanth, Velandai K.
Arabshahi, Simin
Varma, Ravi P.
Guggilla, Rama K.
D'Esposito, Fabrizio
Sathish, Thirunavukkarasu
Alim, Mohammed
Thrift, Amanda G.
Effectiveness of a scalable group-based education and monitoring program, delivered by health workers, to improve control of hypertension in rural India : a cluster randomised controlled trial
description Background: New methods are required to manage hypertension in resource-poor settings. We hypothesised that a community health worker (CHW)-led group-based education and monitoring intervention would improve control of blood pressure (BP). Methods and findings: We conducted a baseline community-based survey followed by a cluster randomised controlled trial of people with hypertension in 3 rural regions of South India, each at differing stages of epidemiological transition. Participants with hypertension, defined as BP ≥ 140/90 mm Hg or taking antihypertensive medication, were advised to visit a doctor. In each region, villages were randomly assigned to intervention or usual care (UC) in a 1:2 ratio. In intervention clusters, trained CHWs delivered a group-based intervention to people with hypertension. The program, conducted fortnightly for 3 months, included monitoring of BP, education about hypertension, and support for healthy lifestyle change. Outcomes were assessed approximately 2 months after completion of the intervention. The primary outcome was control of BP (BP < 140/90 mm Hg), analysed using mixed effects regression, clustered by village within region and adjusted for baseline control of hypertension (using intention-to-treat principles). Of 2,382 potentially eligible people, 637 from 5 intervention clusters and 1,097 from 10 UC clusters were recruited between November 2015 and April 2016, with follow-up occurring in 459 in the intervention group and 1,012 in UC. Mean age was 56.9 years (SD 13.7). Baseline BP was similar between groups. Control of BP improved from baseline to follow-up more in the intervention group (from 227 [49.5%] to 320 [69.7%] individuals) than in the UC group (from 528 [52.2%] to 624 [61.7%] individuals) (odds ratio [OR] 1.6, 95% CI 1.2–2.1; P = 0.001). In secondary outcome analyses, there was a greater decline in systolic BP in the intervention than UC group (−5.0 mm Hg, 95% CI −7.1 to −3.0; P < 0.001) and a greater decline in diastolic BP (−2.1 mm Hg, 95% CI −3.6 to −0.6; P < 0.006), but no detectable difference in the use of BP-lowering medications between groups (OR 1.2, 95% CI 0.8–1.9; P = 0.34). Similar results were found when using imputation analyses that included those lost to follow-up. Limitations include a relatively short follow-up period and use of outcome assessors who were not blinded to the group allocation. Conclusions: While the durability of the effect is uncertain, this trial provides evidence that a low-cost program using CHWs to deliver an education and monitoring intervention is effective in controlling BP and is potentially scalable in resource-poor settings globally.
author2 Lee Kong Chian School of Medicine (LKCMedicine)
author_facet Lee Kong Chian School of Medicine (LKCMedicine)
Gamage, Dilan Giguruwa
Riddell, Michaela A.
Joshi, Rohina
Thankappan, Kavumpurathu R.
Chow, Clara K.
Oldenburg, Brian
Evans, Roger G.
Mahal, Ajay S.
Kalyanram, Kartik
Kartik, Kamakshi
Suresh, Oduru
Thomas, Nihal
Mini, Gomathyamma K.
Maulik, Pallab K.
Srikanth, Velandai K.
Arabshahi, Simin
Varma, Ravi P.
Guggilla, Rama K.
D'Esposito, Fabrizio
Sathish, Thirunavukkarasu
Alim, Mohammed
Thrift, Amanda G.
format Article
author Gamage, Dilan Giguruwa
Riddell, Michaela A.
Joshi, Rohina
Thankappan, Kavumpurathu R.
Chow, Clara K.
Oldenburg, Brian
Evans, Roger G.
Mahal, Ajay S.
Kalyanram, Kartik
Kartik, Kamakshi
Suresh, Oduru
Thomas, Nihal
Mini, Gomathyamma K.
Maulik, Pallab K.
Srikanth, Velandai K.
Arabshahi, Simin
Varma, Ravi P.
Guggilla, Rama K.
D'Esposito, Fabrizio
Sathish, Thirunavukkarasu
Alim, Mohammed
Thrift, Amanda G.
author_sort Gamage, Dilan Giguruwa
title Effectiveness of a scalable group-based education and monitoring program, delivered by health workers, to improve control of hypertension in rural India : a cluster randomised controlled trial
title_short Effectiveness of a scalable group-based education and monitoring program, delivered by health workers, to improve control of hypertension in rural India : a cluster randomised controlled trial
title_full Effectiveness of a scalable group-based education and monitoring program, delivered by health workers, to improve control of hypertension in rural India : a cluster randomised controlled trial
title_fullStr Effectiveness of a scalable group-based education and monitoring program, delivered by health workers, to improve control of hypertension in rural India : a cluster randomised controlled trial
title_full_unstemmed Effectiveness of a scalable group-based education and monitoring program, delivered by health workers, to improve control of hypertension in rural India : a cluster randomised controlled trial
title_sort effectiveness of a scalable group-based education and monitoring program, delivered by health workers, to improve control of hypertension in rural india : a cluster randomised controlled trial
publishDate 2021
url https://hdl.handle.net/10356/146854
_version_ 1759853933333839872
spelling sg-ntu-dr.10356-1468542023-03-05T16:47:26Z Effectiveness of a scalable group-based education and monitoring program, delivered by health workers, to improve control of hypertension in rural India : a cluster randomised controlled trial Gamage, Dilan Giguruwa Riddell, Michaela A. Joshi, Rohina Thankappan, Kavumpurathu R. Chow, Clara K. Oldenburg, Brian Evans, Roger G. Mahal, Ajay S. Kalyanram, Kartik Kartik, Kamakshi Suresh, Oduru Thomas, Nihal Mini, Gomathyamma K. Maulik, Pallab K. Srikanth, Velandai K. Arabshahi, Simin Varma, Ravi P. Guggilla, Rama K. D'Esposito, Fabrizio Sathish, Thirunavukkarasu Alim, Mohammed Thrift, Amanda G. Lee Kong Chian School of Medicine (LKCMedicine) Centre for Population Health Sciences Science::Medicine Hypertension Antihypertensives Background: New methods are required to manage hypertension in resource-poor settings. We hypothesised that a community health worker (CHW)-led group-based education and monitoring intervention would improve control of blood pressure (BP). Methods and findings: We conducted a baseline community-based survey followed by a cluster randomised controlled trial of people with hypertension in 3 rural regions of South India, each at differing stages of epidemiological transition. Participants with hypertension, defined as BP ≥ 140/90 mm Hg or taking antihypertensive medication, were advised to visit a doctor. In each region, villages were randomly assigned to intervention or usual care (UC) in a 1:2 ratio. In intervention clusters, trained CHWs delivered a group-based intervention to people with hypertension. The program, conducted fortnightly for 3 months, included monitoring of BP, education about hypertension, and support for healthy lifestyle change. Outcomes were assessed approximately 2 months after completion of the intervention. The primary outcome was control of BP (BP < 140/90 mm Hg), analysed using mixed effects regression, clustered by village within region and adjusted for baseline control of hypertension (using intention-to-treat principles). Of 2,382 potentially eligible people, 637 from 5 intervention clusters and 1,097 from 10 UC clusters were recruited between November 2015 and April 2016, with follow-up occurring in 459 in the intervention group and 1,012 in UC. Mean age was 56.9 years (SD 13.7). Baseline BP was similar between groups. Control of BP improved from baseline to follow-up more in the intervention group (from 227 [49.5%] to 320 [69.7%] individuals) than in the UC group (from 528 [52.2%] to 624 [61.7%] individuals) (odds ratio [OR] 1.6, 95% CI 1.2–2.1; P = 0.001). In secondary outcome analyses, there was a greater decline in systolic BP in the intervention than UC group (−5.0 mm Hg, 95% CI −7.1 to −3.0; P < 0.001) and a greater decline in diastolic BP (−2.1 mm Hg, 95% CI −3.6 to −0.6; P < 0.006), but no detectable difference in the use of BP-lowering medications between groups (OR 1.2, 95% CI 0.8–1.9; P = 0.34). Similar results were found when using imputation analyses that included those lost to follow-up. Limitations include a relatively short follow-up period and use of outcome assessors who were not blinded to the group allocation. Conclusions: While the durability of the effect is uncertain, this trial provides evidence that a low-cost program using CHWs to deliver an education and monitoring intervention is effective in controlling BP and is potentially scalable in resource-poor settings globally. Published version 2021-03-18T06:54:57Z 2021-03-18T06:54:57Z 2020 Journal Article Gamage, D. G., Riddell, M. A., Joshi, R., Thankappan, K. R., Chow, C. K., Oldenburg, B., Evans, R. G., Mahal, A. S., Kalyanram, K., Kartik, K., Suresh, O., Thomas, N., Mini, G. K., Maulik, P. K., Srikanth, V. K., Arabshahi, S., Varma, R. P., Guggilla, R. K., D'Esposito, F., ...Thrift, A. G. (2020). Effectiveness of a scalable group-based education and monitoring program, delivered by health workers, to improve control of hypertension in rural India : a cluster randomised controlled trial. PLoS Medicine, 17(1). https://dx.doi.org/10.1371/journal.pmed.1002997 1549-1277 https://hdl.handle.net/10356/146854 10.1371/journal.pmed.1002997 31895945 2-s2.0-85077444289 1 17 en PLoS Medicine © 2020 The Author(s). This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. application/pdf