Structured Lifestyle Modification Interventions Involving Frontline Health Workers for Population-Level Blood
Dimple Kondal1,2, Panniyammakal Jeemon2,3, Sathyaprakash Manimunda4
1Public Health Foundation of India Centre for Control of Chronic Conditions Gurugram Haryana India.
Journal of the American Heart Association
|March 1, 2022
Summary
Task-sharing with frontline health workers did not reduce population blood pressure in India. More intensive training for health professionals may be needed for effective cardiovascular disease prevention.
Area of Science:
- Public Health
- Cardiovascular Disease Prevention
- Health Workforce Research
Background:
- Population-wide blood pressure reduction is crucial for primary prevention of cardiovascular disease.
- Task-sharing strategies involving frontline health workers are being explored to achieve this goal.
- The effectiveness of such strategies in diverse settings like India requires rigorous evaluation.
Purpose of the Study:
- To evaluate the effectiveness of a task-sharing strategy using frontline health workers for the primary prevention of elevated blood pressure in India.
- To assess the impact of a structured lifestyle modification intervention delivered by Anganwadi Workers and Accredited Social Health Activists (ASHAs).
Main Methods:
- A cluster randomized controlled trial (DISHA study) was conducted across 4 Indian states.
- The study involved 12 villages per state, with frontline health workers delivering a lifestyle intervention.
- Baseline and post-intervention surveys (18 months) were conducted on large participant groups in control and intervention clusters.
Main Results:
- Systolic blood pressure increased slightly in both control and intervention groups over 18 months.
- The mean systolic blood pressure change in control clusters was 0.4 mm Hg, and in intervention clusters was 2.3 mm Hg.
- The population average adjusted mean difference in systolic blood pressure change was 1.75 mm Hg, not statistically significant.
Conclusions:
- Task-sharing interventions with minimally trained non-physician health workers were ineffective in reducing population average blood pressure in this Indian setting.
- Expanding task sharing to include more intensively trained professionals like nurses or nutritionists may be more effective for population-level cardiovascular risk management.
- Further research into optimized health worker roles and training is needed for effective primary prevention of cardiovascular disease.
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