1. Structured Lifestyle Modification Interventions Involving Frontline Health Workers for Population‐Level Blood Pressure Reduction: Results of a Cluster Randomized Controlled Trial in India (DISHA Study)
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Dimple Kondal, Panniyammakal Jeemon, Sathyaprakash Manimunda, Gitanjali Narayanan, Anil Jacob Purty, Prakash Chand Negi, Sulaiman Sadruddin Ladhani, Jyoti Sanghvi, Kuldeep Singh, Ajit Deshpande, Nidhi Sobti, Gurudayal Singh Toteja, Dorairaj Prabhakaran, Kashvi Kahol, Mumtaz Ali, Supriya Dwivedi, Zian Gonmei, Priyanka Gupta Bansal, Subodh Banzal, Susmit Kosta, Urvi Waghela, Dinesh Dalal, Late Narayan Suryawanshi, Garima Singh, Dleep Alawa, Kamlesh Patidar, Shankar Lal Maru, Shailendra Singh Mandloi, Varun Mandoliya, Rahul Chouhan, Laxman Singh, Harshada Bhalerao, Kranti Laxman Rayamane, Maitreyee Patwardhan, Himanshu Narendrabhai Bhatt, Yogesh Ratilal Dave, Nitaben Bharat Koriya, Ramila Lakha Sondarava, Rekhaben Vinod Thakar, Sabnam Jariya, Anjana Bhatt, Asmita Subhashbhai Vadsariya, Asheesh Shasuddin Kachi, Reena Yadav, Mehul Kariya, Hansaben Patel, Sanjay Patel, Trupti Sachin Lalya, Prabhakaran Stalin, Ramesh Chauhan, Z Singh, Yogesh Sharma, Mark Christopher, Maghida Sridhar, Sangeeta Narayanasamy, Prasanna Sundara Raju, Mehru Sudha, Radhika Devi, Shanmuga Sundari, Vanitha Arulsamy, Chinniah Devadas, Allimuthu Nasudan, Raja Rajeswaran, Manglaraj Rajasekar, Mohan Venkatesh, Jeyalakshmi Sreenivasan, Baby Rama Balakrishnan, Bakkiyalakshmi Ranganatha, Anjali Mahajan, Rajeev Merwaha, Virendra Mohan Singh Jaiswal, Sucheta Sharma, Raminder Dhiman, Ravinder Kumar, Reeta Sharma, Ravindra Thakur, Ashu Kanwar, Rama Kumari, Pratibha Sharma, Kiran Sharma, and Saurabh Thakur
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Cross-Sectional Studies ,Cardiovascular Diseases ,Hypertension ,Humans ,India ,Blood Pressure ,Hypotension ,Cardiology and Cardiovascular Medicine ,Life Style - Abstract
Background Population‐wide reduction in mean blood pressure is proposed as a key strategy for primary prevention of cardiovascular disease. We evaluated the effectiveness of a task‐sharing strategy involving frontline health workers in the primary prevention of elevated blood pressure. Methods and Results We conducted DISHA (Diet and lifestyle Interventions for Hypertension Risk reduction through Anganwadi Workers and Accredited Social Health Activists) study, a cluster randomized controlled trial involving 12 villages each from 4 states in India. Frontline health workers delivered a custom‐made and structured lifestyle modification intervention in the selected villages. A baseline survey was conducted in 23 and 24 clusters in the control (n=6663) and intervention (n=7150) groups, respectively. The baseline characteristics were similar between control and intervention clusters. In total 5616 participants from 23 clusters in the control area and 5699 participants from 24 clusters in the intervention area participated in a repeat cross‐sectional survey conducted immediately after the intervention phase of 18‐months. The mean (SD) systolic blood pressure increased from 125.7 (18.1) mm Hg to 126.1 (16.8) mm Hg in the control clusters, and it increased from 124.4 (17.8) mm Hg to 126.7 (17.5) mm Hg in the intervention clusters. The population average adjusted mean difference in difference in systolic blood pressure was 1.75 mm Hg (95% CI, −0.21 to 3.70). Conclusions Task‐sharing interventions involving minimally trained nonphysician health workers are not effective in reducing population average blood pressure in India. Expanding the scope of task sharing and intensive training of health workers such as nurses, nutritionists, or health counselors in management of cardiovascular risk at the population level may be more effective in primary prevention of cardiovascular disease. Registration URL: https://www.ctri.nic.in ; Unique identifier: CTRI/2013/10/004049.
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- 2022
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