Low-cost intervention by community health workers can help reduce blood pressure in rural areas

In what could come as a big boost to control of hypertension in rural areas of the country, a new study has provided fresh evidence that a low-cost education and monitoring intervention delivered by community health workers is effective in controlling blood pressure and is potentially scalable in resource-poor settings in India and globally.

The study entitled “Control of Hypertension in rural India” was conducted in three diverse regions of rural India – Trivandrum region in Kerala, in the Rishi Valley region located in Chittoor district and in the West Godavari district of Andhra Pradesh and involved community health workers providing training and support to people living in villages.

Researchers from Monash University, the George Institute for Global Health, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Rishi Valley Rural Health Centre, Melbourne University and Christian Medical College, Vellore, were involved in the study. The study was funded by Australia’s National Health Research and Medical Council (NHMRC) through the Global Alliance for Chronic Disease (GACD).

Prof Amanda Thrift, Principal Investigator of the study stated that many regions of the world have inadequate or inaccessible health resources and health professionals to diagnose, monitor or manage hypertension. The results from this study now suggest that this gap could potentially be addressed by using non-physician community health workers (CHWs), who reside in the community and are available in sufficient numbers.”

“Our approach overcomes limitations in access to healthcare by utilising a health workforce that is available and embedded in the community and requires basic training and monitoring,” says Associate Prof Rohina Joshi, Head of the Global Workforce Programme at the George Institute for Global Health, adding that “this potentially low-cost strategy is scalable for use in other resource-constrained settings.”

The study, which was in the form of a cluster randomised controlled pilot trial, involved 637 participants with hypertension from five clusters who were recruited and randomised to the intervention, and 1,097 with hypertension from 10 clusters were recruited and randomised to usual care.

Every two weeks, community health workers educated people in the intervention clusters about hypertension and measured their blood pressure. Blood pressure declined an average of 5.0/2.1 mm Hg more in the intervention group than the usual care group, and control of blood pressure improved. Outcomes were assessed approximately two months after the completion of the intervention.

“This CHW led group-based education and monitoring intervention can potentially help reduce the emergence of cardiovascular diseases in low-resource settings”, says Prof KR Thankappan of Sree Chitra Tirunal Institute of Medical Sciences and Technology.

Key stakeholders such as community members, local clinicians and policymakers were involved in the shaping of the intervention programme in a number of ways. First, the results of focus group discussion and preliminary analyses of the baseline survey drove content for the educational materials. These interactions highlighted poor knowledge of hypertension and poor access to health services. Community health workers who were involved in the pilot training and local clinicians in the Rishi Valley also provided feedback on this content, enabling refinement of the educational resources. A workshop was held with policymakers and clinicians to develop the intervention in line with the country programmes.

“Our findings add to the limited research on task-shifting interventions for treating hypertension in low- and middle-income countries. In particular, we have shown that this intervention is applicable across very diverse rural settings in India,” says Dr Kartik Kalyanram from Rishi Valley Rural Health Centre.

As India strives for universal health coverage, this study demonstrates how the available health workforce and infrastructure can be utilised to deliver healthcare and improve access for better health outcomes.