ASHA-Led Community-Based Groups to Support Control of Hypertension in Rural India Are Feasible and Potentially Scalable
Background: To improve the control of hypertension in low- and middle-income countries, we trialed a community-based group program co-designed with local policy makers to fit within the framework of India's health system. Trained accredited social health activists (ASHAs), delivered the program...
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Frontiers Media S.A.
2021
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oai:doaj.org-article:7139c911224c46e2b68391763a68cd252021-11-22T05:04:24ZASHA-Led Community-Based Groups to Support Control of Hypertension in Rural India Are Feasible and Potentially Scalable2296-858X10.3389/fmed.2021.771822https://doaj.org/article/7139c911224c46e2b68391763a68cd252021-11-01T00:00:00Zhttps://www.frontiersin.org/articles/10.3389/fmed.2021.771822/fullhttps://doaj.org/toc/2296-858XBackground: To improve the control of hypertension in low- and middle-income countries, we trialed a community-based group program co-designed with local policy makers to fit within the framework of India's health system. Trained accredited social health activists (ASHAs), delivered the program, in three economically and developmentally diverse settings in rural India. We evaluated the program's implementation and scalability.Methods: Our mixed methods process evaluation was guided by the United Kingdom Medical Research Council guidelines for complex interventions. Meeting attendance reports, as well as blood pressure and weight measures of attendees and adherence to meeting content and use of meeting tools were used to evaluate the implementation process. Thematic analysis of separate focus group discussions with participants and ASHAs as well as meeting reports and participant evaluation were used to investigate the mechanisms of impact.Results: Fifteen ASHAs led 32 community-based groups in three rural settings in the states of Kerala and Andhra Pradesh, Southern India. Overall, the fidelity of intervention delivery was high. Six meetings were delivered over a 3-month period to each of the intervention groups. The mean number of meetings attended by participants at each site varied significantly, with participants in Rishi Valley attending fewer meetings [mean (SD) = 2.83 (1.68)] than participants in West Godavari (Tukeys test, p = 0.009) and Trivandrum (Tukeys test, p < 0.001) and participants in West Godavari [mean (SD) = 3.48 (1.72)] attending significantly fewer meetings than participants in Trivandrum [mean (SD) = 4.29 (1.76), Tukeys test, p < 0.001]. Culturally appropriate intervention resources and the training of ASHAs, and supportive supervision of them during the program were critical enablers to program implementation. Although highly motivated during the implementation of the program ASHA reported historical issues with timely remuneration and lack of supportive supervision.Conclusions: Culturally appropriate community-based group programs run by trained and supported ASHAs are a successful and potentially scalable model for improving the control of hypertension in rural India. However, consideration of issues related to unreliable/insufficient remuneration for ASHAs, supportive supervision and their formal role in the wider health workforce in India will be important to address in future program scale up.Trial Registration: Clinical Trial Registry of India [CTRI/2016/02/006678, Registered prospectively].Michaela A. RiddellMichaela A. RiddellG. K. MiniG. K. MiniRohina JoshiRohina JoshiRohina JoshiAmanda G. ThriftRama K. GuggillaRoger G. EvansKavumpurathu R. ThankappanKavumpurathu R. ThankappanKate ChalmersClara K. ChowClara K. ChowClara K. ChowAjay S. MahalAjay S. MahalKartik KalyanramKamakshi KartikOduru SureshOduru SureshNihal ThomasPallab K. MaulikPallab K. MaulikVelandai K. SrikanthVelandai K. SrikanthSimin ArabshahiRavi P. VarmaFabrizio D'EspositoBrian OldenburgBrian OldenburgFrontiers Media S.A.articlehypertension controlself-managementcommunity-basedtask-shiftingimplementation evaluationaccredited social health activistMedicine (General)R5-920ENFrontiers in Medicine, Vol 8 (2021) |
| institution |
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| collection |
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| language |
EN |
| topic |
hypertension control self-management community-based task-shifting implementation evaluation accredited social health activist Medicine (General) R5-920 |
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hypertension control self-management community-based task-shifting implementation evaluation accredited social health activist Medicine (General) R5-920 Michaela A. Riddell Michaela A. Riddell G. K. Mini G. K. Mini Rohina Joshi Rohina Joshi Rohina Joshi Amanda G. Thrift Rama K. Guggilla Roger G. Evans Kavumpurathu R. Thankappan Kavumpurathu R. Thankappan Kate Chalmers Clara K. Chow Clara K. Chow Clara K. Chow Ajay S. Mahal Ajay S. Mahal Kartik Kalyanram Kamakshi Kartik Oduru Suresh Oduru Suresh Nihal Thomas Pallab K. Maulik Pallab K. Maulik Velandai K. Srikanth Velandai K. Srikanth Simin Arabshahi Ravi P. Varma Fabrizio D'Esposito Brian Oldenburg Brian Oldenburg ASHA-Led Community-Based Groups to Support Control of Hypertension in Rural India Are Feasible and Potentially Scalable |
| description |
Background: To improve the control of hypertension in low- and middle-income countries, we trialed a community-based group program co-designed with local policy makers to fit within the framework of India's health system. Trained accredited social health activists (ASHAs), delivered the program, in three economically and developmentally diverse settings in rural India. We evaluated the program's implementation and scalability.Methods: Our mixed methods process evaluation was guided by the United Kingdom Medical Research Council guidelines for complex interventions. Meeting attendance reports, as well as blood pressure and weight measures of attendees and adherence to meeting content and use of meeting tools were used to evaluate the implementation process. Thematic analysis of separate focus group discussions with participants and ASHAs as well as meeting reports and participant evaluation were used to investigate the mechanisms of impact.Results: Fifteen ASHAs led 32 community-based groups in three rural settings in the states of Kerala and Andhra Pradesh, Southern India. Overall, the fidelity of intervention delivery was high. Six meetings were delivered over a 3-month period to each of the intervention groups. The mean number of meetings attended by participants at each site varied significantly, with participants in Rishi Valley attending fewer meetings [mean (SD) = 2.83 (1.68)] than participants in West Godavari (Tukeys test, p = 0.009) and Trivandrum (Tukeys test, p < 0.001) and participants in West Godavari [mean (SD) = 3.48 (1.72)] attending significantly fewer meetings than participants in Trivandrum [mean (SD) = 4.29 (1.76), Tukeys test, p < 0.001]. Culturally appropriate intervention resources and the training of ASHAs, and supportive supervision of them during the program were critical enablers to program implementation. Although highly motivated during the implementation of the program ASHA reported historical issues with timely remuneration and lack of supportive supervision.Conclusions: Culturally appropriate community-based group programs run by trained and supported ASHAs are a successful and potentially scalable model for improving the control of hypertension in rural India. However, consideration of issues related to unreliable/insufficient remuneration for ASHAs, supportive supervision and their formal role in the wider health workforce in India will be important to address in future program scale up.Trial Registration: Clinical Trial Registry of India [CTRI/2016/02/006678, Registered prospectively]. |
| format |
article |
| author |
Michaela A. Riddell Michaela A. Riddell G. K. Mini G. K. Mini Rohina Joshi Rohina Joshi Rohina Joshi Amanda G. Thrift Rama K. Guggilla Roger G. Evans Kavumpurathu R. Thankappan Kavumpurathu R. Thankappan Kate Chalmers Clara K. Chow Clara K. Chow Clara K. Chow Ajay S. Mahal Ajay S. Mahal Kartik Kalyanram Kamakshi Kartik Oduru Suresh Oduru Suresh Nihal Thomas Pallab K. Maulik Pallab K. Maulik Velandai K. Srikanth Velandai K. Srikanth Simin Arabshahi Ravi P. Varma Fabrizio D'Esposito Brian Oldenburg Brian Oldenburg |
| author_facet |
Michaela A. Riddell Michaela A. Riddell G. K. Mini G. K. Mini Rohina Joshi Rohina Joshi Rohina Joshi Amanda G. Thrift Rama K. Guggilla Roger G. Evans Kavumpurathu R. Thankappan Kavumpurathu R. Thankappan Kate Chalmers Clara K. Chow Clara K. Chow Clara K. Chow Ajay S. Mahal Ajay S. Mahal Kartik Kalyanram Kamakshi Kartik Oduru Suresh Oduru Suresh Nihal Thomas Pallab K. Maulik Pallab K. Maulik Velandai K. Srikanth Velandai K. Srikanth Simin Arabshahi Ravi P. Varma Fabrizio D'Esposito Brian Oldenburg Brian Oldenburg |
| author_sort |
Michaela A. Riddell |
| title |
ASHA-Led Community-Based Groups to Support Control of Hypertension in Rural India Are Feasible and Potentially Scalable |
| title_short |
ASHA-Led Community-Based Groups to Support Control of Hypertension in Rural India Are Feasible and Potentially Scalable |
| title_full |
ASHA-Led Community-Based Groups to Support Control of Hypertension in Rural India Are Feasible and Potentially Scalable |
| title_fullStr |
ASHA-Led Community-Based Groups to Support Control of Hypertension in Rural India Are Feasible and Potentially Scalable |
| title_full_unstemmed |
ASHA-Led Community-Based Groups to Support Control of Hypertension in Rural India Are Feasible and Potentially Scalable |
| title_sort |
asha-led community-based groups to support control of hypertension in rural india are feasible and potentially scalable |
| publisher |
Frontiers Media S.A. |
| publishDate |
2021 |
| url |
https://doaj.org/article/7139c911224c46e2b68391763a68cd25 |
| work_keys_str_mv |
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