Effectiveness of community-based health education and home support program to reduce blood pressure among patients with uncontrolled hypertension in Nepal: A cluster-randomized trial.

<h4>Background</h4>Hypertension is a major global public health problem. Elevated blood pressure can cause cardiovascular and kidney diseases. We assessed the effectiveness of health education sessions and home support programs in reducing blood pressure among patients with uncontrolled...

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Autores principales:	Mahesh Kumar Khanal, Pratiksha Bhandari, Raja Ram Dhungana, Pratik Bhandari, Lal B Rawal, Yadav Gurung, K N Paudel, Amit Singh, Surya Devkota, Barbora de Courten
Formato:	article
Lenguaje:	EN
Publicado:	Public Library of Science (PLoS) 2021
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/f389cb8993c5404080d91568e59f3162
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spelling	oai:doaj.org-article:f389cb8993c5404080d91568e59f31622021-12-02T20:19:18ZEffectiveness of community-based health education and home support program to reduce blood pressure among patients with uncontrolled hypertension in Nepal: A cluster-randomized trial.1932-620310.1371/journal.pone.0258406https://doaj.org/article/f389cb8993c5404080d91568e59f31622021-01-01T00:00:00Zhttps://doi.org/10.1371/journal.pone.0258406https://doaj.org/toc/1932-6203<h4>Background</h4>Hypertension is a major global public health problem. Elevated blood pressure can cause cardiovascular and kidney diseases. We assessed the effectiveness of health education sessions and home support programs in reducing blood pressure among patients with uncontrolled hypertension in a suburban community of Nepal.<h4>Methods</h4>We conducted a community-based, open-level, parallel-group, cluster randomized controlled trial in Birendranagar municipality of Surkhet, Nepal. We randomly assigned four clusters (wards) into intervention and control arms. We provided four health education sessions, frequent home and usual care for intervention groups over six months. The participants of the control arm received only usual care from health facilities. The primary outcome of this study was the proportion of controlled systolic blood pressure (SBP). The analysis included all participants who completed follow-up at six months.<h4>Results</h4>125 participants were assigned to either the intervention (n = 63) or the control (n = 62) group. Of them, 60 participants in each group completed six months follow-up. The proportion of controlled SBP was significantly higher among the intervention participants compared to the control (58.3% vs. 40%). Odds ratio of this was 2.1 with 95% CI: 1.01-4.35 (p = 0.046) and that of controlled diastolic blood pressure (DBP) was 1.31 (0.63-2.72) (p = 0.600). The mean change (follow-up minus baseline) in SBP was significantly higher in the intervention than in the usual care (-18.7 mmHg vs. -11.2 mmHg, p = 0.041). Such mean change of DBP was also higher in the intervention (-10.95 mmHg vs. -5.53 mmHg, p = 0.065). The knowledge score on hypertension improved by 2.38 (SD 2.4) in the intervention arm, which was significantly different from that of the control group, 0.13 (1.8) (p<0.001).<h4>Conclusions</h4>Multiple health education sessions complemented by frequent household visits by health volunteers can effectively improve knowledge on hypertension and reduce blood pressure among uncontrolled hypertensive patients at the community level in Nepal.<h4>Trial registration</h4>ClinicalTrial.gov: NCT02981251.Mahesh Kumar KhanalPratiksha BhandariRaja Ram DhunganaPratik BhandariLal B RawalYadav GurungK N PaudelAmit SinghSurya DevkotaBarbora de CourtenPublic Library of Science (PLoS)articleMedicineRScienceQENPLoS ONE, Vol 16, Iss 10, p e0258406 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q Mahesh Kumar Khanal Pratiksha Bhandari Raja Ram Dhungana Pratik Bhandari Lal B Rawal Yadav Gurung K N Paudel Amit Singh Surya Devkota Barbora de Courten Effectiveness of community-based health education and home support program to reduce blood pressure among patients with uncontrolled hypertension in Nepal: A cluster-randomized trial.
description	<h4>Background</h4>Hypertension is a major global public health problem. Elevated blood pressure can cause cardiovascular and kidney diseases. We assessed the effectiveness of health education sessions and home support programs in reducing blood pressure among patients with uncontrolled hypertension in a suburban community of Nepal.<h4>Methods</h4>We conducted a community-based, open-level, parallel-group, cluster randomized controlled trial in Birendranagar municipality of Surkhet, Nepal. We randomly assigned four clusters (wards) into intervention and control arms. We provided four health education sessions, frequent home and usual care for intervention groups over six months. The participants of the control arm received only usual care from health facilities. The primary outcome of this study was the proportion of controlled systolic blood pressure (SBP). The analysis included all participants who completed follow-up at six months.<h4>Results</h4>125 participants were assigned to either the intervention (n = 63) or the control (n = 62) group. Of them, 60 participants in each group completed six months follow-up. The proportion of controlled SBP was significantly higher among the intervention participants compared to the control (58.3% vs. 40%). Odds ratio of this was 2.1 with 95% CI: 1.01-4.35 (p = 0.046) and that of controlled diastolic blood pressure (DBP) was 1.31 (0.63-2.72) (p = 0.600). The mean change (follow-up minus baseline) in SBP was significantly higher in the intervention than in the usual care (-18.7 mmHg vs. -11.2 mmHg, p = 0.041). Such mean change of DBP was also higher in the intervention (-10.95 mmHg vs. -5.53 mmHg, p = 0.065). The knowledge score on hypertension improved by 2.38 (SD 2.4) in the intervention arm, which was significantly different from that of the control group, 0.13 (1.8) (p<0.001).<h4>Conclusions</h4>Multiple health education sessions complemented by frequent household visits by health volunteers can effectively improve knowledge on hypertension and reduce blood pressure among uncontrolled hypertensive patients at the community level in Nepal.<h4>Trial registration</h4>ClinicalTrial.gov: NCT02981251.
format	article
author	Mahesh Kumar Khanal Pratiksha Bhandari Raja Ram Dhungana Pratik Bhandari Lal B Rawal Yadav Gurung K N Paudel Amit Singh Surya Devkota Barbora de Courten
author_facet	Mahesh Kumar Khanal Pratiksha Bhandari Raja Ram Dhungana Pratik Bhandari Lal B Rawal Yadav Gurung K N Paudel Amit Singh Surya Devkota Barbora de Courten
author_sort	Mahesh Kumar Khanal
title	Effectiveness of community-based health education and home support program to reduce blood pressure among patients with uncontrolled hypertension in Nepal: A cluster-randomized trial.
title_short	Effectiveness of community-based health education and home support program to reduce blood pressure among patients with uncontrolled hypertension in Nepal: A cluster-randomized trial.
title_full	Effectiveness of community-based health education and home support program to reduce blood pressure among patients with uncontrolled hypertension in Nepal: A cluster-randomized trial.
title_fullStr	Effectiveness of community-based health education and home support program to reduce blood pressure among patients with uncontrolled hypertension in Nepal: A cluster-randomized trial.
title_full_unstemmed	Effectiveness of community-based health education and home support program to reduce blood pressure among patients with uncontrolled hypertension in Nepal: A cluster-randomized trial.
title_sort	effectiveness of community-based health education and home support program to reduce blood pressure among patients with uncontrolled hypertension in nepal: a cluster-randomized trial.
publisher	Public Library of Science (PLoS)
publishDate	2021
url	https://doaj.org/article/f389cb8993c5404080d91568e59f3162
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Effectiveness of community-based health education and home support program to reduce blood pressure among patients with uncontrolled hypertension in Nepal: A cluster-randomized trial.

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