Does home-based screening and health information provision improve hypertension diagnosis, treatment, and control? A regression discontinuity analysis in urban India

Background In India, several state governments are implementing or considering home-based hypertension screening programs to improve population-wide diagnosis and blood pressure (BP) control rates. However, there is limited evidence on the effectiveness of home-based screening programs in India. Methods Using six waves of population-representative cohort data (N = 15,573), we estimate the causal effect of a home-based hypertension screening intervention on diagnosis, treatment, and BP using a novel application of the Regression Discontinuity Design. Findings We find that screening individuals’ BP in their homes and providing health information and a referral to those with elevated BP did not meaningfully improve hypertension diagnosis (0.1, p-value: 0.82), treatment (−0.2, p-value: 0.49), or BP levels (systolic: −1.8, p-value: 0.03; diastolic: 0.5, p-value: 0.39). This null effect is robust across subpopulations and alternative specifications. Interpretation Our findings suggest that a lack of knowledge of one’s hypertension status might not be the primary reason for low diagnosis and treatment rates in India, where other structural and behavioral barriers may be more relevant. Adapting screening efforts to address these additional barriers will be essential for translating India’s screening efforts into improved population health. Funding This study received no funding. Research in context: Evidence before this study Indian state governments are implementing and scaling-up large home-based screening programs to address the growing burden of cardiometabolic diseases Studies evaluating home-based screening activities in China and Malawi find that they lead to modest improvements in blood pressure levels However, studies from South Africa and Germany find null effects of home-based screening on blood pressure and long-term cardiometabolic outcomes Added value of this study We provide the first evaluation of home-based hypertension screening in India using data representative of adults aged 30 years and older in two of India’s largest cities. In addition to blood pressure level, we investigate the effect of screening on diagnosis and treatment initiation to identify the effects of screening across the continuum of care. We find that home-based hypertension screening did not improve hypertension outcomes suggesting that a lack of knowledge of one’s hypertension status is not the main barrier to health care seeking and achievement of hypertension control. Implications of all the available evidence The mere provision of information on an individual’s hypertension status does not seem to increase hypertension diagnosis and treatment initiation. Other barriers, such as health literacy and inadequate communication strategies, need to be considered when designing home-based hypertension screening programs. Before scaling up existing home-based screening programs, health communication needs to be adapted to local needs and their effectiveness evaluated.