Key result
A community health worker-led group-based education and monitoring program significantly reduced mean systolic blood pressure from 158 mmHg to 149 mmHg and diastolic blood pressure from 97 mmHg to 92 mmHg.
Why the study?
Individuals with poor healthcare access may be unaware of their high BP, and CHWs in Uganda had not been previously used for BP screening and management.
Does a CHW-led group-based education and monitoring program reduce blood pressure in adults with hypertension in hard-to-reach island communities?
Does a CHW-led group-based education and monitoring program reduce blood pressure in adults with hypertension in hard-to-reach island communities?
Mean Difference: -9
Absolute Event Rate: 149% vs 158%
p-value: p=<0.001
A CHW-led group-based education and monitoring program significantly reduced systolic and diastolic blood pressure over 3 months in a hard-to-reach Ugandan population with highly undiagnosed hypertension.
May support CHW-led BP control in remote settings; hypothesis-generating without randomized confirmation.
Background: Individuals living in communities with poor access to healthcare may be unaware of their high blood pressure (BP). While the use of community health workers (CHWs) can address gaps in human resources for health, CHWs in Uganda have not been used previously for BP screening and management. We report the results of an initiative to train CHWs to evaluate BP and to administer group-based education in Kalangala and Buvuma Island Districts of Lake Victoria, Uganda. Methods: We randomly selected 42 of 212 villages. We trained 84 CHWs based in island districts on measuring BP. CHWs visited all households in the selected villages and invited all adults ≥18 years to be screened for high BP. We used the World Health Organization’s STEPwise tool to collect data on demographic and behavioral characteristics and BPmeasurements. High blood pressure was defined as systolic BP (SBP) ≥140 mm Hg and/or diastolic BP (DBP) ≥90 mm Hg over three readings. CHWs created and led fortnight support groups for individuals identified with high blood pressure at baseline. At each group meeting, CHWs re-measured BP and administered an intervention package, which included self-management and lifestyle education to participants. The paired t-test was used to compare mean values of systolic blood pressure (SBP) and diastolic blood pressure (DBP) before and after the intervention. Generalized estimating equations (GEE) were used to model longitudinal changes in BP. Results: We trained 84 CHWs to measure BP and deliver the intervention package. Among 2,016 community members, 570 (28.3%) had high blood pressure; of these, 63 (11.1%) had a previous diagnosis of hypertension. The comparison of SBP and DBP before and after the intervention revealed significant reductions in mean SBP from 158mmHg (SD=29.8) to 149 mmHg (SD=29.8) (p<0.001) and mean DBP from 97mmHg (SD=14.3) to 92mmHg (p<0.001). GEE showed decreases of -1.133 (SBP) and -0.543 mmHg (DBP)/fortnight. Conclusion: High BP was common but previously undiagnosed. The CHW-led group-based self-management and education for controlling high BP was effective in the island districts in Uganda. Scaling up the intervention in other hard-to-reach districts could improve control of high BP on a large scale.
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Kwiringira et al. (2023) studied High blood pressure (Hypertension) (n=2,016). Community health worker-led group-based education and blood pressure monitoring program vs. Baseline (pre-intervention) was evaluated on Mean systolic blood pressure (SBP) (MD -9 mmHg, p=<0.001). A community health worker-led group-based education and monitoring program significantly reduced mean systolic blood pressure from 158 mmHg to 149 mmHg and diastolic blood pressure from 97 mmHg to 92 mmHg.
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