A pilot project on a community-supported approach to blood pressure management to improve sustainability in a rural community in Bangladesh

The aim of this study is to examine how design ethnography and door-to-door approach to community organization can facilitate community support to sustain hypertension screening and management in Khoriapara, Bangladesh. The project adopted a community-supported approach that seeks to maximize resident self-mobilization and reduce external dependency in hypertension management. Design ethnography used remote interviews and field observation to map resources, identify barriers, and embed health efforts within community realities. Community organization involved forming health and inclusion committees through door-to-door engagement and selecting health workers via key informant. All adults (age > 18) were screened for hypertension (systolic ≥140 mmHg or diastolic ≥90 mmHg, measured twice). Patients received education and biweekly follow-up through a locally operated internet-based system. Despite limited access to health, education, and nutrition, residents offered shared spaces, interpersonal networks, and technological familiarity. Committees formed by community consensus were accepted, while key-informant–driven selection caused conflict that the inclusion committee resolved, increasing community engagement. Of 260 residents screened, 20 met criteria. From October 2020 to December 2022, mean systolic BP dropped by 27 mmHg and diastolic by 9.9 mmHg (paired t-test, p < .05). Community-embedded design may improve outcomes and sustainability, though attention to power dynamics remains essential.