Community Health Worker Led Hypertension Prevention and Control (CHPC) in Nepal: An Implementation Trial
尼泊尔社区卫生工作者主导的高血压预防和控制 (CHPC):实施试验
基本信息
- 批准号:10719933
- 负责人:
- 金额:$ 61.36万
- 依托单位:
- 依托单位国家:美国
- 项目类别:
- 财政年份:2023
- 资助国家:美国
- 起止时间:2023-09-01 至 2028-06-30
- 项目状态:未结题
- 来源:
- 关键词:AddressAdoptedAdultAlcoholsAntihypertensive AgentsAwarenessBehavioralBeliefBlood PressureBlood Pressure MonitorsBlood VesselsBody Weight decreasedCessation of lifeClientCommunitiesCommunity Health AidesCommunity HealthcareCoronary heart diseaseDataDiastolic blood pressureDiseaseEatingEconomicsEffectivenessEventEvidence based interventionExpenditureGeographyGovernmentHealthHealth PersonnelHealth care facilityHealth systemHealthcare SystemsHigh PrevalenceHomeHouseholdHuman ResourcesHybridsHypertensionIndividualIntakeInterruptionLife StyleLife Style ModificationMeasuresMedicineMethodsModelingNepalOutcomeParticipantPatientsPeer PressurePharmaceutical PreparationsPhysical activityPositioning AttributePredispositionPrevalencePreventionPrimary Health CarePrimary PreventionProtocols documentationProviderPublic HealthRandomizedRandomized, Controlled TrialsReach, Effectiveness, Adoption, Implementation, and MaintenanceRecommendationReportingResource-limited settingRisk FactorsSecondary PreventionSelf EfficacySodiumStrokeTimeTranslatingblood pressure controlblood pressure reductioncardiovascular disorder riskcomparativecostcost effectivenesseffectiveness evaluationeffectiveness/implementation studyempowermentexperiencefruits and vegetablesgood diethigh salt diethypertension controlhypertension preventionhypertension treatmentimplementation barriersimplementation evaluationimplementation outcomesimplementation scienceimplementation strategyimplementation trialimprovedincremental costlow and middle-income countrieslow health literacymedical supplymedication compliancemortalityphysical inactivitypopulation healthprematurepreventprimary outcomepublic health prioritiesrecruitresponsesaturated fatsecondary outcomestandard of careuptake
项目摘要
ABSTRACT
In Nepal, the prevalence of HTN among adults is 25% is similar to the global prevalence. In Nepal, however, a
comparatively larger proportion of adults (44%) are unaware of their HTN status, 33% of HTN patients are
receiving treatment, and only 12% of the patients have their BP under control. Despite the availability of proven
effective lifestyle changes and low-cost anti-HTN treatment in preventing major vascular events and total
mortality, these recommendations have not been translated into practice. In Nepal, the Package of Essential
Non Communicable Diseases (PEN) was adopted that
includes
protocols to detect and manage HTN at the
basic health facilities However, major implementation barriers at multiple levels exists: (a) Individual level: low
perceived susceptibility, low health literacy, misconceptions; (b) Interpersonal level: peer pressure; (c)
Community level: norms supporting unhealthy eating and low medication adherence; and (d) Organizational
level: unfilled human resource positions, overburdened health staff, interrupted medical supplies and
medicines; inefficient recording and reporting, and inadequate provider-patient interaction. In response to these
multi-level implementation barriers, we propose to implement and evaluate a new task-shifting strategy to
community health workers (CHW), leading to improved HTN prevention and control. CHWs will : (a) engage
with and educate clients more frequently, for longer periods, and in their homes, hence building clients' self-
efficacy; (b) improve health system efficiency by providing quality provider-client time to modify lifestyle,
monitor blood pressure; and (c) CHWs will directly connect the HTN patients with health care providers at
health facilities through time referral. We will conduct a type III hybrid effectiveness-implementation study to
implement and evaluate a CHW led HTN prevention and control (CHPC) implementation strategy to deliver
increased uptake and sustainment of healthy diet, physical activity, and antihypertensive medication use;
leading to lowering of blood pressure.Aim 1 will assessimplementation outcomes of CHPC implementation
strategy using the RE-AIM framework at the patient, provider and health system levels. We will utilize mixed
methods to measure the Reach, Effectiveness, Adoption, Implementation and Maintenance outcomes for
sustained implementation of CHPC. Aim 2 will assess the effectiveness of the CHPC implementation strategy
compared to facility-based PEN on systolic BP via a cluster randomized controlled trial. We will recruit 2432
participants with high blood pressure in 171 geographic clusters randomized to assess CHPC on systolic BP
(primary outcome). Aim 3 will evaluate the economic sustainability of CHPC. We will collect primary cost data
from facilities and participants and use the effectiveness estimate from aim 2 to model the costs and cost-
effectiveness and household out of pocket expenditure impacts. If successful, this study will provide the
governments of Nepal and other LMICs a HTN prevention and control strategy to mitigate the burden of HTN in
low resource settings.
抽象的
在尼泊尔,成人高血压患病率为 25%,与全球患病率相似。然而在尼泊尔,
相对较大比例的成年人 (44%) 不知道自己的高血压状况,33% 的高血压患者
接受治疗后,只有12%的患者血压得到控制。尽管有经过验证的可用
有效的生活方式改变和低成本的抗HTN治疗可预防主要血管事件和总体事件
死亡率方面,这些建议尚未转化为实践。在尼泊尔,必需品包
非传染性疾病 (PEN) 的采用
包括
检测和管理 HTN 的协议
基本卫生设施 然而,在多个层面上存在主要的实施障碍: (a) 个人层面:低
感知易感性、健康素养低、误解; (b) 人际关系层面:同侪压力; (三)
社区层面:支持不健康饮食和药物依从性低的规范; (d) 组织方面
水平:人力资源职位空缺、卫生人员负担过重、医疗供应中断和
药物;记录和报告效率低下,医患互动不足。针对这些
多层次的实施障碍,我们建议实施和评估新的任务转移策略
社区卫生工作者 (CHW),从而改善高血压的预防和控制。社区卫生工作者将: (a) 参与
更频繁、更长时间地在客户家中与客户进行交流和教育,从而建立客户的自我意识
功效; (b) 通过提供优质的提供者-客户时间来改变生活方式,提高卫生系统的效率,
监测血压; (c) 社区卫生工作者将直接将高血压患者与医疗保健提供者联系起来:
通过时间转介的卫生设施。我们将进行 III 类混合有效性实施研究
实施和评估 CHW 主导的 HTN 预防和控制 (CHPC) 实施策略,以交付
增加健康饮食、体力活动和抗高血压药物的摄入和维持;
导致血压降低。目标 1 将评估 CHPC 实施的实施结果
在患者、提供者和卫生系统层面使用 RE-AIM 框架的策略。我们将利用混合
衡量覆盖范围、有效性、采用、实施和维护结果的方法
持续实施CHPC。目标 2 将评估 CHPC 实施策略的有效性
通过整群随机对照试验将收缩压与基于设施的 PEN 进行比较。我们将招募2432名
171 个地理集群中患有高血压的参与者随机评估 CHPC 对收缩压的影响
(主要结果)。目标 3 将评估 CHPC 的经济可持续性。我们将收集主要成本数据
来自设施和参与者,并使用目标 2 的有效性估计来对成本和成本进行建模
有效性和家庭自付费用影响。如果成功的话,这项研究将提供
尼泊尔和其他中低收入国家政府制定了高血压预防和控制战略,以减轻尼泊尔和其他中低收入国家的高血压负担
低资源设置。
项目成果
期刊论文数量(0)
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