The Department of Endocrinology, 
ASHA-Led Community-Based Groups to Support Control of Hypertension in Rural India Are Feasible and Potentially Scalable.
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Melbourne, VIC, Australia.
- Kirby Institute, University of New South Wales, Sydney, NSW, Australia.
- Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India.
- Global Institute of Public Health, Ananthapuri Hospitals and Research Institute, Trivandrum, India.
- George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia.
- George Institute for Global Health, New Delhi, India.
- School of Population Health, University of New South Wales, Sydney, NSW, Australia.
- Department of Population Medicine and Lifestyle Diseases Prevention, Medical University of Białystok, Białystok, Poland.
- Cardiovascular Disease Program, Department of Physiology, Biomedicine Discovery Institute, Monash University, Melbourne, VIC, Australia.
- Department of Public Health & Community Medicine, Central University of Kerala, Kasaragod, India.
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia.
- Westmead Applied Research Centre, University of Sydney, Sydney, NSW, Australia.
- Department of Cardiology, Westmead Hospital, Sydney, NSW, Australia.
- School of Public Health and Preventative Medicine, Monash University, Melbourne, VIC, Australia.
- Melbourne School of Population and Global Health, Nossal Institute for Global Health, University of Melbourne, Melbourne, VIC, Australia.
- Rishi Valley Rural Health Centre, Chittoor, India.
- Department of Endocrinology, Diabetes and Metabolism, Christian Medical College, Vellore, India.
- Peninsula Clinical School, Central Clinical School, Monash University, Frankston, VIC, Australia.
- Baker Heart and Diabetes Institute and Larobe University, Melbourne, VIC, Australia.
Frontiers in medicine Vol. 8 · pp. 771822
PMID 34881267 DOI 10.3389/fmed.2021.771822
Cite This Article
Michaela A Riddell, G K Mini, Rohina Joshi, Amanda G Thrift, Rama K Guggilla, Roger G Evans, Kavumpurathu R Thankappan, Kate Chalmers, Clara K Chow, Ajay S Mahal, Kartik Kalyanram, Kamakshi Kartik, Oduru Suresh, Nihal Thomas, Pallab K Maulik, Velandai K Srikanth, Simin Arabshahi, Ravi P Varma, Fabrizio D'Esposito, Brian Oldenburg. ASHA-Led Community-Based Groups to Support Control of Hypertension in Rural India Are Feasible and Potentially Scalable. Frontiers in medicine. 2021;8:771822. doi:10.3389/fmed.2021.771822
Abstract
To improve the control of hypertension in low- and middle-income countries, we trialed a community-based group program co-designed with local policy makers to fit within the framework of India's health system. Trained accredited social health activists (ASHAs), delivered the program, in three economically and developmentally diverse settings in rural India. We evaluated the program's implementation and scalability. Our mixed methods process evaluation was guided by the United Kingdom Medical Research Council guidelines for complex interventions. Meeting attendance reports, as well as blood pressure and weight measures of attendees and adherence to meeting content and use of meeting tools were used to evaluate the implementation process. Thematic analysis of separate focus group discussions with participants and ASHAs as well as meeting reports and participant evaluation were used to investigate the mechanisms of impact. Fifteen ASHAs led 32 community-based groups in three rural settings in the states of Kerala and Andhra Pradesh, Southern India. Overall, the fidelity of intervention delivery was high. Six meetings were delivered over a 3-month period to each of the intervention groups. The mean number of meetings attended by participants at each site varied significantly, with participants in Rishi Valley attending fewer meetings [mean (SD) = 2.83 (1.68)] than participants in West Godavari (Tukeys test, = 0.009) and Trivandrum (Tukeys test, < 0.001) and participants in West Godavari [mean (SD) = 3.48 (1.72)] attending significantly fewer meetings than participants in Trivandrum [mean (SD) = 4.29 (1.76), Tukeys test, < 0.001]. Culturally appropriate intervention resources and the training of ASHAs, and supportive supervision of them during the program were critical enablers to program implementation. Although highly motivated during the implementation of the program ASHA reported historical issues with timely remuneration and lack of supportive supervision. Culturally appropriate community-based group programs run by trained and supported ASHAs are a successful and potentially scalable model for improving the control of hypertension in rural India. However, consideration of issues related to unreliable/insufficient remuneration for ASHAs, supportive supervision and their formal role in the wider health workforce in India will be important to address in future program scale up. Clinical Trial Registry of India [CTRI/2016/02/006678, Registered prospectively].
Keywords
- India
- accredited social health activist
- community-based
- hypertension control
- implementation evaluation
- rural
- self-management
- task-shifting
