tps cvd final presentation

Addressing Hypertension in Rural India:

Intervention Design, Implementation

Strategies, and Evaluation Plan

Nancy Mueller, Josh Yudkin, & Leslie Duling

Overview

Disease Burden

Hypertension Determinants

Intervention and Implementation

Evaluation

Burden of Disease

Shift in the burden of disease

80% of global CVD deaths occur in low and

middle income countries1

By 2025, 1.56 billion people worldwide will be

living with hypertension2

Estimated 20% hypertension prevalence rate

in Tamil Nadu3

Determinants of Hypertension

Weight (BMI and WC)

Physical Activity

Tobacco Use

Alcohol Consumption

Stress

Diet

Intervention Outline

• Awareness and resource dissemination

Population Level

• Flipbook education, maintenance efforts, and technology based activities

Personal/Familial Level

• Technology services and educational workshops at RMHC

Health Systems Level

Implementation Strategies

Population Level Strategies

CHW SHG*SHG

members

Population Level Strategies

• Flipbook use

• Salt reduction

• Resources

CHWTraining

• 2 group leads

• Provided educational materials

SHGEducation

• Disseminate materials among group members

*SHG dissemination

Population Level Strategies

• Flipbook use

• Salt reduction

• Resources

CHWTraining

• 2 group leads

• Provided educational materials

SHGEducation

• Disseminate materials among group members

*SHG dissemination

Population Level Strategies

• Flipbook use

• Salt reduction

• Resources

CHWTraining

• 2 group leads

• Provided educational materials

SHGEducation

• Disseminate materials among group members

*SHG dissemination

Household Level Strategies

Home-based hypertension

screening by SVG

High blood pressure reading

≥140/90

Flipbook education

Invitation to workshop

Referred to RMHC

Normal blood pressure reading

Follow up annually

Health Systems Level Strategies

• HMIS flagging

• SVG home visit/callIncreased follow up

• SVG and RMHC based

• Salt reductionEducation workshops

• SVG-household or RMHC level

• Baseline, mid-line, end lineOvernight urine test

• HMIS IPD module

• Care center partnerships, PISP questionsCare continuum loop

Evaluation Plan:

Formative, Process, and Evaluation

Formative Processes

Informs:

Program materials

Intervention plans

Strategies and activities

Considers:

Key stakeholders

Formative Evaluation

Qualitative approaches

Informal interviews

Focus groups

Quantitative approaches

Cost evaluations

Resource audits

Process Objectives

Training the community health workers

Ensure fidelity of program delivery

Determining public penetration rate

Process Evaluation

Qualitative methods

KAP survey (training)

ICTPH model of practical exams

Focus groups

CHW observations (delivery)

Group lead observations

Informal interview or survey (received)

Quantitative methods

Educational session audit (delivery)

Attendee assessment

Follow up system audit (delivery/received)

Impact Objectives

Increased awareness and knowledge

Increased self efficacy

Decreased sodium intake

Impact Evaluation

Qualitative approaches

Survey (KAP)

Informal interview

Quantitative

Education activity and workshop audits

Health metrics (urine test)

Decreased sodium intake

Decreased blood

pressure

Reduced risk for CVD

Multiple genetic and environmental factors

Increased awareness,

resources, and self efficacy

Acknowledgements

ICTPH Staff

Selva Swetha

Sughavazhvu guides

Karambayam residents

Contact Information

Nancy Mueller

BA, MPH candidate

E: nancymueller@go.wustl.edu

Leslie Duling

BA, MPH/MSW candidate

E: leslie.duling@go.wustl.edu

Joshua Yudkin,

BA/MPH candidate

E: jsyudkin@wustl.edu

Washington University in St. Louis

Thank you

References

1World Health Organization (2005). National Cardiovascular Disease Database. Retrieved from

http://www.whoindia.org/LinkFiles/NMH_Resources_National_CVD_database-

Final_Report.pdf

2Kearney, P.M., Whelton, M., Reynolds, K., Muntner, P., Whelton, P.K., He, J. (2005). Global

Burden of Hypertension: Analysis of Worldwide Data. Lancet: 365, 217-223. Retrieved from

http://www.sld.cu/galerias/pdf/servicios/hta/global_burden_of_hypertension.pdf

3Mohan, V., Deepa, M., Farooq, S., Datta, M. and Deepa, R. (2007). Prevalence, Awareness, and

Control of Hypertension in Chennai – The Chennai Urban Rural Epidemiology Study (CURES

– 52). Journal of the Association of Physicians of India, 55(May).