Structured Lifestyle Modification Interventions Involving Frontline Health Workers for Population‐Level Blood Pressure Reduction: Results of a Cluster Randomized Controlled Trial in India (DISHA Study)
Authors: Kondal Dimple , Jeemon Panniyammakal , Manimunda Sathyaprakash , Narayanan Gitanjali , Purty Anil Jacob , Negi Prakash Chand , Ladhani Sulaiman Sadruddin , Sanghvi Jyoti , Singh Kuldeep , Deshpande Ajit , Sobti Nidhi , Toteja Gurudayal Singh , Prabhakaran Dorairaj , Prabhakaran Dorairaj , Manimunda Sathyaprakash , Jeemon Panniyammakal , Kondal Dimple , Sobti Nidhi , Kahol Kashvi , Ali Mumtaz , Toteja Gurudayal Singh , Dwivedi Supriya , Gonmei Zian , Bansal Priyanka Gupta , Sanghvi Jyoti , Singh Kuldeep , Deshpande Ajit , Banzal Subodh , Kosta Susmit , Waghela Urvi , Dalal Dinesh , Suryawanshi Late Narayan , Singh Garima , Alawa Dleep , Patidar Kamlesh , Maru Shankar Lal , Mandloi Shailendra Singh , Mandoliya Varun , Chouhan Rahul , Singh Laxman , Ladhani Sulaiman Sadruddin , Bhalerao Harshada , Rayamane Kranti Laxman , Patwardhan Maitreyee , Bhatt Himanshu Narendrabhai , Dave Yogesh Ratilal , Koriya Nitaben Bharat , Sondarava Ramila Lakha , Thakar Rekhaben Vinod , Jariya Sabnam , Bhatt Anjana , Vadsariya Asmita Subhashbhai , Kachi Asheesh Shasuddin , Yadav Reena , Kariya Mehul , Patel Hansaben , Patel Sanjay , Lalya Trupti Sachin , Purty Anil Jacob , Stalin Prabhakaran , Chauhan Ramesh , Singh Z , Sharma Yogesh , Christopher Mark , Sridhar Maghida , Narayanasamy Sangeeta , Raju Prasanna Sundara , Sudha Mehru , Devi Radhika , Sundari Shanmuga , Arulsamy Vanitha , Devadas Chinniah , Nasudan Allimuthu , Rajeswaran Raja , Rajasekar Manglaraj , Venkatesh Mohan , Sreenivasan Jeyalakshmi , Balakrishnan Baby Rama , Ranganatha Bakkiyalakshmi , Negi Prakash Chand , Mahajan Anjali , Merwaha Rajeev , Jaiswal Virendra Mohan Singh , Sharma Sucheta , Dhiman Raminder , Kumar Ravinder , Sharma Reeta , Thakur Ravindra , Kanwar Ashu , Kumari Rama , Sharma Pratibha , Sharma Kiran , Thakur Saurabh 
Published: March 2022

Background
Population‐wide reduction in mean blood pressure is proposed as a key strategy for primary prevention of cardiovascular disease. We evaluated the effectiveness of a task‐sharing strategy involving frontline health workers in the primary prevention of elevated blood pressure.

Methods and Results
We conducted DISHA (Diet and lifestyle Interventions for Hypertension Risk reduction through Anganwadi Workers and Accredited Social Health Activists) study, a cluster randomized controlled trial involving 12 villages each from 4 states in India. Frontline health workers delivered a custom‐made and structured lifestyle modification intervention in the selected villages. A baseline survey was conducted in 23 and 24 clusters in the control (n=6663) and intervention (n=7150) groups, respectively. The baseline characteristics were similar between control and intervention clusters. In total 5616 participants from 23 clusters in the control area and 5699 participants from 24 clusters in the intervention area participated in a repeat cross‐sectional survey conducted immediately after the intervention phase of 18‐months. The mean (SD) systolic blood pressure increased from 125.7 (18.1) mm Hg to 126.1 (16.8) mm Hg in the control clusters, and it increased from 124.4 (17.8) mm Hg to 126.7 (17.5) mm Hg in the intervention clusters. The population average adjusted mean difference in difference in systolic blood pressure was 1.75 mm Hg (95% CI, −0.21 to 3.70).

Conclusions
Task‐sharing interventions involving minimally trained nonphysician health workers are not effective in reducing population average blood pressure in India. Expanding the scope of task sharing and intensive training of health workers such as nurses, nutritionists, or health counselors in management of cardiovascular risk at the population level may be more effective in primary prevention of cardiovascular disease.

Registration

URL:
https://www.ctri.nic.in
; Unique identifier: CTRI/2013/10/004049.