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IntroductionAs non-communicable disease (NCD) burden rises worldwide, community-based programmes are a promising strategy to bridge gaps in NCD care. The HealthRise programme sought to improve hypertension and diabetes management for underserved communities in nine sites across Brazil, India, South Africa and the USA between 2016 and 2018. This study presents findings from the programme’s endline evaluation.MethodsThe evaluation utilises a mixed-methods quasi-experimental design. Process indicators assess programme implementation; quantitative data examine patients’ biometric measures and qualitative data characterise programme successes and challenges. Programme impact was assessed using the percentage of patients meeting blood pressure and A1c treatment targets and tracking changes in these measures over time.ResultsAlmost 60 000 screenings, most of them in India, resulted in 1464 new hypertension and 295 new diabetes cases across sites. In Brazil, patients exhibited statistically significant reductions in blood pressure and A1c. In Shimla, India, and in South Africa, country with the shortest implementation period, there were no differences between patients served by facilities in HealthRise areas relative to comparison areas. Among participating patients with diabetes in Hennepin and Ramsey counties and hypertension patients in Hennepin County, the percentage of HealthRise patients meeting treatment targets at endline was significantly higher relative to comparison group patients. Qualitative analysis identified linking different providers, services, communities and information systems as positive HealthRise attributes. Gaps in health system capacities and sociodemographic factors, including poverty, low levels of health education and limited access to nutritious food, are remaining challenges.ConclusionsFindings from Brazil and the USA indicate that the HealthRise model has the potential to improve patient outcomes. Short implementation periods and strong emphasis on screening may have contributed to the lack of detectable differences in other sites. Community-based care cannot deliver its full potential if sociodemographic and health system barriers are not addressed in tandem.

Psychological constructs, such as negative affect and substance use cravings that closely predict relapse, show substantial intra-individual day-to-day variability. This intra-individual variability of relevant psychological states combined with the “one day of a time” nature of sustained abstinence warrant a day-to-day investigation of substance use recovery. This study examines day-to-day associations among substance use cravings, negative affect, and tobacco use among 30 college students in 12-step recovery from drug and alcohol addictions. To account for individual variability in day-to-day process, it applies an idiographic approach. The sample of 20 males and 10 females (mean age = 21) was drawn from members of a collegiate recovery community at a large university. Data were collected with end-of-day data collections taking place over an average of 26.7 days. First-order vector autoregression models were fit to each individual predicting daily levels of substance use cravings, negative affect, and tobacco use from the same three variables one day prior. Individual model results demonstrated substantial inter-individual differences in intra-individual recovery process. Based on estimates from individual models, cluster analyses were used to group individuals into two homogeneous subgroups. Group comparisons demonstrate distinct patterns in the day-to-day associations among substance use cravings, negative affect, and tobacco use, suggesting the importance of idiographic approaches to recovery management and that the potential value of focusing on negative affect or tobacco use as prevention targets depends on idiosyncratic processes.

Support from a campus recovery program is essential for many recovering students. There are a variety of recovery program components that can foster the sense of community that was so important to the students in this study.