Approaches and outcomes of community health worker’s interventions for hypertension management and control in low-income and middle-income countries: systematic review

Abstract

ObjectivesTo critically appraise the scope, content and outcomes of community health worker (CHW) interventions designed to reduce blood pressure (BP) in low-income and middle-income countries (LMICs).MethodWe performed a database search (PUBMED, EMBASE, CINAHL, PsycINFO, OpenGrey, Cochrane Central Trials Register and Cochrane Database of Systematic Reviews) to identify studies in LMICs from 2000 to 2020. Eligible studies were interventional studies published in English and reporting CHW interventions for management of BP in LMICs. Two independent reviewers screened the titles, abstracts and full texts of publications for eligibility and inclusion. Relevant information was extracted from these studies using a tailored template. Risk of bias was assessed using the Cochrane collaboration risk of bias tool. Qualitative synthesis of results was done through general summary of the characteristics and findings of each study. We also analysed the patterns of interventions and their outcomes across the studies. Results were presented in form of narrative and tables.ResultsOf the 1557 articles identified, 14 met the predefined criteria. Of these, 12 were cluster randomised trials whereas two were pretest/post-test studies. The CHW interventions were mainly community-based and focused on behaviour change for promoting BP control among hypertensive patients as well as healthy individuals. The interventions had positive effects in the BP reduction, linkage to care, treatment adherence and in reducing cardivascular-disease risk level.Discussion and conclusionThe current review is limited in that, a meta-analysis to show the overall effect of CHW interventions in the management of hypertension was not possible due to the diversity of the interventions, and outcomes of the studies included in the review. Summarised outcomes of individual studies showed CHW enhanced the control and management of hypertension. Further studies are needed to indicate the impact and cost-effectiveness of CHW-led interventions in the control and management of hypertension in LMICs.

Innovative Remote Management Solutions for the Control of Hypertension

“…Positive interventions incorporating community health workers in low- and middle-income countries have focused mainly on behavior change for promoting BP control. 24 Residents in rural China who were randomized to a large-scale intervention involving trained village doctors saw significant improvements in BP control compared with enhanced usual care. 63 These providers initiated and titrated medications according to a standardized protocol under medical supervision and provided patient coaching.…”

“…[21][22][23] Community health worker interventions have also been associated with enhanced home BP monitoring, improvements in control, linkage to care, treatment adherence, and overall cardiovascular risk reduction in low-and middle-income settings. [24][25][26][27]…”

Community Health Workers as Key Allies in the Global Battle Against Hypertension: Current Roles and Future Possibilities

“…4,5 CHWs can be vital in the effort to improve BP though a variety of actions complimentary to traditional healthcare professionals including culturally sensitive health coaching and education, improving engagement, trust and adherence, as well as addressing social-economic issues. 2,4,5 While their effectiveness has been most well established in recent studies among resource-constrained countries, 5 history shows that CHWs have long been involved in hypertension research in the United States as well. An analysis of 14 trials conducted between 1983 and 2005 6 and a review of more recent studies (n=5; 2010-2020) 4 both concluded that CHWs hold significant promise for improving BP control.…”

“…A key new team member in this model is the community health worker (CHW). 4,5 CHWs can be vital in the effort to improve BP though a variety of actions complimentary to traditional healthcare professionals including culturally sensitive health coaching and education, improving engagement, trust and adherence, as well as addressing social-economic issues. 2,4,5 While their effectiveness has been most well established in recent studies among resource-constrained countries, 5 history shows that CHWs have long been involved in hypertension research in the United States as well.…”

“…Given methodological heterogeneity across studies, no formal meta-analysis has yet been conducted. 4,5…”