Community-based interventions for detection and management of diabetes and hypertension in underserved communities: a mixed-methods evaluation in Brazil, India, South Africa and the USA

Abstract

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.

Unhealthy Food and Psychological Stress: The Association between Ultra-Processed Food Consumption and Perceived Stress in Working-Class Young Adults

“…It was a part of the HealthRise global initiative's longitudinal HealthRise Vitória da Conquista project. The HealthRise initiative was developed to implement and evaluate pilot programs aimed at improving the screening, diagnosis, management, and control of non-communicable diseases among underserved communities [18].…”

Quality of Life and Associated Factors in Young Workers

“…This was a cross-sectional study conducted in Brazil on users of the HealthRise program—a program targeting the reduction of premature death from chronic non-communicable diseases, such as diabetes and hypertension—in Vitória da Conquista, aimed at improving users’ access to primary health services, qualifying care, implementing medical records, and offering special tests to patients with chronic diseases (hypertension and diabetes) [ 11 ].…”

Community-Based Interventions to Improve the Control of Non-Communicable Diseases in Underserved Rural Areas in Brazil: A Before-and-After Study

“…The prevalence of non-communicable diseases (NCDs) has been increasing worldwide and this significantly impacts the health systems (Flor et al, 2020). In Brazil, hypertension and diabetes are the second and third leading causes of disability-adjusted lifeyears (DALY) (Costa et al, 2017;Nascimento et al, 2020), a measure that combines information about premature death and disability due to a condition (Nascimento et al, 2020).…”

“…The investment in the implementation and improvement of strategies to provide patients with NCDs in the primary health care settings has yielded good results by reducing the need for specialized care and health system expenses (Flor et al, 2020;American Diabetes Association, 2020). Given that a variety of factors can influence the clinical outcomes of chronic diseases, multifaceted interventions are required to achieve the desired results, either at the individual level with a timely medical diagnosis and appropriate drug treatment, or at the community level, with health education and monitoring (He et al, 2017;Flor et al, 2020;Silva-Tinoco et al, 2020). In other words, multicomponent community intervention programs are more successful than interventions based on a single activity (Philip et al, 2018).…”