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Final presentation - CVD Team on July 21, 2011 on the Concluding Day of the Trans Disciplinary Problem Solving Course: co-taught by Washington University in St. Louis and ICTPH.
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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
Leslie Duling
BA, MPH/MSW candidate
Joshua Yudkin,
BA/MPH candidate
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).
