Article Text
Abstract
Introduction As 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.
Methods The 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.
Results Almost 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.
Conclusions Findings 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.
- diabetes
- hypertension
- public health
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Footnotes
Handling editor Valery Ridde
Contributors LSF, KC, NF and EG contributed to the analysis of the data, produced tables and figures, and wrote the initial draft of the manuscript. LSF, NF and EG finalised the manuscript based on reviewer feedback. LSF, SW, MB, JNC, DVC, KC, HCD, NF, RG, TG, KPH, CRM, VM, MN, BP, MBR, GR, BT, AW and EG developed survey instruments, collected data, verified and managed data, contributed to analyses or some combination of the aforementioned contributions. EG conceptualised and managed the evaluation. PB, NC, JD and MTUB provided guidance on the HealthRise project as a whole. AB, CCh, CCi, HCN, MLC, VEK, PE, MALB, JMa, CM, MSM, SMa, DSdM, SMi, JMu, JAQO, MGO, VP, TR, ALR, DR, GS, DAS, TT, HT and SV developed, managed or implemented HealthRise intervention activities or data monitoring systems, or some combination of the aforementioned activities. VC and TPN managed data collection activities. All authors read and approved the final manuscript.
Funding Funding for the HealthRise project came from the Medtronic Foundation. The corresponding author had full access to all the data in the study and had final responsibility for the decision to submit for publication. This study was financed in part by the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - Brasil (CAPES) - Finance Code 001. JAQO received doctoral scholarship from CNPq/CAPES/IATS, Brazil. ALR was supported in part by CNPq (grant 310679/2016–8), and Instituto de Avaliação de Tecnologia em Saúde - IATS, grant 465518/2014–1) and by FAPEMIG (Programa Pesquisador Mineiro, PPM-00 428–17).
Competing interests PB, NC, JD and MTUB are employees of the Medtronic Foundation. AB, CCh, CCi, MLC, VEK, PE, MALB, JMa, CM, MSM, SMa, DSdM, SMi, JMu, HCN, JAQO, MGO, VP, TR, ALR, DR, GS, DAS, TT, HT and SV are recipients of HealthRise grants from the Medtronic Foundation to implement HealthRise interventions. LSF, SW, MB, JNC, DVC, KC, HCD, NF, RG, TG, KPH, CRM, VM, MN, BP, MBR, GR, BT, AW, VC, TPN, and EG are recipients of funding from grants from the Medtronic Foundation to evaluate HealthRise interventions.
Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.
Patient consent for publication Not required.
Ethics approval Ethical approval for this study was obtained from the institutional review board of the University of Washington, as well as the local data collection agencies and government entities for each site. This research conforms to the principles embodied in the Declaration of Helsinki. All personal identifiers were removed prior to the data being sent to IHME for analysis; only de-identified data were analysed.
Provenance and peer review Not commissioned; externally peer reviewed.
Data availability statement Data are available in a public, open access repository. The datasets generated and/or analysed during the current study are available, when possible, in the GHDx data repository, http://ghdx.healthdata.org/series/healthrise-evaluation