RT Journal Article
SR Electronic
T1 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
JF BMJ Global Health
JO BMJ Global Health
FD BMJ Publishing Group Ltd
SP e001959
DO 10.1136/bmjgh-2019-001959
VO 5
IS 6
A1 Luisa S Flor
A1 Shelley Wilson
A1 Paurvi Bhatt
A1 Miranda Bryant
A1 Aaron Burnett
A1 Joseph N Camarda
A1 Vasudha Chakravarthy
A1 Chandrashekhar Chandrashekhar
A1 Nayanjeet Chaudhury
A1 Christiane Cimini
A1 Danny V Colombara
A1 Haricharan Conjeevaram Narayanan
A1 Matheus Lopes Cortes
A1 Krycia Cowling
A1 Jessica Daly
A1 Herbert Duber
A1 Vinayakan Ellath Kavinkare
A1 Patrick Endlich
A1 Nancy Fullman
A1 Rose Gabert
A1 Thomas Glucksman
A1 Katie Panhorst Harris
A1 Maria Angela Loguercio Bouskela
A1 Junia Maia
A1 Charlie Mandile
A1 Milena S Marcolino
A1 Susan Marshall
A1 Claire R McNellan
A1 Danielle Souto de Medeiros
A1 Sóstenes Mistro
A1 Vasudha Mulakaluri
A1 Jennifer Murphree
A1 Marie Ng
A1 J A Q Oliveira
A1 Márcio Galvão Oliveira
A1 Bryan Phillips
A1 Vânia Pinto
A1 Tara Polzer Ngwato
A1 Tia Radant
A1 Marissa B Reitsma
A1 Antonio Luiz Ribeiro
A1 Gregory Roth
A1 Davi Rumel
A1 Gaurav Sethi
A1 Daniela Arruda Soares
A1 Tsega Tamene
A1 Blake Thomson
A1 Harsha Tomar
A1 Mark Thomaz Ugliara Barone
A1 Sameer Valsangkar
A1 Alexandra Wollum
A1 Emmanuela Gakidou
YR 2020
UL http://gh.bmj.com/content/5/6/e001959.abstract
AB 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.