Project Title

Strategies for Enhanced Population Engagement and Health Care Seeking for Prevention and Control of Hypertension and Diabetes in India - STEPS India

Program Officer

Dr. Roopa Shivashankar | Scientist E Division of Delivery Research

NHRP Area

Ambulatory Non-Communicable Disease (NCD) Care

Project Status

Pilot testing of Intervention

Date of Start

15th October 2024

Duration

48 months

  • Summary

  • Hypertension and Diabetes are the most prevalent of all Non-communicable diseases (NCDs). These NCDs are a risk factor for cardiovascular diseases (CVDs), and stroke. Together all NCDs are estimated to account for 63% of all deaths, thus making them the leading causes of death globally and in India. The control of hypertension and diabetes has been shown to reduce premature mortality and prevent or delay the development of complications. However, current control rates of both of these conditions are suboptimal suggesting a need for better and more effective strategies. Meaningful engagement of communities and those living with NCDs has been highlighted in the revised Operational Guidelines of NP-NCD and the WHO Framework on Meaningful Engagement of People Living with NCDs and Mental and Neurological Conditions. Empowering communities to actively manage their health can lead to sustainable, long-lasting solutions for preventing and managing NCDs. It can address not only their health needs but also social, environmental, and behavioural factors. These approaches can lead to a more comprehensive understanding of the factors contributing to NCDs and facilitate more effective solutions. This multi- district research study is aimed at developing and testing strategies for improving community engagement and population healthcare seeking, to improve the cascade of care from screening to control of Hypertension and Diabetes.

  • Public Health Relevance

  • Hypertension and Diabetes are common non-communicable diseases, contributing to cardiovascular issues and strokes. These NCDs cause most global and Indian deaths. Better control reduces premature deaths and complications. However, current control rates are insufficient, necessitating improved strategies. Empowering communities to manage their health can provide sustainable solutions by addressing health, social, environmental, and behavioral factors, leading to better understanding and effective solutions in managing NCDs.

  • Problem Statement

  • What is the effectiveness of enhanced context-specific, socio-culturally appropriate, co-developed community engagement strategies (eCES) targeted at hypertension or diabetes care within the primary healthcare setting compared to the existing strategy under NP-NCD in achieving blood pressure and glycemic control among adults with hypertension and diabetes respectively?

  • Objectives

  • Primary Objective:
    • 1. To evaluate the effectiveness of enhanced context-specific, socio-culturally appropriate, co-developed community engagement strategies (eCES) targeted at hypertension or diabetes care within the primary healthcare setting compared to the existing strategy under NP-NCD in achieving blood pressure and glycemic control among adults with hypertension and diabetes respectively.
    • Secondary Objectives:
      • 1. TTo assess the current state of community engagement and CES implemented in conjunction with the NP- NCD
      • 2. To evaluate the factors influencing the uptake of NCD services and the implementation of related programs, its alignment with diverse community contexts.
      • 3. To evaluate the effectiveness of eCES on:
      • 4. Level of community engagement in the NCD care and related activities
      • 5. Population-level screening and diagnosis of the hypertension or diabetes;
      • 6. Initiation of treatment, adherence to medication and lifestyle advices, and follow-up (continuity of care) among the adults with hypertension or diabetes;
      • 7. Reversal among persons with prehypertension (elevated blood pressure) or prediabetes (impaired glycemia)
      • 8. Population-level preventive and promotive efforts to reduce the common shared modifiable risk factors for NCDs (namely physical inactivity, unhealthy diet, tobacco use and alcohol use)
      • 9. To document incremental cost-effectiveness of the eCES package compared to the existing strategy within the primary healthcare setting under NP-NCD in the study districts.
      • 10. To document the experiences, lessons, facilitators and barriers related to implementation of the enhanced community engagement strategies (eCES) targeted at NCD care within the primary healthcare settings.

  • Project Sites

  • 1. AIIMS Bhopal
  • 2. AIIMS Jammu
  • 3. AIIMS Madhurai
  • 4. HRIDAY New Delhi
  • 5. KIMS Bhubaneswar
  • 6. MGIMS Sevagram

  • Anticipated Outcomes

  • 1. Primary Outcomes:
  • The trial has two primary outcomes, each measured at 18 months in its own analytical cohort:
  • • Blood-pressure control among adults with hypertension — systolic blood pressure below 140 mmHg and diastolic blood pressure below 90 mmHg, per the NP-NCD operational definition.
  • • Glycaemic control among adults with diabetes — HbA1c below 7.0%, measured on a verified- HbA1c denominator.
  • 2. Secondary Outcome:
  • • Population-level secondary outcomes (reversal from prehypertension and prediabetes, risk-factor prevalence, cascade indicators, community readiness) are assessed through the repeated cross-sectional risk-factor surveys at baseline and endline; individual-level secondary outcomes (treatment coverage) are assessed in the closed cohorts.

  • Activities

  •  
    1. 1. Training workshop on qualitative methods at MGIMS, Wardha
    2. 2. Pilot testing of intervention
    3. 3. Analysis of pilot testing
    4. 4. Field visit completed for all 6 sites for monitoring of pilot testing
    5. 5. Finalization of intervention package based on the result of pilot testing
    6. 6. Finalization of communication aids

  • Policy Implications & Public Health Impact

  • This NHRP project holds significant public health potential by addressing the critical implementation gaps in the prevention and control of hypertension and diabetes in India. The introduction of Enhanced Community Engagement Strategy (eCES) as an optimization layer built directly upon existing government sectors, this trial bypasses the limitations of vertical, parallel programming to offer a sustainable model for the public health ecosystem. The trial aims to provide a highly scalable, socio- culturally tailored framework capable of expanding population-level treatment coverage, mitigating shared non-communicable disease (NCD) risk factors, and improving clinical control rates.

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  • Media