TPS CVD Final Presentation
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Transcript of TPS CVD Final Presentation
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Addressing Hypertension in Rural India:
Intervention Design, Implementation
Strategies, and Evaluation Plan
Nancy Mueller, Josh Yudkin, & Leslie Duling
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Overview
Disease Burden
Hypertension Determinants
Intervention and Implementation
Evaluation
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Burden of Disease
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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
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Determinants of Hypertension
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Weight (BMI and WC)
Physical Activity
Tobacco Use
Alcohol Consumption
Stress
Diet
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Intervention Outline
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• 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
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Implementation Strategies
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Population Level Strategies
CHW SHG*SHG
members
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Population Level Strategies
• Flipbook use
• Salt reduction
• Resources
CHWTraining
• 2 group leads
• Provided educational materials
SHGEducation
• Disseminate materials among group members
*SHG dissemination
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Population Level Strategies
• Flipbook use
• Salt reduction
• Resources
CHWTraining
• 2 group leads
• Provided educational materials
SHGEducation
• Disseminate materials among group members
*SHG dissemination
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Population Level Strategies
• Flipbook use
• Salt reduction
• Resources
CHWTraining
• 2 group leads
• Provided educational materials
SHGEducation
• Disseminate materials among group members
*SHG dissemination
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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
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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
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Evaluation Plan:
Formative, Process, and Evaluation
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Formative Processes
Informs:
Program materials
Intervention plans
Strategies and activities
Considers:
Key stakeholders
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Formative Evaluation
Qualitative approaches
Informal interviews
Focus groups
Quantitative approaches
Cost evaluations
Resource audits
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Process Objectives
Training the community health workers
Ensure fidelity of program delivery
Determining public penetration rate
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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)
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Quantitative methods
Educational session audit (delivery)
Attendee assessment
Follow up system audit (delivery/received)
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Impact Objectives
Increased awareness and knowledge
Increased self efficacy
Decreased sodium intake
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Impact Evaluation
Qualitative approaches
Survey (KAP)
Informal interview
Quantitative
Education activity and workshop audits
Health metrics (urine test)
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Decreased sodium intake
Decreased blood
pressure
Reduced risk for CVD
Multiple genetic and environmental factors
Increased awareness,
resources, and self efficacy
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Acknowledgements
ICTPH Staff
Selva Swetha
Sughavazhvu guides
Karambayam residents
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Contact Information
Nancy Mueller
BA, MPH candidate
Leslie Duling
BA, MPH/MSW candidate
Joshua Yudkin,
BA/MPH candidate
Washington University in St. Louis
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Thank you
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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).