Evaluation of a training program of hypertension for accredited social health activists (ASHA) in rural India.

BACKGROUND: Hypertension is a major risk factor for cardiovascular disease, a leading cause of premature death and disability in India. Since access to health services is poor in rural India and Accredited Social Health Activists (ASHAs) are available throughout India for maternal and child health, a potential solution for improving hypertension control is by utilising this available workforce. We aimed to develop and implement a training package for ASHAs to identify and control hypertension in the community, and evaluate the effectiveness of the training program using the Kirkpatrick Evaluation Model. METHODS: The training program was part of a cluster randomised feasibility trial of a 3-month intervention to improve hypertension outcomes in South India. Training materials incorporated details on managing hypertension, goal setting, facilitating group meetings, and how to measure blood pressure and weight. The 15 ASHAs attended a five-day training workshop that was delivered using interactive instructional strategies. ASHAs then led community-based education support groups for 3 months. Training was evaluated using Kirkpatrick's evaluation model for measuring reactions, learning, behaviour and results using tests on knowledge at baseline, post-training and post-intervention, observation of performance during meetings and post-intervention interviews. RESULTS: The ASHAs' knowledge of hypertension improved from a mean score of 64% at baseline to 76% post-training and 84% after the 3-month intervention. Research officers, who observed the community meetings, reported that ASHAs delivered the self-management content effectively without additional assistance. The ASHAs reported that the training materials were easy to understand and useful in educating community members. CONCLUSION: ASHAs can be trained to lead community-based group educational discussions and support individuals for the management of high blood pressure. TRIAL REGISTRATION: The feasibility trial is registered with the Clinical Trials Registry - India (CTRI) CTRI/2016/02/006678 (25/02/2016).

Scale-up of the Kerala Diabetes Prevention Program (K-DPP) in Kerala, India: implementation evaluation findings.

The cluster-randomized controlled trial of the Kerala Diabetes Prevention Program (K-DPP) demonstrated some significant improvements in cardiometabolic risk factors and other outcomes. We aimed to refine and improve K-DPP for wider implementation in the Kerala state of India. The specific objectives of the scale-up program were (a) to develop a scalable program delivery model and related capacity building in Kerala and (b) to achieve significant improvements in cardiometabolic risk factors in the target population. A total of 118 key trainers of a large women's organization trained 15,000 peer leaders in three districts of Kerala. Each of these peer leaders was required to deliver 12 monthly sessions to ~25 people, reaching an estimated total of 375,000 adults over 12 months. We evaluated the number of sessions conducted, the participation of men, and program reach. We also assessed the effectiveness of the program in a random sample of 1,200 adults before and after the intervention and performed a biochemical evaluation on a subsample of 321. Of the 15,222 peer leaders who were trained, 1,475 (9.7%) returned their evaluation forms, of which, 98% reported conducting at least 1 session, 88% ≥6 sessions, and 74% all 12 sessions. Tobacco use among men reduced from 30% to 25% (p = .02) and alcohol use from 40% to 32% (p = .001). Overall, mean waist circumference reduced from 89.5 to 87.5 cm (p < .001). Although there were some study shortcomings, the approach to scale-up and its implementation was quite effective in reaching a large population in Kerala and there were also some significant improvements in key cardiometabolic risk factors following the 1 year intervention.