Urban-rural disparities in blood pressure and lifestyle risk factors of hypertension among Indian individuals.

Objectives: This study aims to assess the urban-rural difference in prevalence of hypertension (HT) and to explore the disparities in lifestyle risk factors of HT among urban and rural individuals aged 15-49 years in India. Study Design: The cross-sectional data collected as a part of the fourth round of National Family Health Survey (NFHS-4) was analysed in this observational study. NFHS-4 was conducted between January 2015 and December 2016 amongst men aged 15-54 years and women aged 15-49 years. In order to maintain uniformity, age group of 15-49 years was considered. Descriptive analyses were performed for sociodemographic and lifestyle factors. Binary logistic regression was conducted to assess the predictors of HT in men and women in urban and rural settings. The presence of HT was considered as the outcome variable. Results: The overall age adjusted prevalence of HT was 17.2% and was greater in urban (18.3%) than in rural population (15.5%). The age adjusted prevalence was also higher in males (18.2%) as compared to females (16.1%). Age and wealth were associated with HT in both urban and rural population. Education and dietary habits played a role in all except rural men. Alcohol consumption, diabetic status and marital status were significantly associated with HT in both urban and rural women. Occupation was associated with HT only in urban women. Conclusions: The study has shown higher HT prevalence in urban areas despite higher prevalence of lifestyle risk factors in rural settings. This calls for more robust screening and health education in the entire population, especially in rural areas.

Development of integrated model of communication for implementing media strategy to prevent hypertension in a northern state of India.

OBJECTIVE: Media plays a major role in inculcating positive changes or averting negative changes in health-related behaviors across populations. Although various mass media interventions have proven their effectiveness in changing individuals' behavior for various diseases and risk factors, current literature is limited regarding a conceptual framework/model for the prevention of hypertension and cardiovascular diseases. The present study describes the process of development and implementation of a comprehensive and need-based media strategy with an aim to generate politico-administrative support for strengthening hypertension services in the state of Punjab, India. METHODS: The preparation of theoretical framework underwent two stages, that is, item generation and item reduction. The item generation involved extensive literature search, development of consensus among experts using Delphi technique and its validation. The item reduction involved the selection of models among existing communication and health promotion models, placement of items in the selected models and development of final conceptual framework model. RESULTS: Based upon the review and expert's consensus, we zeroed in on three models of communication - communication campaign model, paid earned social owned model, and staircase model - in order to come up with the framework requisite for a systematic media strategy. The model focused upon context-specific messages involving both traditional and modern means and tools of communication. This model (conceptual framework) was the product of intense literature review followed by opinion of the experts from various disciplines such as medical professionals, public health specialists, communication experts, social scientists, politicians, bureaucrats, state-level representatives, media journalists and hypertensive patients. CONCLUSION: The present model can effectively be used by the program implementers, educators and policy makers in similar settings.

Evaluation of a women group led health communication program in Haryana, India.

BACKGROUND: Sakshar Mahila Smooh (SMS) program was launched in rural areas of Haryana in India during 2008. A total of 6788 SMSs, each having 5-10 literate women, were equipped to enhance health communication. We carried out process evaluation of this program as an external agency. METHODOLOGY: After a review of program documents, a random sample survey of Auxiliary Nurse Midwives (ANMs), SMS members, and village women was conducted. Out of four divisions of the state, one was randomly chosen, which had five districts. From 330 randomly chosen villages, 283 ANMs, 1164 SMS members, and 1123 village women were interviewed using a semi- structured interview schedule. Program inputs, processes, and outputs were compared in the five districts. Chi square was used for significance test. RESULTS: In the sampled division, out of 2009 villages, 1732 (86%) had functional SMS. In three years, SMS conducted 15036 group meetings, 2795 rallies, 2048 wall writings, and 803 competitions, and 44.5% of allocated budget was utilized. Most ANMs opined that SMSs are better health communicators. SMS members were aware about their roles and responsibilities. Majority of village women reported that SMS carry out useful health education activities. The characteristics of SMS members were similar but program performance was better in districts where health managers were proactive in program planning and monitoring. CONCLUSIONS: SMS Program has communicated health messages to majority of rural population, however, better planning & monitoring can improve program performance.