BMJ Global Health (Jun 2020)
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
- Antonio Luiz Ribeiro,
- Milena S Marcolino,
- Luisa S Flor,
- Shelley Wilson,
- Paurvi Bhatt,
- Miranda Bryant,
- Aaron Burnett,
- Joseph N Camarda,
- Vasudha Chakravarthy,
- Chandrashekhar Chandrashekhar,
- Nayanjeet Chaudhury,
- Christiane Cimini,
- Danny V Colombara,
- Haricharan Conjeevaram Narayanan,
- Matheus Lopes Cortes,
- Krycia Cowling,
- Jessica Daly,
- Herbert Duber,
- Vinayakan Ellath Kavinkare,
- Patrick Endlich,
- Nancy Fullman,
- Rose Gabert,
- Thomas Glucksman,
- Katie Panhorst Harris,
- Maria Angela Loguercio Bouskela,
- Junia Maia,
- Charlie Mandile,
- Susan Marshall,
- Claire R McNellan,
- Danielle Souto de Medeiros,
- Sóstenes Mistro,
- Vasudha Mulakaluri,
- Jennifer Murphree,
- Marie Ng,
- J A Q Oliveira,
- Márcio Galvão Oliveira,
- Bryan Phillips,
- Vânia Pinto,
- Tara Polzer Ngwato,
- Tia Radant,
- Marissa B Reitsma,
- Gregory Roth,
- Davi Rumel,
- Gaurav Sethi,
- Daniela Arruda Soares,
- Tsega Tamene,
- Blake Thomson,
- Harsha Tomar,
- Mark Thomaz Ugliara Barone,
- Sameer Valsangkar,
- Alexandra Wollum,
- Emmanuela Gakidou
Affiliations
- Antonio Luiz Ribeiro
- Milena S Marcolino
- Luisa S Flor
- Department of Health Metrics Sciences, University of Washington, Institute for Health Metrics and Evaluation, Seattle, Washington, USA
- Shelley Wilson
- Department of Health Metrics Sciences, University of Washington, Institute for Health Metrics and Evaluation, Seattle, Washington, USA
- Paurvi Bhatt
- Medtronic Foundation, Minneapolis, Minnesota, USA
- Miranda Bryant
- Department of Health Metrics Sciences, University of Washington, Institute for Health Metrics and Evaluation, Seattle, Washington, USA
- Aaron Burnett
- Department of Emergency Medicine, University of Minnesota, Minneapolis, Minnesota, USA
- Joseph N Camarda
- Department of Health Metrics Sciences, University of Washington, Institute for Health Metrics and Evaluation, Seattle, Washington, USA
- Vasudha Chakravarthy
- Development Solutions, New Delhi, Delhi, India
- Chandrashekhar Chandrashekhar
- MAMTA Health Institute for Mother and Child, New Delhi, Delhi, India
- Nayanjeet Chaudhury
- Medtronic Foundation, Minneapolis, Minnesota, USA
- Christiane Cimini
- School of Medicine, Federal University of Jequitinhonha and Mucuri Valleys, Teofilo Otoni, MG, Brazil
- Danny V Colombara
- Public Health Seattle and King County, Seattle, Washington, USA
- Haricharan Conjeevaram Narayanan
- ABT Associates Inc, Cambridge, Massachusetts, USA
- Matheus Lopes Cortes
- Anisio Teixeira Campus, Federal University of Bahia Multidisciplinary Institute in Health, Vitoria da Conquista, Bahia, Brazil
- Krycia Cowling
- Department of Health Metrics Sciences, University of Washington, Institute for Health Metrics and Evaluation, Seattle, Washington, USA
- Jessica Daly
- Medtronic Foundation, Minneapolis, Minnesota, USA
- Herbert Duber
- Department of Health Metrics Sciences, University of Washington, Institute for Health Metrics and Evaluation, Seattle, Washington, USA
- Vinayakan Ellath Kavinkare
- MAMTA Health Institute for Mother and Child, New Delhi, Delhi, India
- Patrick Endlich
- School of Medicine, Federal University of Jequitinhonha and Mucuri Valleys, Teofilo Otoni, MG, Brazil
- Nancy Fullman
- Department of Health Metrics Sciences, University of Washington, Institute for Health Metrics and Evaluation, Seattle, Washington, USA
- Rose Gabert
- School of Medicine, University of Washington, Seattle, Washington, USA
- Thomas Glucksman
- Department of Health Metrics Sciences, University of Washington, Institute for Health Metrics and Evaluation, Seattle, Washington, USA
- Katie Panhorst Harris
- Department of Health Metrics Sciences, University of Washington, Institute for Health Metrics and Evaluation, Seattle, Washington, USA
- Maria Angela Loguercio Bouskela
- Research and Teaching Institute, Hospital Sirio-Libanes, Sao Paulo, São Paulo, Brazil
- Junia Maia
- Telehealth Department, Federal University of Minas Gerais, Belo Horizonte, MG, Brazil
- Charlie Mandile
- HealthFinders Collaborative, Northfield, Minnesota, USA
- Susan Marshall
- Regions Hospital, Saint Paul, Minnesota, USA
- Claire R McNellan
- National CASA/GAL Association for Children, Seattle, Washington, USA
- Danielle Souto de Medeiros
- Anisio Teixeira Campus, Federal University of Bahia Multidisciplinary Institute in Health, Vitoria da Conquista, Bahia, Brazil
- Sóstenes Mistro
- Anisio Teixeira Campus, Federal University of Bahia Multidisciplinary Institute in Health, Vitoria da Conquista, Bahia, Brazil
- Vasudha Mulakaluri
- Department of Health Metrics Sciences, University of Washington, Institute for Health Metrics and Evaluation, Seattle, Washington, USA
- Jennifer Murphree
- Regions Hospital, Saint Paul, Minnesota, USA
- Marie Ng
- IBM Watson Health, San Jose, California, USA
- J A Q Oliveira
- Telehealth Department, Federal University of Minas Gerais, Belo Horizonte, MG, Brazil
- Márcio Galvão Oliveira
- Anisio Teixeira Campus, Federal University of Bahia Multidisciplinary Institute in Health, Vitoria da Conquista, Bahia, Brazil
- Bryan Phillips
- Health Policy and Management, University of California Los Angeles, Los Angeles, California, USA
- Vânia Pinto
- School of Medicine, Federal University of Jequitinhonha and Mucuri Valleys, Teofilo Otoni, MG, Brazil
- Tara Polzer Ngwato
- Social Surveys Africa, Johannesburg, Gauteng, South Africa
- Tia Radant
- Regions Hospital, Saint Paul, Minnesota, USA
- Marissa B Reitsma
- Department of Health Metrics Sciences, University of Washington, Institute for Health Metrics and Evaluation, Seattle, Washington, USA
- Gregory Roth
- Department of Health Metrics Sciences, University of Washington, Institute for Health Metrics and Evaluation, Seattle, Washington, USA
- Davi Rumel
- Research and Teaching Institute, Hospital Sirio-Libanes, Sao Paulo, São Paulo, Brazil
- Gaurav Sethi
- MAMTA Health Institute for Mother and Child, New Delhi, Delhi, India
- Daniela Arruda Soares
- Anisio Teixeira Campus, Federal University of Bahia Multidisciplinary Institute in Health, Vitoria da Conquista, Bahia, Brazil
- Tsega Tamene
- Pillsbury United Communities, Minneapolis, Minnesota, USA
- Blake Thomson
- Nuffield Department of Population Health, University of Oxford, Oxford, Oxfordshire, UK
- Harsha Tomar
- MAMTA Health Institute for Mother and Child, New Delhi, Delhi, India
- Mark Thomaz Ugliara Barone
- Medtronic Foundation, Minneapolis, Minnesota, USA
- Sameer Valsangkar
- Research and Monitoring Systems, The Catholic Health Association of India, Hyderabad, Telangana, India
- Alexandra Wollum
- Ibis Reproductive Health, Cambridge, Massachusetts, USA
- Emmanuela Gakidou
- Department of Health Metrics Sciences, University of Washington, Institute for Health Metrics and Evaluation, Seattle, Washington, USA
- DOI
- https://doi.org/10.1136/bmjgh-2019-001959
- Journal volume & issue
-
Vol. 5,
no. 6
Abstract
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.
