Abstract:
Objectives To critically appraise the scope, content and
outcomes of community health worker (CHW) interventions
designed to reduce blood pressure (BP) in low-income and
middle- income countries (LMICs).
Method We performed a database search (PUBMED,
EMBASE, CINAHL, PsycINFO, OpenGrey, Cochrane Central
Trials Register and Cochrane Database of Systematic
Reviews) to identify studies in LMICs from 2000 to 2020.
Eligible studies were interventional studies published in
English and reporting CHW interventions for management
of BP in LMICs. Two independent reviewers screened the
titles, abstracts and full texts of publications for eligibility
and inclusion. Relevant information was extracted from
these studies using a tailored template. Risk of bias was
assessed using the Cochrane collaboration risk of bias
tool. Qualitative synthesis of results was done through
general summary of the characteristics and findings of
each study. We also analysed the patterns of interventions
and their outcomes across the studies. Results were
presented in form of narrative and tables.
Results Of the 1557 articles identified, 14 met the
predefined criteria. Of these, 12 were cluster randomised
trials whereas two were pretest/post-test studies. The
CHW interventions were mainly community-based
and focused on behaviour change for promoting BP
control among hypertensive patients as well as healthy
individuals. The interventions had positive effects in the
BP reduction, linkage to care, treatment adherence and in
reducing cardivascular-disease risk level.
Discussion and conclusion The current review is limited
in that, a meta-analysis to show the overall effect of
CHW interventions in the management of hypertension
was not possible due to the diversity of the interventions,
and outcomes of the studies included in the review.
Summarised outcomes of individual studies showed CHW
enhanced the control and management of hypertension.
Further studies are needed to indicate the impact and
cost-effectiveness of CHW-led interventions in the control
and management of hypertension in LMICs
