A model for national assessment of barriers for implementing digital technology interventions to improve hypertension management in the public health care system in India

Abstract

Background There is substantial interest in leveraging digital health technology to support hypertension management in low- and middle-income countries such as India. The potential for healthcare infrastructure and broader context to support such initiatives in India has not been examined. We evaluated existing healthcare infrastructure to support digital health interventions and examined epidemiologic, socioeconomic, and geographical contextual correlates of healthcare infrastructure in 544 districts covering 29 states and union territories across India. Methods The study was a cross-sectional analysis of India’s Fourth District Level Household and Facility Survey (DLHS-4; 2012–2014), the most up-to-date nationally representative district-level healthcare infrastructure data. Facilities were the unit of analysis, and analyses accounted for clustering within states. The main outcome was healthcare system infrastructural context to implement hypertension management programs. Domains included diagnostics (functional BP instrument), medications (anti-hypertensive medication in stock), essential clinical staff (e.g., staff nurse, medical officer, pharmacist), and IT specific infrastructure (regular power supply, internet connection, computer availability). Descriptive analysis was conducted for infrastructure indicators based on the Indian Public Health Standards, and logistic regression was conducted to estimate the association between epidemiologic and geographical context (exposures) and the composite measure of healthcare system. Results Data from 32,215 government facilities were analyzed. Among lowest-tier subcenters, 30% had some IT infrastructure, while at the highest-tier district hospitals, 92% possessed IT infrastructure. At mid-tier primary health centres and community health centres, IT infrastructure availability was 28 and 51%, respectively. For all but sub-centres, the availability of essential staff was lower than the availability of IT infrastructure. For all but district hospitals, higher levels of blood pressure, body mass index, and urban residents were correlated with more favorable infrastructure. By region, districts in Western India tended towards having the best prepared health facilities. Conclusions IT infrastructure to support digital health interventions is more frequently lacking at lower and mid-tier healthcare facilities compared with apex facilities in India. Gaps were generally larger for staffing than physical infrastructure, suggesting that beyond IT infrastructure, shortages in essential staff impose significant constraints to the adoption of digital health interventions. These data provide early benchmarks for state- and district-level planning.

Digital intervention for public health: searching for implementing characteristics, concepts and recommendations: scoping review

“…The articles focused on diverse concepts for the digital intervention for public health and also on different methods on the topic. Article focus on commercial corporations to adopt cutting-edge technologies ( 62 ), advance information and health literacy ( 63 ), framework for evaluation that integrates biological and digital methods ( 7 ), multidimensional, global public based on an awareness of structural, societal, and individual extents of violence against women and girls ( 10 ), factors that influence recruitment and involvement in DHIs ( 64 ), DHI’s impact on rural communities’ ( 66 ), range of technological developments for the global public health ( 65 ), collection of iterative techniques ( 41 ), theoretically based implementation strategy ( 67 ), share information and thoughts from public health academics, healthcare system’s ability to support digital health treatments ( 68 ), encourage community engagement ( 56 ), digital health support on hemoglobin ( 46 ), circumstances and important players in China’s quick deployment of digital health solutions ( 69 ) and teaching hospitals that make use of social media ( 70 ).…”

“…The seven dimensions that contextual indicators consider are; geographical, epidemiological, sociocultural, socioeconomic, ethical, legal, and political setting. Here, researchers look into the interactions between the political (healthcare infrastructure), epidemiological (blood pressure, body mass index, and older population) and geographical (region, urbanicity) domains of the contextual indicators ( 56 ).…”

Cross fertilisation of Public Health and Translational Research

“…The potential for healthcare infrastructure and broader context to support infrastructure to support digital health interventions, and this study 32 examined healthcare infrastructure in 544 districts covering 29 states and union territories in India’s Fourth District Level Household and Facility Survey (DLHS-4; 2012–2014), the most up-to-date nationally representative district-level healthcare infrastructure data. Descriptive analysis was conducted for infrastructure indicators based on the Indian Public Health Standards.…”

InSH Consensus Guideline for the Management of Hypertension, 2023

“…Barriers to implementing digital technology interventions to improve hypertension diagnosis andmanagement in India include a lack of healthcare infrastructure, a shortage of trained healthcare professionals, a lack of technology literacy, data privacy & security concerns, affordability, and resistance to change. 357,358 Addressing these barriers requires a multi-faceted approach involving collaboration between stakeholders, including state and national governments, healthcare institutes, and healthcare device manufacturers.…”