Core health-components, contextual factors and program elements of community-based interventions in Southeast Asia – a realist synthesis regarding hypertension and diabetes

Abstract

Background In Southeast Asia, diabetes and hypertension are on the rise and have become major causes of death. Community-based interventions can achieve the required behavioural change for better prevention. The aims of this review are 1) to assess the core health-components of community-based interventions and 2) to assess which contextual factors and program elements affect their impact in Southeast Asia. Methods A realist review was conducted, combining empirical evidence with theoretical understanding. Documents published between 2009 and 2019 were systematically searched in PubMed/Medline, Web of Science, Cochrane Library, Google Scholar and PsycINFO and local databases. Documents were included if they reported on community-based interventions aimed at hypertension and/or diabetes in Southeast Asian context; and had a health-related outcome; and/or described contextual factors and/or program elements. Results We retrieved 67 scientific documents and 12 grey literature documents. We identified twelve core health-components: community health workers, family support, educational activities, comprehensive programs, physical exercise, telehealth, peer support, empowerment, activities to achieve self-efficacy, lifestyle advice, activities aimed at establishing trust, and storytelling. In addition, we found ten contextual factors and program elements that may affect the impact: implementation problems, organized in groups, cultural sensitivity, synergy, access, family health/worker support, gender, involvement of stakeholders, and referral and education services when giving lifestyle advice. Conclusions We identified a considerable number of core health-components, contextual influences and program elements of community-based interventions to improve diabetes and hypertension prevention. The main innovative outcomes were, that telehealth can substitute primary healthcare in rural areas, storytelling is a useful context-adaptable component, and comprehensive interventions can improve health-related outcomes. This extends the understanding of promising core health-components, including which elements and in what Southeast Asian context.

Risk factors of increased blood pressure among adolescents in rural areas of Indonesia

“…The results showed that adolescents with normal blood pressure were 31 respondents (70.5 %), while an increase in blood pressure was 13 respondents (29.5 %). There was a significant relationship between smoking (OR =0.173, 95 % CI 0.038-0.785, p-value 0.016) and a history of alcohol consumption (OR= 4,000, with an increase in blood pressure in adolescents. Gender, family history of hypertension, physical activity, and a high salt diet did not have a significant relationship with an increase in blood pressure in adolescents with a p-value > 0.05.…”

“…Hypertension is a growing problem and might be happened at all periods of age (1,2). Hypertension is a long-term health problem and a leading cause of premature death in adults worldwide, including in developed and developing countries (3)(4)(5)(6). Unfortunately, hypertension in children and adolescents is often neglected and continues into adulthood (7).…”

A Guideline for Contextual Adaptation of Community-Based Health Interventions

“…As a result, this guideline can be more widely applied to other CBHIs and in other countries. Furthermore, as indicated in the literature, a guideline with a checklist for contextual adaptation of CBHIs can lead to more effective interventions to promote health [1,[4][5][6], but not only health. All stakeholders indicated that the usefulness of this guideline extends beyond health-related communitybased interventions.…”

“…In Southeast Asia, community-based health interventions (CBHIs) are often implemented to target non-communicable diseases (NCDs) [1][2][3]. There is some indication that CBHIs-that are tailored to sociocultural aspects of health and well-being: local language, religion, customs, traditions, individual preferences, needs, values, and interests-may promote health more effectively than when no attention is paid to these aspects [4][5][6].…”

“…There is some indication that CBHIs-that are tailored to sociocultural aspects of health and well-being: local language, religion, customs, traditions, individual preferences, needs, values, and interests-may promote health more effectively than when no attention is paid to these aspects [4][5][6]. CBHIs are complex social processes involving multiple components such as screening, physical exercise and education, and are aimed at preventing illness and unhealthy behavior and promoting the well-being of various population groups [1]. These CBHIs address health risk behaviors that are major determinants of NCDs, such as tobacco smoking, alcohol, unhealthy diet, and physical inactivity.…”