The effect of community-based intervention packages on common metabolic risk factors for non-communicable diseases: a field trial study

Abstract

Background: Non-communicable diseases can be controlled and managed by reducing their associated metabolic risk factors. In this study, a set of intervention packages were designed to reduce the prevalence of three common metabolic risk factors (hypertension, hyperlipidemia, and obesity and overweight) in the community by motivating non-physician health workers. Methods: A field trial study was conducted in 4 districts of Iran. Thirty-two community health centers were randomly selected in the districts. A survey of 30 to 70-year-old participants in each community health center was conducted to measure baseline metabolic risk factors. The intervention packages focused on improving hypertension, hyperlipidemia, obesity and overweight. The interventions included goal-setting, evidence-based education, operational planning, and incentive payments for non-physician health workers. A second survey to measure the final metabolic risk factors was performed after one year. The difference-in-difference method was used to evaluate the effectiveness of the intervention packages.Results: The average age of participants in both surveys was 49 years, and the sex ratio did not change. In percentage of surveyed individuals with a college education was greater in non-intervention centers. The interventions had statistically significant effects only on decreasing the prevalence of overweight and obesity. The package with all the interventions except pay-for-performance decreased the odds of overweight and obesity to 0.57 (95% CI: 0.34, 0.95). Conclusion: Involving non-physician health workers and having action plans based on the health needs of the covered population, as well as holding training courses, and introducing new prevention and control strategies, can decrease obesity and overweight in the community. However, longer trials are needed to observe the effects on hypertension and hyperlipidemia.Trial Registration: This trial was registered in the Iranian Registry of Clinical Trials (IRCT20081205001488N2) on 03/06/2018 (https://en.irct.ir/trial/774).