The Heartfile Lodhran CVD Prevention Project- end of Project Evaluation

Abstract

Mainstream preventive interventions often fail to reach poor populations with a high risk of cardiovascular diseases (CVDs) in Pakistan. A community-based CVD primary prevention project aimed at developing approaches to reduce risk factors in such populations was established by Heartfile in collaboration with the National Rural Support Program in the district of Lodhran. The project implemented a range of activities integrated with existing social and health service mechanisms during a three year intervention period 2000/01-03/04. These were targeted in 4 key settings: community health education, mass media interventions, training of health professionals and health education through Lady Health Workers. The project received support from the Department for International Development, U.K. At the community level, a pre-test-post-test quasi-experimental design was used for examining project outcomes related to the community component of the intervention. Pre and post-intervention (training) evaluations were conducted involving all health care providers in randomly selected workshops in order to determine baseline levels of knowledge and the impact of training on knowledge level. In order to assess practices of physician and non-physician health care providers patient interviews, with control comparisons were conducted at each health care facility. Significant positive changes were observed in knowledge levels at a community level in the district of intervention compared with baseline knowledge levels particularly in relation to a heart healthy diet, beneficial level of physical activity, the causes of high blood pressure and heart attack and the effects of high blood pressure and active and passive smoking on health. Significant changes in behaviors at a practice level were not shown in the district of intervention. However the project played a critical role in spurring national action for the prevention and control of non-communicable diseases and introducing sustainable public health interventions for poor communities in Pakistan.

The global pendulum swing towards community health workers in low- and middle-income countries: a scoping review of trends, geographical distribution and programmatic orientations, 2005 to 2014

“…They included primary preventive programmes for cardiovascular disease and diabetes, focusing on lifestyle risk factors such as physical activity, diet and smoking cessation in Thailand [69], India [70], Pakistan [71], Brazil [72] and Ghana [73]; community-based screening, referral and follow-up in Kenya [74], South Africa [75], Iran [76], Brazil [77] and Pakistan [78]; and population surveillance for NCDs in India [79]. There were no reviews within or across low- and middle-income countries (LMIC) of CHW roles in chronic disease care in the period.…”

Community-Based Cardiovascular Health Interventions in Vulnerable Populations

“…All but seven 23–25,29, 30, 38,43 represented unique study samples. Vulnerable (i.e., susceptible to harm) populations studied included Asian/Asian American 25,30,38–40,41,43,50 , African/African American 26,29,32,34,42,47,50–52 , Latino/Hispanic American 23,24,31,36,48 , as well as low-income or populations from socially disadvantaged neighborhoods 27,28,33,35,37,41,44,45,46 , rural settings 37 , or neighborhoods with elevated mortality rates 46 . Two investigations 25,29 were with adolescents and the remainder with adult populations.…”

“…Two investigations 25,29 were with adolescents and the remainder with adult populations. Most studies were conducted in the United States with the remainder completed in South Africa 26 , Guatemala 34 , China 39 , Norway 41 , Pakistan 44 , Sweden 45 , the Netherlands 28,46 , or Australia 27 . Sample sizes varied widely from as few as 16 52 to more than 110,000 39 .…”

‘Continuity of care’: a critical interpretive synthesis of how the concept was elaborated by a national research programme

“…This has implications for the ways in which future studies might choose to investigate the achievement of continuity of care. For example, use of patient (and carer) reported outcome measures (PROMS) [29], as well as qualitative studies of their perspectives on the processes or means by which continuity was achieved or not, and the influence of ‘assets’ or social capital [30] that patients and carers/families may have (or not have) to engage with services, are all consistent with this way of thinking about continuity of care. So too is consideration of professionals’ part in the achievement of continuity.…”