TPS CVD Final Presentation

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Final presentation - CVD Team on July 21, 2011 on the Concluding Day of the Trans Disciplinary Problem Solving Course: co-taught by Washington University in St. Louis and ICTPH.

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TPS CVD Final Presentation

  1. 1. Addressing Hypertension in Rural India: Intervention Design, Implementation Strategies, and Evaluation Plan Nancy Mueller, Josh Yudkin, & Leslie Duling
  2. 2. OverviewDisease BurdenHypertension DeterminantsIntervention and ImplementationEvaluation
  3. 3. Burden of Disease
  4. 4. Shift in the burden of disease80% of global CVD deaths occur in low and middle income countries1By 2025, 1.56 billion people worldwide will be living with hypertension2Estimated 20% hypertension prevalence rate in Tamil Nadu3
  5. 5. Determinants of Hypertension
  6. 6. Weight (BMI and WC)Physical ActivityTobacco UseAlcohol ConsumptionStressDiet
  7. 7. Intervention Outline
  8. 8. • Awareness and resourcePopulation Level dissemination • Flipbook education,Personal/Familial maintenance efforts, and Level technology based activities • Technology services andHealth Systems educational workshops at Level RMHC
  9. 9. Implementation Strategies
  10. 10. Population Level Strategies *SHGCHW SHG members
  11. 11. Population Level Strategies SHG Education• Flipbook use • 2 group leads • Disseminate• Salt reduction materials among • Provided group members• Resources educational materials CHW *SHG Training dissemination
  12. 12. Population Level Strategies SHG Education• Flipbook use • 2 group leads • Disseminate• Salt reduction • Provided materials among• Resources group members educational materials CHW *SHG Training dissemination
  13. 13. Population Level Strategies SHG Education• Flipbook use • 2 group leads • Disseminate• Salt reduction • Provided materials among• Resources group members educational materials CHW *SHG Training dissemination
  14. 14. Household Level Strategies Flipbook education High blood pressure reading Invitation to workshop ≥140/90 Home-based Referred to hypertension RMHCscreening by SVG Normal blood Follow up pressure reading annually
  15. 15. Health Systems Level Strategies • HMIS flaggingIncreased follow up • SVG home visit/call • SVG and RMHC basedEducation workshops • Salt reduction • SVG-household or RMHC levelOvernight urine test • Baseline, mid-line, end line • HMIS IPD moduleCare continuum loop • Care center partnerships, PISP questions
  16. 16. Evaluation Plan:Formative, Process, and Evaluation
  17. 17. Formative ProcessesInforms: Program materials Intervention plans Strategies and activitiesConsiders: Key stakeholders
  18. 18. Formative EvaluationQualitative approaches Informal interviews Focus groupsQuantitative approaches Cost evaluations Resource audits
  19. 19. Process ObjectivesTraining the community health workersEnsure fidelity of program deliveryDetermining public penetration rate
  20. 20. Process EvaluationQualitative methods KAP survey (training) ICTPH model of practical exams Focus groups CHW observations (delivery) Group lead observations Informal interview or survey (received)
  21. 21. Quantitative methods Educational session audit (delivery) Attendee assessment Follow up system audit (delivery/received)
  22. 22. Impact ObjectivesIncreased awareness and knowledgeIncreased self efficacyDecreased sodium intake
  23. 23. Impact EvaluationQualitative approaches Survey (KAP) Informal interviewQuantitative Education activity and workshop audits Health metrics (urine test)
  24. 24. Multiple genetic and environmental factorsDecreased Decreased Reduced risk sodium blood for CVD intake pressure Increased awareness,resources, and self efficacy
  25. 25. AcknowledgementsICTPH StaffSelva SwethaSughavazhvu guidesKarambayam residents
  26. 26. Contact InformationNancy MuellerBA, MPH candidateE: nancymueller@go.wustl.eduLeslie DulingBA, MPH/MSW candidateE: leslie.duling@go.wustl.eduJoshua Yudkin,BA/MPH candidateE: jsyudkin@wustl.eduWashington University in St. Louis
  27. 27. Thank you
  28. 28. References1World Health Organization (2005). National Cardiovascular Disease Database. Retrieved from http://www.whoindia.org/LinkFiles/NMH_Resources_National_CVD_database- Final_Report.pdf2Kearney, P.M., Whelton, M., Reynolds, K., Muntner, P., Whelton, P.K., He, J. (2005). Global Burden of Hypertension: Analysis of Worldwide Data. Lancet: 365, 217-223. Retrieved from http://www.sld.cu/galerias/pdf/servicios/hta/global_burden_of_hypertension.pdf3Mohan, V., Deepa, M., Farooq, S., Datta, M. and Deepa, R. (2007). Prevalence, Awareness, and Control of Hypertension in Chennai – The Chennai Urban Rural Epidemiology Study (CURES – 52). Journal of the Association of Physicians of India, 55(May).

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