Secondary prevention of stroke by a primary health care approach: An open-label cluster randomised trial

Abstract

Background and aim: Increasing stroke burden in developing countries necessitates measures to strengthen health systems. We aimed to evaluate whether a Community Health Worker (CHW) based educational intervention will improve risk factor control among stroke survivors and enhance behavior change communication.

Method: An open-label, cluster-randomized trial was conducted in rural area of Thiruvananthapuram district, Kerala from December 2017 to December 2018. A CHW-based educational intervention in addition to standard of care was provided in intervention arm and compared to standard clinical care in the control arm with follow-up at three and six months. The primary outcome measures were risk factor control and quality of behavior change communication provided by CHWs.

Results: Of the 234 Stroke/TIA survivors enrolled, the mean age (SD) was 59.43 (11.07) years. At 6-month follow up, all patients with smokeless tobacco consumption had quit in the intervention arm (5 at baseline and 0 at six months) and no relapse in smoking was found (as compared to control arm wherein 9 at baseline and one at 6 months). The control of hypertension and diabetes was not significant at 3 months and 6 months in both intervention and control groups. Home visits as well as health education on risk factors by CHWs in the intervention arm were significantly higher.

Conclusion: Community health worker-based intervention is feasible in resource constrained settings for secondary stroke prevention. Training of CHW on risk factor control and lifestyle modifications for stroke survivors enhances quality of health education provided by health services.

Keywords: Health worker; Primary care; Secondary prevention; Stroke; Task shifting.