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Health extension workers led home-based multicomponent intervention improves linkage to hypertension care in northwest Ethiopia: cluster-randomized controlled trial.

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  • Additional Information
    • Source:
      Publisher: BioMed Central Country of Publication: England NLM ID: 101263253 Publication Model: Electronic Cited Medium: Internet ISSN: 1745-6215 (Electronic) Linking ISSN: 17456215 NLM ISO Abbreviation: Trials Subsets: MEDLINE
    • Publication Information:
      Original Publication: [London] : BioMed Central, 2006-
    • Subject Terms:
      Hypertension*/physiopathology ; Hypertension*/diagnosis ; Hypertension*/drug therapy ; Hypertension*/therapy ; Antihypertensive Agents*/therapeutic use ; Blood Pressure*/drug effects ; Community Health Workers* ; Home Care Services*; Humans ; Ethiopia ; Female ; Male ; Middle Aged ; Adult ; Treatment Outcome ; Medication Adherence ; Time Factors ; Referral and Consultation ; Health Knowledge, Attitudes, Practice ; Counseling ; Aged ; Risk Reduction Behavior
    • Abstract:
      Competing Interests: Declarations. Ethics approval and consent to participate: The Institutional Review Board (IRB) of the University of Gondar approved this trial (Ref. No: V/P/RCS/05/2293/2020). Written informed consent for participation in the form of a signature or thumb print was obtained from each study participant prior to enrollment. Consent for randomization to either of the intervention or control groups was obtained from the district health officer before randomization. Potential participants have been given detailed information about the study’s objectives, procedures, importance, risks, and benefits. Confidentiality of data was assured by using identification numbers and limiting access to the data. Participant participation in the study were on a voluntary basis. The chance to ask any question about the study, as well as the right to refuse or terminate the interview, was provided. Consent for publication: Not applicable. Competing interests: Authors declare no competing interests.
      Background: Uncontrolled hypertension is the leading cause of cardiovascular and cerebrovascular diseases in Ethiopia. Early detection and referral of hypertensive patients for clinical care is critical for initiating lifestyle changes and antihypertensive medications. This study aimed to evaluate the effects of health extension workers led home-based multicomponent intervention on linkage to hypertension care in patients with hypertension in rural districts of northwest Ethiopia.
      Methods: A parallel group, cluster randomized controlled trial was conducted in 20 rural communities. A total of 456 (228 in the intervention and 228 in the control clusters) participants were enrolled and followed for nine months. Participants in the intervention clusters received the interventions (home health education, behavioral and medication adherence counseling, and referral to nearby health facility) four times every other month for 40-60 min. The primary outcome was clinical linkage for hypertension care and the secondary outcome was initiation of antihypertensive treatment. Generalized estimating equation was used to evaluate the intervention's effect using an intention-to-treat approach. Effect sizes of relative benefit increases, absolute benefit increases, and attributable benefit were used. All statistical analyses were two-sided with a p-value of < 0.05.
      Results: The overall average systolic and diastolic blood pressure at baseline were 145.81 (± 13.89) mmHg and 87.11 (± 7.42) mmHg, respectively. The proportion of linkage to hypertension care increased from 11.0% at baseline to 66.2% at 9 months in the intervention group and from 12.3 to 39.7% in the control group, with an absolute benefit increase of 27.5% (95% CI: 19.6%, 35.4%; P-value < 0.001). The attributable benefit associated with the intervention was 40.1% (95% CI 20.7%, 59.5%) which means that more than a third of linkage to hypertension care was due to the HEWs led home-based multicomponent intervention. However, it is noteworthy that only 10.3% of patients initiated antihypertensive medication.
      Conclusions: In this study, health extension workers led home-based multicomponent interventions that provided home health education, behavioral counseling, and referral to a nearby health facility to improve linkage to hypertension care. A multicomponent intervention implemented on a large scale is likely to improve linkage to hypertension care and reduce hypertension-related morbidity and mortality in the country.
      Trial Registration: PACTR202102729454417.
      (© 2025. The Author(s).)
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    • Contributed Indexing:
      Keywords: Ethiopia; Health extension workers; Hypertension; Linkage
    • Accession Number:
      0 (Antihypertensive Agents)
    • Publication Date:
      Date Created: 20250519 Date Completed: 20250520 Latest Revision: 20250610
    • Publication Date:
      20250611
    • Accession Number:
      PMC12090684
    • Accession Number:
      10.1186/s13063-025-08862-2
    • Accession Number:
      40390051