Community Health Worker-Based Secondary Stroke Prevention: A Cluster Randomized Trial.pdf

Community Health Worker Intervention for Secondary Stroke Prevention

Key Points:

Problem: Stroke burden is increasing in developing countries, with limited access to secondary prevention services due to a shortage of healthcare professionals.

Approach: This open-label, cluster randomized trial evaluated the effectiveness of training Community Health Workers (CHWs) on stroke risk factor control and behavior change communication for stroke survivors in rural Kerala, India.

Participants: 234 stroke/TIA survivors were enrolled from 16 rural health blocks.

Intervention: CHW-based educational intervention focused on smoking cessation, hypertension control, diabetes management, and healthy lifestyle modifications.

Comparison: Standard clinical care served as the control arm.

Outcomes:
Primary outcome: Improved risk factor control (smokeless tobacco use cessation, blood pressure and blood sugar control).
Secondary outcome: Enhanced quality of behavior change communication provided by CHWs.

Findings:

The CHW intervention successfully achieved 100% smokeless tobacco cessation at 6 months in the intervention arm compared to 27% in the control arm.
There was no significant difference in hypertension or diabetes control between arms at 3 and 6 months.
* Home visits and health education on risk factors by CHWs were significantly higher in the intervention arm.

Conclusion:

The study concluded that a CHW-based intervention is feasible for secondary stroke prevention in resource-constrained settings. Training CHWs in risk factor control and lifestyle modifications can enhance the quality of health education provided to stroke survivors.