Development and Effect of a Coordinated Community Health Worker Intervention Model for the Stroke Survivors in Kerala, South India

Abstract

Introduction: Structured models for secondary prevention of stroke in community settings are scarce. We aimed to develop and evaluate a model for improving medication adherence and enhanced risk factor monitoring. Methods: We developed a multimodal coordinated community health worker (CHW) intervention (C-CHW-I) model for stroke survivors. Following training, all patients received a minimum of three CHW home visits, and once in 3-month telephone call and health education for 6 months by CHWs. Seven blocks from 16 blocks of the study area were randomised to additionally receive an SMS alert for 6 months to reinforce CHW involvement. The primary outcomes were medication adherence and risk factor monitoring, and the secondary outcome was risk factor control. Results: The mean age of the study population was 64 ± 12 years, 765 (85%) had ischaemic stroke. In the overall study cohort receiving the CHW intervention, mean medication adherence significantly improved from 3.56 (0.88) at baseline to 3.78 (0.61) at 6 months; p p p = 0.008); however, no difference persisted at 6 months. The proportion of smokers and alcohol users reduced in both groups with a trend to greater reduction in the intervention group (smokers: 5.9% vs. 2.8% [p = 0.446] and alcohol users: 1.6% vs. 1.4% [p = 0.474]). At 6 months, the SBP did not differ (SBP 132.1 (16.2) in the SMS group vs. 133.2 (15.8) mm Hg in the control group, p = 0.409). Conclusion: Our model improved medication adherence and risk factor monitoring of stroke survivors in community settings, and this can reduce stroke burden in the community.