Task sharing management of non-communicable diseases using mobile health in rural India

INTERVENTION: The intervention group will receive two main components of the intervention. The overall duration of the intervention will be 12 months (Step A for 3‐month and step B for 9‐month). The first 3 months will involve Step A and step B will begin immediately on completion of step A. Step A: Group‐based education will be delivered by an Accredited Social Health Activist (ASHA) focusing on various aspects of knowledge to manage hypertension and comorbid conditions fortnightly up to three months (six meeting sessions). She will perform a routine check‐up and provide health education to all enrolled participants living in her village. Step A will be conducted in the community hall. Each meeting session will consist of two activities. Firstly, the ASHA will measure blood pressure (BP), heart rate, and weight of the participants. The ASHA will also inquire about their last visit to the health and wellness centre for managing hypertension and assess their current adherence to prescribed medications. The ASHA will use a tablet device (The Arogya Sahyog application) to store these data and let the participant know how s/he is doing with regard to management of blood pressure. Secondly, she will conduct group‐based education sessions. The sessions will last for 90 minutes and include the following activities. • Introduction: ASHAs will teach participants about risk factors, their consequences, and management • Self‐management education: ASHAs will advise the participants on dietary changes and adherence to medications. • Physical activity: ASHAs will instruct the participants to increase their physical activity. ASHAs will also advise on the type, frequency, and intensity of various exercises that can help them to reduce weight and keep healthy. • Nutrition CONDITION: Blood ‐ Anaemia Cardiovascular ‐ Hypertension Cardiovascular ‐ Other cardiovascular diseases Diet and Nutrition ‐ Obesity Hypertension ;Diabetes ;Pre‐diabetes;Anaemia;Hyperlipidaemia;Obesity; ; Hypertension ; Diabetes ; Pre‐diabetes ; Anaemia ; Hyperlipidaemia ; Obesity Metabolic and Endocrine ‐ Diabetes Public Health ‐ Health promotion/education Public Health ‐ Other public health PRIMARY OUTCOME: The primary outcome is a between‐group change of systolic blood pressure between baseline and 12 months ; ; ; [One year after randomisation (ASHAs will use sphygmomanometer for collecting data on tablet devices)] SECONDARY OUTCOME: Acceptability of using ASHAs to manage hypertension and vascular risk factors[One year after randomisation (In‐depth interview guideline will be used for collecting information related to acceptability among ASHAs)] Between‐group differences in adherence to treatment[Three months and one year after randomisation (ASHAs will use a standard questionnaire for collecting data on tablet devices. The questionnaire was designed specifically for this study) ; ] Between‐group differences in control of hypertension, i.e. blood pressure less than 140/90 mmHg[Three months and one year after randomisation (ASHAs will use sphygmomanometer for collecting data on tablet devices) ; ] Changes of knowledge on health literacy among people with hypertension with or without co‐morbidities (diabetes, pre‐diabetes, anaemia, and hyperlipidaemia)[Three months and one year after randomisation (ASHAs will use the Health Literacy Questionnaire for collecting data on tablet devices) INCLUSION CRITERIA: 1. Participants aged 30 years and above 2. Systolic blood pressure greater than 139 mmHg and/or diastolic arterial pressure greater than 89 mmHg or prescription of antihypertensive medications. ; ] Perceptions of patients about the type and availability of support they received from ASHAs[One year after randomisation (In‐depth interview guideline will be used for ASHA supervisors and auxiliary nurse midwives collecting information)]