Improving the control of hypertension in rural India: overcoming the barriers to diagnosis and effective treatment. A study funded through the NHMRC as part of the Global Alliance for Chronic Diseases (GACD).

This global alliance of health research funders provide an avenue for funding  innovative research collaborations between low- and middle-income and high-income countries in the fight against chronic diseases.

Our project, undertaken in three diverse rural regions in India, was conducted to identify and explore system barriers across these three regions, each of which is at a different stage of economic and epidemiological transition. The objectives of the project were:

  • To quantify and identify the determinants of the prevalence, awareness, treatment, and control of hypertension in three different rural populations in India.
  • Identify barriers to hypertension diagnosis and control.
  • Develop and pilot intervention strategies to improve the control of hypertension. The pilot program was based on those factors identified as contributing to hypertension control in these settings and includes management and prevention strategies aimed at the individual, health service delivery and policy levels.

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The study protocol was published in:

Major Findings

This low-cost education and monitoring intervention delivered by community health workers was effective in controlling blood pressure. This approach overcomes limitations in access to healthcare by utilising a health workforce that is available and embedded in the community. Importantly, the intervention was effective in very diverse regions and so is potentially scalable in resource-poor settings in India and globally."  See link.

Other major findings

It is possible to train Accredited Social Health Activists (ASHAs), who are available throughout India, to lead community-based group educational discussions and support individuals in the management of high blood pressure. The training program developed included training materials on managing hypertension, goal setting, facilitating group meetings, and how to measure blood pressure and weight. 15 ASHAs attended five-day training workshops and then led community-based education support groups for 3 months. The ASHAs' knowledge of hypertension improved from a mean score of 64% at baseline to 76% post-training and 84% after the 3-month intervention. Research officers, who observed the community meetings, reported that ASHAs delivered the self-management content effectively without additional assistance. The ASHAs reported that the training materials were easy to understand and useful in educating community members.


Shared Team Approach between Nurses and Doctors for Improved Risk Factor Management for stroke patients (STAND-FIRM) - A Randomised Controlled Trial

Approximately 28% (14,000 of the 50,000) of annual stroke events in Australia are recurrent events, costing about $305 million per year. We can prevent these recurrent strokes from occurring by ensuring that patients are taking appropriate medications that have proven efficacy. Currently, uptake of these therapies is poor. This project is aimed at assessing whether risk factor management after stroke can be successfully improved. Our intervention incorporates a simple approach that maximises participation of General Practitioners, and use of Chronic Disease Management Plans. We have already found that:

  • The effectiveness of an organised secondary prevention program for stroke may be limited in patients from high-performing hospitals where usual care was close to optimal, i.e. provision of regular post-discharge follow-up and communication with general practitioners. This model of care that included an individualised nurse-led education program and review of stroke care plans by stroke specialists, may be more beneficial in settings where there is lack of adequate specialist follow-up, or lack of communication with GPs on care of survivors. Further details can be accessed in:
  • Among 391 survivors of stroke/TIA, 87% reported considerable unmet needs ≥ 2 years after discharge from hospital. These unmet needs were particularly prominent in the domain of secondary prevention. Further details can be accessed in:
  • The intervention in this largely negative trial, improved attainment of targets for the control lipids in survivors of stroke/TIA after a 12-month follow-up. This limited effect may be attributable to inadequate uptake of behaviour/lifestyle interventions, despite the comprehensive intervention. This highlights the need for new, more effective and targeted approaches to achieve meaningful behavioural change. Further details can be accessed in:


North East Melbourne Stroke Incidence Study (NEMESIS)

NEMESIS is the largest population-based study of stroke conducted in Australia. The team has followed the progress of stroke sufferers in Melbourne to determine the long-term effects of stroke in the community. In North-East Melbourne Stroke Incidence Study (NEMESIS), Prof Thrift has tracked the health of 1686 people - aged from two to 102 - who suffered a stroke between May 1, 1996 and April 30, 1999. Since then, their lives have been tracked on an annual basis and information has been gathered on their ongoing healthcare arrangements and their needs. Prof Thrift's research has provided the evidence base for the development of health policy for the management of stroke over the next decade. More hospital and nursing home beds will be needed if stroke figures are not reduced. A three per cent reduction in stroke incidence is needed per year just to prevent an increase in the number of strokes occurring in the future.

The major findings to date from NEMSIS: