Agrawal Twinkle, Fathima Farah Naaz, Hegde Shailendra Kumar B, Joshi Rajnish, Srinivasan Nallasamy, Misquith Dominic
Department of Community Health, St John's Medical College, Koramangala, Bangalore, Karnataka, India.
Department of Community Medicine, S R M Medical College, Potheri, Kattankulathur, Kanchipuram, Tamil Nadu, India.
WHO South East Asia J Public Health. 2015 Jan-Jun;4(1):98-103. doi: 10.4103/2224-3151.206628.
Cardiovascular diseases account for almost half of all deaths from noncommunicable diseases, and almost 80% of these deaths occur in low- and middle-income countries such as India. The PrePAre (Primary pREvention strategies at the community level to Promote treatment Adherence to pREvent cardiovascular disease) trial was a primary prevention trial of community health workers aimed at improving adherence to prescribed pharmacological and nonpharmacological therapies in cardiovascular diseases. It was conducted at three geographically, culturally and linguistically diverse sites across India, comprising 28 villages and 5699 households. Planning and implementing large-scale community-based trials is filled with numerous challenges that must be tackled, while keeping in mind the local community dynamics. Some of the challenges are especially pronounced when the focus of the activities is on promoting health in communities where treating disease is considered a priority rather than maintaining health. This report examines the challenges that were encountered while performing the different phases of the trial, along with the solutions and strategies used to tackle those difficulties. We must strive to find feasible and cost-effective solutions to these challenges and thereby develop targeted strategies for primary prevention of cardiovascular diseases in resource-constrained rural settings.
心血管疾病几乎占所有非传染性疾病死亡人数的一半，其中近80%的死亡发生在印度等低收入和中等收入国家。PrePAre（社区层面促进心血管疾病治疗依从性的初级预防策略）试验是一项针对社区卫生工作者的初级预防试验，旨在提高心血管疾病患者对规定的药物和非药物治疗的依从性。该试验在印度三个地理、文化和语言各异的地点进行，包括28个村庄和5699户家庭。规划和实施大规模的社区试验充满了必须应对的众多挑战，同时要牢记当地社区的动态情况。当活动的重点是在将治疗疾病视为优先事项而非保持健康的社区促进健康时，其中一些挑战尤为突出。本报告审视了在试验的不同阶段所遇到的挑战，以及用于应对这些困难的解决方案和策略。我们必须努力找到应对这些挑战的可行且具有成本效益的解决方案，从而为资源有限的农村地区制定有针对性的心血管疾病初级预防策略。
