Centre for Global Health, Usher Institute, University of Edinburgh, Edinburgh, UK.
School of Social Sciences, Monash University, Clayton, Victoria, Australia.
J Glob Health. 2023 Oct 13;13:04075. doi: 10.7189/jogh.13.04075.
Hypertension is the global, leading cause of mortality and is the main risk factor for cardiovascular disease. Community-based partnerships can provide cost-saving ways of delivering effective blood pressure (BP) interventions to people in resource-poor settings. Faith-based organisations (FBOs) prove important potential health partners, given their reach and community standing. This potential is especially strong in hard-to-reach, socio-economically marginalised communities. This systematic review explores the state of the evidence of FBO-based interventions on BP management, with a focus on randomised controlled trials (RCTs) and cluster RCTs (C-RCTs).
Seven academic databases (English = 5, Chinese = 2) and grey literature were searched for C-/RCTs of community-based interventions in FBO settings. Only studies with pre- and post-intervention BP measures were kept for analysis. Random effects models were developed using restricted maximum likelihood estimation (REML) to estimate the population average mean change and 95% confidence interval (CI) of both systolic and diastolic blood pressure (SBP and DBP). The overall heterogeneity was assessed by successively adding studies and recording changes in heterogeneity. Prediction intervals were generated to capture the spread of the pooled effect across study settings.
Of the 19 055 titles identified, only 11 studies of fair to good quality were kept for meta-analysis. Non-significant, average mean differences between baseline and follow-up for the intervention and control groups were found for both SBP (0.78 mm of mercury (mmHg) (95% CI = 2.11-0.55)) and DBP (-0.20 mm Hg (95% CI = -1.16 to 0.75)). Subgroup analysis revealed a significant reduction in SBP of -6.23 mm Hg (95% CI = -11.21 to -1.25) for populations with mean baseline SBP of ≥140 mm Hg.
The results support the potential of FBO-based interventions in lowering SBP in clinically hypertensive populations. However, the limited evidence was concentrated primarily in Christian communities in the US More research is needed to understand the implications of such interventions in producing clinically meaningful long-term effects in a variety of settings. Further research can illuminate factors that affect success and potential expansion to sites outside the US as well as non-Christian FBOs. Current evidence is inadequate to evaluate the potential of FBO-based interventions in preventing hypertension in non-hypertensive populations. Intervention effects in non-hypertensive population might be better reflected through intermediate outcomes.
高血压是全球主要的致死原因，也是心血管疾病的主要危险因素。以社区为基础的伙伴关系可以为资源匮乏地区的人们提供节省成本的有效血压（BP）干预措施。鉴于其影响力和社区地位，信仰组织（FBOs）是重要的潜在健康合作伙伴。在难以企及的、社会经济边缘化的社区中，这种潜力尤为强大。本系统评价探讨了基于 FBO 的干预措施在 BP 管理方面的证据现状，重点关注随机对照试验（RCTs）和整群 RCT（C-RCTs）。
在 7 个学术数据库（英文=5，中文=2）和灰色文献中搜索 FBO 环境下基于社区的干预措施的 C-/RCT。仅保留有干预前后 BP 测量值的研究进行分析。使用受限最大似然估计（REML）开发随机效应模型，以估计收缩压和舒张压（SBP 和 DBP）的总体平均变化和 95%置信区间（CI）。通过逐步添加研究并记录异质性变化来评估总体异质性。生成预测区间以捕捉整个研究环境中汇总效果的分布。
在 19055 个标题中，只有 11 项研究质量良好或中等，被保留进行荟萃分析。干预组和对照组的 SBP（0.78 毫米汞柱（mmHg）（95%CI=2.11-0.55））和 DBP（-0.20 毫米汞柱（mmHg）（95%CI=-1.16 至 0.75））的干预前后平均差异均无统计学意义。亚组分析显示，对于平均基线 SBP≥140mmHg 的人群，SBP 显著降低-6.23mmHg（95%CI=-11.21 至-1.25）。
结果支持基于 FBO 的干预措施在降低临床高血压人群 SBP 方面的潜力。然而，有限的证据主要集中在美国的基督教社区。需要进一步的研究来了解这种干预措施在各种环境中产生有临床意义的长期效果的意义。进一步的研究可以阐明影响成功的因素以及在美国以外的地点以及非基督教 FBO 扩大的潜力。目前的证据不足以评估基于 FBO 的干预措施在预防非高血压人群高血压方面的潜力。非高血压人群的干预效果可能通过中间结果更好地反映出来。
