Female Community Health Volunteers Led Hypertension Prevention and Control in Nepal: An Implementation Study

Study design: The investigators will conduct a Hybrid type II effectiveness-implementation design focusing on implementation outcomes while also collecting effectiveness outcomes as they relate to the uptake or fidelity of the intervention. A mixed-method approach will be used. The investigators will conduct a cluster randomized controlled trial among 520 participants, clustered within 12 health facilities. Among the participants of the intervention arm, the investigators will collect quantitative data on adoption, implementation and reach. The investigators will conduct in-depth interviews with 8-16 patients, at least 2 FGDs with FCHVs and at least 4 Key Informant Interviews (KIIs) with health workers to understand implementation outcomes. The investigators will maintain qualitative tracking logs to document meetings with FCHVs and healthcare workers.

Study site: In partnership with the Ministry of Health and Population (MoHP), the World Health Organization (WHO), and the NCD Flagship Initiative, and with funding from the Norwegian government, Bagmati province has initiated the Hypertension care cascade model in the Kavrepalnchowk district. In this context, our research aims to support the model's objectives by monitoring treatment outcomes and control rates at every stage of care in the Kavre district. The study will involve 12 basic health facilities in Namobuddha municipalities of Kavrepalnchowk, where approximately 82 female community health volunteers (FCHVs) are actively engaged. The selection of the study district and municipalities was done in consultation with WHO Nepal and Nepal Health Research Council, taking into consideration national priorities, Norad priorities, and ongoing NCD care activities in the district.

Study Population: At the facility level, the investigators will include basic health facilities that have implemented PEN, excluding those who are not within the network of the Nepal government health system. At the patient level, inclusion criteria will be: i) 30-75 years old ii) have a high blood pressure of 130/80 mmHg, iii) are able to provide informed consent. Exclusion criteria will include: severe illness requiring bed-rest, and pregnant women due to their special health needs.

Intervention :

We propose a community-based hypertension intervention in Namobuddha Municipality, leveraging Female Community Health Volunteers (FCHVs) as frontline implementers. A total of 34 FCHVs will each form a group of 7-16 participants and conduct one-hour, bi-monthly sessions over three months. Sessions will include: