A community-based intervention to improve screening, referral and follow-up of non-communicable diseases and anaemia amongst pregnant and postpartum women in rural India: study protocol for a cluster randomised trial
<p><strong>Background:</strong> Medical complications during pregnancy, including anaemia, gestational diabetes mellitus and hypertensive disorders of pregnancy place women are at higher risk of long-term complications. Scalable and low-cost strategies to integrate non-com...
| المؤلفون الرئيسيون: | , , , , , , , , , , , , , |
|---|---|
| التنسيق: | Journal article |
| اللغة: | English |
| منشور في: |
BioMed Central
2023
|
| _version_ | 1826311691388846080 |
|---|---|
| author | Hirst, JE Votruba, N Billot, L Arora, V Rajan, E Thout, SR Peiris, D Patel, A Norton, R Mullins, E Sharma, A Kennedy, S Jha, V Praveen, D |
| author_facet | Hirst, JE Votruba, N Billot, L Arora, V Rajan, E Thout, SR Peiris, D Patel, A Norton, R Mullins, E Sharma, A Kennedy, S Jha, V Praveen, D |
| author_sort | Hirst, JE |
| collection | OXFORD |
| description | <p><strong>Background:</strong> Medical complications during pregnancy, including anaemia, gestational diabetes mellitus and hypertensive disorders of pregnancy place women are at higher risk of long-term complications. Scalable and low-cost strategies to integrate non-communicable disease screening into pregnancy care are needed. We aim to determine the effectiveness and implementation components of a community-based, digitally enabled approach, “SMARThealth Pregnancy,” to improve health during pregnancy and the first year after birth.</p>
<p><strong>Methods:</strong> A pragmatic, parallel-group, cluster randomised, type 2 hybrid effectiveness-implementation trial of a community-based, complex intervention in rural India to decrease anaemia (primary outcome, defined as haemoglobin < 12g/dL) and increase testing for haemoglobin, glucose and blood pressure (secondary outcomes) in the first year after birth. Primary Health Centres (PHCs) are the unit of randomisation. PHCs are eligible with (1) > 1 medical officer and > 2 community health workers; and (2) capability to administer intravenous iron sucrose. Thirty PHCs in Telangana and Haryana will be randomised 1:1 using a matched-pair design accounting for cluster size and distance from the regional centre. The intervention comprises (i) an education programme for community health workers and PHC doctors; (ii) the SMARThealth Pregnancy app for health workers to support community-based screening, referral and follow-up of high-risk cases; (iii) a dashboard for PHC doctors to monitor high-risk women in the community; (iv) supply chain monitoring for consumables and medications and (v) stakeholder engagement to co-develop implementation and sustainability pathways. The comparator is usual care with additional health worker education. Secondary outcomes include implementation outcomes assessed by the RE-AIM framework (reach, effectiveness, adoption, implementation, maintenance), clinical endpoints (anaemia, diabetes, hypertension), clinical service delivery indicators (quality of care score), mental health and lactation practice (PHQ9, GAD7, EuroQoL-5D, WHO IYCF questionnaire).</p>
<p><strong>Discussion:</strong> Engaging women with screening after a high-risk pregnancy is a challenge and has been highlighted as a missed opportunity for the prevention of non-communicable diseases. The SMARThealth Pregnancy trial is powered for the primary outcome and will address gaps in the evidence around how pregnancy can be used as an opportunity to improve women’s lifelong health. If successful, this approach could improve the health of women living in resource-limited settings around the world.</p>
<p><strong>Trial registration: </strong>ClinicalTrials.gov NCT05752955. Date of registration 3 March 2023.</p> |
| first_indexed | 2024-03-07T08:14:58Z |
| format | Journal article |
| id | oxford-uuid:fd8acf8f-d48c-420f-b2f9-809a30db2746 |
| institution | University of Oxford |
| language | English |
| last_indexed | 2024-03-07T08:14:58Z |
| publishDate | 2023 |
| publisher | BioMed Central |
| record_format | dspace |
| spelling | oxford-uuid:fd8acf8f-d48c-420f-b2f9-809a30db27462023-12-13T06:22:29ZA community-based intervention to improve screening, referral and follow-up of non-communicable diseases and anaemia amongst pregnant and postpartum women in rural India: study protocol for a cluster randomised trialJournal articlehttp://purl.org/coar/resource_type/c_dcae04bcuuid:fd8acf8f-d48c-420f-b2f9-809a30db2746EnglishSymplectic ElementsBioMed Central2023Hirst, JEVotruba, NBillot, LArora, VRajan, EThout, SRPeiris, DPatel, ANorton, RMullins, ESharma, AKennedy, SJha, VPraveen, D<p><strong>Background:</strong> Medical complications during pregnancy, including anaemia, gestational diabetes mellitus and hypertensive disorders of pregnancy place women are at higher risk of long-term complications. Scalable and low-cost strategies to integrate non-communicable disease screening into pregnancy care are needed. We aim to determine the effectiveness and implementation components of a community-based, digitally enabled approach, “SMARThealth Pregnancy,” to improve health during pregnancy and the first year after birth.</p> <p><strong>Methods:</strong> A pragmatic, parallel-group, cluster randomised, type 2 hybrid effectiveness-implementation trial of a community-based, complex intervention in rural India to decrease anaemia (primary outcome, defined as haemoglobin < 12g/dL) and increase testing for haemoglobin, glucose and blood pressure (secondary outcomes) in the first year after birth. Primary Health Centres (PHCs) are the unit of randomisation. PHCs are eligible with (1) > 1 medical officer and > 2 community health workers; and (2) capability to administer intravenous iron sucrose. Thirty PHCs in Telangana and Haryana will be randomised 1:1 using a matched-pair design accounting for cluster size and distance from the regional centre. The intervention comprises (i) an education programme for community health workers and PHC doctors; (ii) the SMARThealth Pregnancy app for health workers to support community-based screening, referral and follow-up of high-risk cases; (iii) a dashboard for PHC doctors to monitor high-risk women in the community; (iv) supply chain monitoring for consumables and medications and (v) stakeholder engagement to co-develop implementation and sustainability pathways. The comparator is usual care with additional health worker education. Secondary outcomes include implementation outcomes assessed by the RE-AIM framework (reach, effectiveness, adoption, implementation, maintenance), clinical endpoints (anaemia, diabetes, hypertension), clinical service delivery indicators (quality of care score), mental health and lactation practice (PHQ9, GAD7, EuroQoL-5D, WHO IYCF questionnaire).</p> <p><strong>Discussion:</strong> Engaging women with screening after a high-risk pregnancy is a challenge and has been highlighted as a missed opportunity for the prevention of non-communicable diseases. The SMARThealth Pregnancy trial is powered for the primary outcome and will address gaps in the evidence around how pregnancy can be used as an opportunity to improve women’s lifelong health. If successful, this approach could improve the health of women living in resource-limited settings around the world.</p> <p><strong>Trial registration: </strong>ClinicalTrials.gov NCT05752955. Date of registration 3 March 2023.</p> |
| spellingShingle | Hirst, JE Votruba, N Billot, L Arora, V Rajan, E Thout, SR Peiris, D Patel, A Norton, R Mullins, E Sharma, A Kennedy, S Jha, V Praveen, D A community-based intervention to improve screening, referral and follow-up of non-communicable diseases and anaemia amongst pregnant and postpartum women in rural India: study protocol for a cluster randomised trial |
| title | A community-based intervention to improve screening, referral and follow-up of non-communicable diseases and anaemia amongst pregnant and postpartum women in rural India: study protocol for a cluster randomised trial |
| title_full | A community-based intervention to improve screening, referral and follow-up of non-communicable diseases and anaemia amongst pregnant and postpartum women in rural India: study protocol for a cluster randomised trial |
| title_fullStr | A community-based intervention to improve screening, referral and follow-up of non-communicable diseases and anaemia amongst pregnant and postpartum women in rural India: study protocol for a cluster randomised trial |
| title_full_unstemmed | A community-based intervention to improve screening, referral and follow-up of non-communicable diseases and anaemia amongst pregnant and postpartum women in rural India: study protocol for a cluster randomised trial |
| title_short | A community-based intervention to improve screening, referral and follow-up of non-communicable diseases and anaemia amongst pregnant and postpartum women in rural India: study protocol for a cluster randomised trial |
| title_sort | community based intervention to improve screening referral and follow up of non communicable diseases and anaemia amongst pregnant and postpartum women in rural india study protocol for a cluster randomised trial |
| work_keys_str_mv | AT hirstje acommunitybasedinterventiontoimprovescreeningreferralandfollowupofnoncommunicablediseasesandanaemiaamongstpregnantandpostpartumwomeninruralindiastudyprotocolforaclusterrandomisedtrial AT votruban acommunitybasedinterventiontoimprovescreeningreferralandfollowupofnoncommunicablediseasesandanaemiaamongstpregnantandpostpartumwomeninruralindiastudyprotocolforaclusterrandomisedtrial AT billotl acommunitybasedinterventiontoimprovescreeningreferralandfollowupofnoncommunicablediseasesandanaemiaamongstpregnantandpostpartumwomeninruralindiastudyprotocolforaclusterrandomisedtrial AT arorav acommunitybasedinterventiontoimprovescreeningreferralandfollowupofnoncommunicablediseasesandanaemiaamongstpregnantandpostpartumwomeninruralindiastudyprotocolforaclusterrandomisedtrial AT rajane acommunitybasedinterventiontoimprovescreeningreferralandfollowupofnoncommunicablediseasesandanaemiaamongstpregnantandpostpartumwomeninruralindiastudyprotocolforaclusterrandomisedtrial AT thoutsr acommunitybasedinterventiontoimprovescreeningreferralandfollowupofnoncommunicablediseasesandanaemiaamongstpregnantandpostpartumwomeninruralindiastudyprotocolforaclusterrandomisedtrial AT peirisd acommunitybasedinterventiontoimprovescreeningreferralandfollowupofnoncommunicablediseasesandanaemiaamongstpregnantandpostpartumwomeninruralindiastudyprotocolforaclusterrandomisedtrial AT patela acommunitybasedinterventiontoimprovescreeningreferralandfollowupofnoncommunicablediseasesandanaemiaamongstpregnantandpostpartumwomeninruralindiastudyprotocolforaclusterrandomisedtrial AT nortonr acommunitybasedinterventiontoimprovescreeningreferralandfollowupofnoncommunicablediseasesandanaemiaamongstpregnantandpostpartumwomeninruralindiastudyprotocolforaclusterrandomisedtrial AT mullinse acommunitybasedinterventiontoimprovescreeningreferralandfollowupofnoncommunicablediseasesandanaemiaamongstpregnantandpostpartumwomeninruralindiastudyprotocolforaclusterrandomisedtrial AT sharmaa acommunitybasedinterventiontoimprovescreeningreferralandfollowupofnoncommunicablediseasesandanaemiaamongstpregnantandpostpartumwomeninruralindiastudyprotocolforaclusterrandomisedtrial AT kennedys acommunitybasedinterventiontoimprovescreeningreferralandfollowupofnoncommunicablediseasesandanaemiaamongstpregnantandpostpartumwomeninruralindiastudyprotocolforaclusterrandomisedtrial AT jhav acommunitybasedinterventiontoimprovescreeningreferralandfollowupofnoncommunicablediseasesandanaemiaamongstpregnantandpostpartumwomeninruralindiastudyprotocolforaclusterrandomisedtrial AT praveend acommunitybasedinterventiontoimprovescreeningreferralandfollowupofnoncommunicablediseasesandanaemiaamongstpregnantandpostpartumwomeninruralindiastudyprotocolforaclusterrandomisedtrial AT hirstje communitybasedinterventiontoimprovescreeningreferralandfollowupofnoncommunicablediseasesandanaemiaamongstpregnantandpostpartumwomeninruralindiastudyprotocolforaclusterrandomisedtrial AT votruban communitybasedinterventiontoimprovescreeningreferralandfollowupofnoncommunicablediseasesandanaemiaamongstpregnantandpostpartumwomeninruralindiastudyprotocolforaclusterrandomisedtrial AT billotl communitybasedinterventiontoimprovescreeningreferralandfollowupofnoncommunicablediseasesandanaemiaamongstpregnantandpostpartumwomeninruralindiastudyprotocolforaclusterrandomisedtrial AT arorav communitybasedinterventiontoimprovescreeningreferralandfollowupofnoncommunicablediseasesandanaemiaamongstpregnantandpostpartumwomeninruralindiastudyprotocolforaclusterrandomisedtrial AT rajane communitybasedinterventiontoimprovescreeningreferralandfollowupofnoncommunicablediseasesandanaemiaamongstpregnantandpostpartumwomeninruralindiastudyprotocolforaclusterrandomisedtrial AT thoutsr communitybasedinterventiontoimprovescreeningreferralandfollowupofnoncommunicablediseasesandanaemiaamongstpregnantandpostpartumwomeninruralindiastudyprotocolforaclusterrandomisedtrial AT peirisd communitybasedinterventiontoimprovescreeningreferralandfollowupofnoncommunicablediseasesandanaemiaamongstpregnantandpostpartumwomeninruralindiastudyprotocolforaclusterrandomisedtrial AT patela communitybasedinterventiontoimprovescreeningreferralandfollowupofnoncommunicablediseasesandanaemiaamongstpregnantandpostpartumwomeninruralindiastudyprotocolforaclusterrandomisedtrial AT nortonr communitybasedinterventiontoimprovescreeningreferralandfollowupofnoncommunicablediseasesandanaemiaamongstpregnantandpostpartumwomeninruralindiastudyprotocolforaclusterrandomisedtrial AT mullinse communitybasedinterventiontoimprovescreeningreferralandfollowupofnoncommunicablediseasesandanaemiaamongstpregnantandpostpartumwomeninruralindiastudyprotocolforaclusterrandomisedtrial AT sharmaa communitybasedinterventiontoimprovescreeningreferralandfollowupofnoncommunicablediseasesandanaemiaamongstpregnantandpostpartumwomeninruralindiastudyprotocolforaclusterrandomisedtrial AT kennedys communitybasedinterventiontoimprovescreeningreferralandfollowupofnoncommunicablediseasesandanaemiaamongstpregnantandpostpartumwomeninruralindiastudyprotocolforaclusterrandomisedtrial AT jhav communitybasedinterventiontoimprovescreeningreferralandfollowupofnoncommunicablediseasesandanaemiaamongstpregnantandpostpartumwomeninruralindiastudyprotocolforaclusterrandomisedtrial AT praveend communitybasedinterventiontoimprovescreeningreferralandfollowupofnoncommunicablediseasesandanaemiaamongstpregnantandpostpartumwomeninruralindiastudyprotocolforaclusterrandomisedtrial |