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Randomized Controlled Trial
. 2016 Mar 15:16:264.
doi: 10.1186/s12889-016-2891-6.

Task shifting of frontline community health workers for cardiovascular risk reduction: design and rationale of a cluster randomised controlled trial (DISHA study) in India

Panniyammakal Jeemon  1   2 , Gitanjali Narayanan  2 , Dimple Kondal  2 , Kashvi Kahol  2 , Ashok Bharadwaj  3 , Anil Purty  4 , Prakash Negi  5 , Sulaiman Ladhani  6 , Jyoti Sanghvi  7 , Kuldeep Singh  7 , Deksha Kapoor  2 , Nidhi Sobti  2 , Dorothy Lall  2 , Sathyaprakash Manimunda  2   8 , Supriya Dwivedi  9 , Gurudyal Toteja  9 , Dorairaj Prabhakaran  10   11 ; DISHA Study Investigators
Collaborators, Affiliations
Randomized Controlled Trial

Task shifting of frontline community health workers for cardiovascular risk reduction: design and rationale of a cluster randomised controlled trial (DISHA study) in India

Panniyammakal Jeemon et al. BMC Public Health. .

Abstract

Background: Effective task-shifting interventions targeted at reducing the global cardiovascular disease (CVD) epidemic in low and middle-income countries (LMICs) are urgently needed.

Methods: DISHA is a cluster randomised controlled trial conducted across 10 sites (5 in phase 1 and 5 in phase 2) in India in 120 clusters. At each site, 12 clusters were randomly selected from a district. A cluster is defined as a small village with 250-300 households and well defined geographical boundaries. They were then randomly allocated to intervention and control clusters in a 1:1 allocation sequence. If any of the intervention and control clusters were <10 km apart, one was dropped and replaced with another randomly selected cluster from the same district. The study included a representative baseline cross-sectional survey, development of a structured intervention model, delivery of intervention for a minimum period of 18 months by trained frontline health workers (mainly Anganwadi workers and ASHA workers) and a post intervention survey in a representative sample. The study staff had no information on intervention allocation until the completion of the baseline survey. In order to ensure comparability of data across sites, the DISHA study follows a common protocol and manual of operation with standardized measurement techniques.

Discussion: Our study is the largest community based cluster randomised trial in low and middle-income country settings designed to test the effectiveness of 'task shifting' interventions involving frontline health workers for cardiovascular risk reduction.

Trial registration: CTRI/2013/10/004049 . Registered 7 October 2013.

Keywords: Cardio-vascular disease; India; Low and middle-income countries; Task shifting interventions.

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Figures

Fig. 1
Fig. 1
Geographic location of study sites
Fig. 2
Fig. 2
Study flow chart
See this image and copyright information in PMC

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