A village doctor-led mobile health intervention for cardiovascular risk reduction in rural China: cluster randomised controlled trial

Abstract

Objective: To assess the effectiveness of a village doctor-led mobile health intervention on cardiovascular risk reduction among residents in rural China.

Design: Cluster randomised controlled trial.

Setting: 127 villages from five provinces and autonomous regions in China.

Participants: 4533 participants from 127 villages: 2297 (64 villages) were randomly assigned to the intervention group and 2236 (63 villages) to the control group. Participants were aged ≥35 years, had no established atherosclerotic cardiovascular disease (ASCVD) but a predicted 10 year risk of ≥10%, had contracted a family doctor service with the local village doctor, and owned a smart phone.

Interventions: In addition to usual clinical care and basic public health services provided for the control group, the intervention led by village doctors included five components: assessing risk factors to identify individualised intervention targets, setting gradual goals based on doctor-participant communication, providing targeted short videos on health education, conducting health monitoring with periodic feedback, and providing motivation to reduce risk based on gamification.

Main outcome measure: Mean change in predicted 10 year risk of ASCVD from baseline to 12 months.

Results: Enrolment took place between March 2023 and May 2023. During the 12 month follow-up (completion rate 99.4%), the 10 year risk of ASCVD decreased from 18.0% to 11.7% in the intervention group and from 17.8% to 13.6% in the control group (absolute difference -1.88% (95% confidence interval (CI) -2.57% to -1.19%; P<0.001). Compared with the control group, the intervention group showed larger reductions in lifetime ASCVD risk (-15.9% v -11.0%; difference -4.59%; P<0.001), systolic blood pressure (-23.2 mm Hg v -15.2 mm Hg; difference -7.64 mm Hg; P<0.001), diastolic blood pressure (-10.9 mm Hg v -6.9 mm Hg; difference: -3.59 mm Hg; P<0.001), fasting blood glucose (-0.9 mmol/L v -0.5 mmol/L; difference -0.30 mmol/L; P=0.008), proportion of daily smokers (-3.1% v -0.6%; odds ratio 0.60, 95% CI 0.43 to 0.84; P=0.003), and insufficient physical activity (-3.0% v 1.3%; odds ratio 0.63, 0.42 to 0.95; P=0.03). No significant differences were observed for change in non-high density lipoprotein cholesterol or proportion of participants with obesity.

Conclusions: The village doctor-led mobile health intervention was effective at reducing cardiovascular risk and improving control of behavioural and metabolic risk factors. This feasible approach could be scaled up in rural China and other under-resourced settings to improve health management based on the local primary healthcare system.

Trial registration: ClinicalTrials.gov NCT05645640.

Fig 1

Trial profile. ASCVD=atherosclerotic cardiovascular disease

Fig 2

Adherence to intervention in participants assigned to village doctor-led mobile health intervention on cardiovascular risk reduction. The tailored target was 6000-8000 steps per exercise day for participants aged ≥60 years and 8000-10 000 steps per exercise day for participants aged <60 years

Fig 3

Trends in control of cardiovascular risk factors during follow-up in participants assigned to village doctor-led mobile health intervention on cardiovascular risk reduction or to usual clinical care and basic public health services. SMARTER=Strategy for cardiovascular disease prevention through tailored health Management and its effectiveness Assessment through a cluster Randomised Trial in individuals with Elevated Risk. An interactive version of this graphic is available at https://public.flourish.studio/visualisation/22895185/