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. 2025 Aug 11;20(8):e0328447.
doi: 10.1371/journal.pone.0328447. eCollection 2025.

Enhancing knowledge of hypertension among general practitioners in Pakistan through a Train-The-Trainer initiative

Tariq Ashraf  1 , Rafat Sultana  1 , Musa Karim  2 , Kanwal Fatima Aamir  2 , Mustajab Mujtaba  3 , Shoukat Memon  4 , Deedar Hussain Gajju  5 , Abdul Qadir Bhutto  6 , Umair Arif  7 , Hassan Irshad Bajwa  8 , Naveed Shehzad  9 , Haji Maqsood Mehmood  10 , Ijaz Ul Hassan  11 , Syed Gulzar Ul Hassan  12 , Waheed Ashraf  13 , Muhammad Saleem  14 , Naeem Tariq  15 , Muhammad Niaz Khan  16 , Khalid Naseem Khan  17 , Muhammad Farooq Saeed Khawaja  18 , Naveed Hussain  19 , Shahid Hussain Memon  20 , Imran Ahmed Kazmi  21 , Muhamamd Shahzad Azeem  22 , Muhammad Akram Asi  8 , Khalid Razaq Malik  23 , Shahzad Aslam  24 , Muhammad Amir Sohail  25 , Arshad Ali Shah  3 , Maha Zainab Zia Yaqub  26 , Syed Khubaib  27 , Hasan Imam  28 , Ghulam Fareed  29 , Rehan Riaz  30
Affiliations

Enhancing knowledge of hypertension among general practitioners in Pakistan through a Train-The-Trainer initiative

Tariq Ashraf et al. PLoS One. .

Abstract

Background: Hypertension (HTN) affects over a billion people worldwide, with most cases in low- and middle-income countries (LMICs) where awareness and control remain low. In Pakistan, general practitioners (GPs) are usually the initial contact for hypertensive patients. Through the Train the Trainer (TTT) initiative, a group of consultant cardiologists were trained as master trainers to conduct training for GPs across Pakistan. This study aimed to assess the effectiveness of the TTT initiative regarding knowledge of GPs about the diagnosis and management of HTN.

Methods: This study included 540 GPs from all over Pakistan. Participants attended HTN training workshops run by Master Trainers under the TTT model and completed a structured online questionnaire in relation to knowledge of HTN before and 1-3 months after training. Knowledge scores were derived from correct responses for 19 items.

Results: Pre-training GPs demonstrated low HTN knowledge scores with a median of 26.3 [IQR: 15.8-36.8] and 92% scoring less than 50. In contrast, post-training medians increased significantly to 42.1 [IQR: 31.6-63.2], with 38.5% of GPs achieving moderate or high knowledge scores ≥50 (p < 0.001). Overall, gains were observed across all demographic groups; significant improvement was observed among female and younger GPs.

Conclusions: The TTT initiative effectively improved knowledge in both the diagnosis and management of hypertension among GPs, thus standing to potentially improve the current gaps in HTN care in many LMICs through similar models. Further studies are warranted to document the long-term clinical impact of this kind of training on patient outcomes and hypertension control.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Effectiveness of the TTT initiative in regards to knowledge of GPs about the diagnosis and management of HTN.
Fig 2
Fig 2. Distribution and median pre and post-median knowledge score by gender.
Fig 3
Fig 3. Distribution and median pre and post-median knowledge score by age.
Fig 4
Fig 4. Distribution and median pre and post-median knowledge score by work experience.
See this image and copyright information in PMC

References

    1. Whelton PK, Carey RM, Aronow WS, Casey DE Jr, Collins KJ, Dennison Himmelfarb C, et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol. 2018;71(19):e127–248. doi: 10.1016/j.jacc.2017.11.006 - DOI - PubMed
    1. Bakris G, Ali W, Parati G. ACC/AHA versus ESC/ESH on hypertension guidelines: JACC guideline comparison. J Am Coll Cardiol 2019;73(23):3018–26. - PubMed
    1. Moran AE, Gupta R. Implementation of global hearts hypertension control programs in 32 low-and middle-income countries: JACC International. J Am Coll Cardiol 2023;82(19):1868–84. - PubMed
    1. Mahadir Naidu B, Mohd Yusoff MF, Abdullah S, Musa KI, Yaacob NM, Mohamad MS, et al. Factors associated with the severity of hypertension among Malaysian adults. PLoS One. 2019;14(1):e0207472. doi: 10.1371/journal.pone.0207472 - DOI - PMC - PubMed
    1. GBD 2019 Risk Factors Collaborators. Global burden of 87 risk factors in 204 countries and territories, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet. 2020;396(10258):1223–49. doi: 10.1016/S0140-6736(20)30752-2 - DOI - PMC - PubMed