Implementation of WHO Package of Essential Noncommunicable-Based Brief Behavior-Change Interventions in Primary Care: A Quasi-Experimental Study from Himachal Pradesh, India.

Abstract

Background: Over 86% of premature deaths from noncommunicable diseases (NCDs) occur in low- and middle-income countries. This study aimed to assess the impact of integrating components of the WHO's Package of Essential Noncommunicable Disease (PEN) protocols on blood pressure control. Secondary objectives included evaluating changes in biological and behavioral NCD risk factors, 10-year cardiovascular disease (CVD) risk, and treatment adherence.

Material and methods: A quasi-experimental study was conducted in four health centers-two intervention (urban and rural) and two control sites. WHO-PEN protocols 1 and 2 were implemented in the intervention arm, where 302 patients received behavior-change interventions by trained nonphysician health workers using "Brief Advice." The control arm (305 patients) received usual care. The intervention lasted six months, with follow-ups at two, four, and six months.

Results: After six months, blood pressure control did not differ significantly between the intervention and control groups after adjustment for baseline blood pressure control, income, and family type (adjusted odds ratio [AOR] 0.71, P = 0.188). In the unadjusted analysis, 88.5% of patients in the intervention arm had controlled blood pressure, with a risk difference of - 7.03 (95% confidence interval [CI]: -12.8 to - 1.27), an odds ratio (OR) of 0.57 (95% CI: 0.36-0.91), and a statistically significant association (P = 0.018). Significant improvements were observed in physical activity (≥150 minutes/week) with a risk difference of - 12.43 (95% CI: -22.25 to - 6.60), P < 0.001; vegetable consumption (-31.06, 95% CI: -34.65 to - 27.47), P < 0.001; and fruit intake (-41.46, 95% CI: -48.48 to - 34.44), P < 0.001.

Conclusions: Behavior-change communication by nonphysician health workers, focusing on modifiable risk factors, improved healthy behaviors among NCD patients, while blood pressure control did not improve significantly after adjustment.