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Table 1 Common barriers to effective control of hypertension, diabetes and secondary prevention of stroke and interventions to address these barriers

From: Effect of a community-based intervention for cardiovascular risk factor control on stroke mortality in rural Gadchiroli, India: study protocol for a cluster randomised controlled trial

Barriers to effective controlIntervention
Lack of awareness about diseases and their risk factors• Mass awareness programme for hypertension, diabetes and stroke
• Individual patient education using culturally appropriate awareness material
• Counselling about risk factors (e.g. tobacco, alcohol and high salt use)
Lack of screening facilities at the village level• Home-based screening of individuals ≥50 years of age for hypertension, diabetes and stroke
Lack of confirmation of diagnosis• Referral of screen positive individuals to the village outreach clinic
• Evaluation and confirmation of diagnosis of hypertension, diabetes and stroke by the OP
Difficulty accessing healthcare facilities on regular basis• Periodic village clinic by the OP
• Monthly home visits by the CHW to reduce need to travel outside the village for seeking care
Lack of treatment adherence• Monthly follow-up by the CHW by making a home visit
• Follow-up by the OP every 2–3 months
Losing or running out of medications• Availability of medication stock with the CHW
• After consulting the OP, the CHW will replenish the patient’s medications
Stopping medications due to side effects• Change in medications by the CHW after consulting the OP when there are side effects due to medications
Affordability of medicines• Free medications
  1. CHW Community Health Worker, OP Outreach Physician