{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,4,24]],"date-time":"2025-04-24T04:26:19Z","timestamp":1745468779681,"version":"3.40.4"},"reference-count":0,"publisher":"S. Karger AG","license":[{"start":{"date-parts":[[2024,1,5]],"date-time":"2024-01-05T00:00:00Z","timestamp":1704412800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/karger.com\/pages\/terms-and-conditions"},{"start":{"date-parts":[[2024,1,5]],"date-time":"2024-01-05T00:00:00Z","timestamp":1704412800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/karger.com\/pages\/terms-and-conditions"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Cerebrovasc Dis"],"abstract":"<b><i>Introduction:<\/i><\/b> Structured models for secondary prevention of stroke in community settings are scarce. We aimed to develop and evaluate a model for improving medication adherence and enhanced risk factor monitoring. <b><i>Methods:<\/i><\/b> We developed a multimodal coordinated community health worker (CHW) intervention (C-CHW-I) model for stroke survivors. Following training, all patients received a minimum of three CHW home visits, and once in 3-month telephone call and health education for 6 months by CHWs. Seven blocks from 16 blocks of the study area were randomised to additionally receive an SMS alert for 6 months to reinforce CHW involvement. The primary outcomes were medication adherence and risk factor monitoring, and the secondary outcome was risk factor control. <b><i>Results:<\/i><\/b> The mean age of the study population was 64 \u00b1 12 years, 765 (85%) had ischaemic stroke. In the overall study cohort receiving the CHW intervention, mean medication adherence significantly improved from 3.56 (0.88) at baseline to 3.78 (0.61) at 6 months; <i>p<\/i> &lt; 0.001. Overall risk factor monitoring improved from 42.7% to 49.7%, and mean (standard deviation) systolic blood pressure (SBP) significantly reduced from 138 (21) mm Hg to 132 (15) mm Hg at 6 months; <i>p<\/i> &lt; 0.001. In patients additionally receiving SMS-based intervention, a statistically significant improvement in medication adherence was seen at 3 months (3.76 + 0.64 vs. 3.61 + 0.81; <i>p<\/i> = 0.008); however, no difference persisted at 6 months. The proportion of smokers and alcohol users reduced in both groups with a trend to greater reduction in the intervention group (smokers: 5.9% vs. 2.8% [<i>p<\/i> = 0.446] and alcohol users: 1.6% vs. 1.4% [<i>p<\/i> = 0.474]). At 6 months, the SBP did not differ (SBP 132.1 (16.2) in the SMS group vs. 133.2 (15.8) mm Hg in the control group, <i>p<\/i> = 0.409). <b><i>Conclusion:<\/i><\/b> Our model improved medication adherence and risk factor monitoring of stroke survivors in community settings, and this can reduce stroke burden in the community. <\/jats:p>","DOI":"10.1159\/000536077","type":"journal-article","created":{"date-parts":[[2024,1,5]],"date-time":"2024-01-05T22:08:06Z","timestamp":1704492486000},"page":"1-7","source":"Crossref","is-referenced-by-count":0,"title":["Development and Effect of a Coordinated Community Health Worker Intervention Model for the Stroke Survivors in Kerala, South India"],"prefix":"10.1159","author":[{"given":"P.N.","family":"Sylaja","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Veena","family":"Babu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"S.","family":"Sivasambath","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Feba","family":"Zechariah","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sivalekshmi","family":"Gireeshan","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Geethu","family":"Ganesan","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Biju","family":"Soman","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gurpreet","family":"Singh","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jeemon","family":"Panniyamakal","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bipin","family":"Gopal","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"127","published-online":{"date-parts":[[2024,1,5]]},"container-title":["Cerebrovascular Diseases"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/karger.com\/ced\/article-pdf\/doi\/10.1159\/000536077\/4162097\/000536077.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/karger.com\/ced\/article-pdf\/doi\/10.1159\/000536077\/4162097\/000536077.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,4,23]],"date-time":"2025-04-23T16:04:16Z","timestamp":1745424256000},"score":1,"resource":{"primary":{"URL":"https:\/\/karger.com\/article\/doi\/10.1159\/000536077"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,1,5]]},"references-count":0,"URL":"https:\/\/doi.org\/10.1159\/000536077","archive":["Portico"],"relation":{"is-supplemented-by":[{"id-type":"doi","id":"10.6084\/m9.figshare.24947976","asserted-by":"subject"}]},"ISSN":["1015-9770","1421-9786"],"issn-type":[{"type":"print","value":"1015-9770"},{"type":"electronic","value":"1421-9786"}],"subject":[],"published":{"date-parts":[[2024,1,5]]}}}