{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,2]],"date-time":"2026-10-02T17:31:55Z","timestamp":1790962315877,"version":"4.1.0"},"reference-count":34,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2024,5,28]],"date-time":"2024-05-28T00:00:00Z","timestamp":1716854400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2024,5,28]],"date-time":"2024-05-28T00:00:00Z","timestamp":1716854400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Prim. Care"],"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Background<\/jats:title>\n                <jats:p>Individuals living in communities with poor access to healthcare may be unaware of their high blood pressure (BP). While the use of community health workers (CHWs) can address gaps in human resources for health, CHWs in Uganda have not been used previously for BP screening and management. We report the results of an initiative to train CHWs to evaluate BP and to administer group-based education in Kalangala and Buvuma Island Districts of Lake Victoria, Uganda.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>We randomly selected 42 of 212 villages. We trained CHWs based in island districts on measuring BP. CHWs visited all households in the selected villages and invited all adults\u2009\u2265\u200918 years to be screened for high BP. We used the World Health Organization\u2019s STEPwise tool to collect data on demographic and behavioral characteristics and BP measurements. High blood pressure was defined as systolic BP (SBP)\u2009\u2265\u2009140\u00a0mm Hg and\/or diastolic BP (DBP)\u2009\u2265\u200990\u00a0mm Hg over three readings. CHWs created and led fortnight support groups for individuals identified with high blood pressure at baseline. At each group meeting, CHWs re-measured BP and administered an intervention package, which included self-management and lifestyle education to participants. The paired t-test was used to compare mean values of systolic blood pressure (SBP) and diastolic blood pressure (DBP) before and after the intervention. Generalized estimating equations (GEE) were used to model longitudinal changes in BP.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>We trained 84 CHWs to measure BP and deliver the intervention package. Among 2,016 community members, 570 (28.3%) had high blood pressure; of these, 63 (11.1%) had a previous diagnosis of hypertension. The comparison of SBP and DBP before and after the intervention revealed significant reductions in mean SBP from 158mmHg (SD\u2009=\u200929.8) to 149 mmHg (SD\u2009=\u200929.8) (<jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001) and mean DBP from 97mmHg (SD\u2009=\u200914.3) to 92mmHg (<jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001). GEE showed decreases of -1.133 (SBP) and \u2212\u20090.543 mmHg (DBP)\/fortnight.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusion<\/jats:title>\n                <jats:p>High BP was common but previously undiagnosed. The CHW-led group-based self-management and education for controlling high BP was effective in the island districts in Uganda. Scaling up the intervention in other hard-to-reach districts could improve control of high BP on a large scale.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1186\/s12875-024-02444-y","type":"journal-article","created":{"date-parts":[[2024,5,28]],"date-time":"2024-05-28T18:24:06Z","timestamp":1716920646000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Group-based Education and monitoring program delivered by community health workers to improve control of high blood pressure in island districts of lake victoria, Uganda"],"prefix":"10.1186","volume":"25","author":[{"given":"Andrew","family":"Kwiringira","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Richard","family":"Migisha","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lilian","family":"Bulage","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Benon","family":"Kwesiga","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel","family":"Kadobera","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"George","family":"Upenytho","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul","family":"Mbaka","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julie R.","family":"Harris","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Donald","family":"Hayes","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alex R.","family":"Ario","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2024,5,28]]},"reference":[{"issue":"6","key":"2444_CR1","doi-asserted-by":"publisher","first-page":"574","DOI":"10.1093\/ehjqcco\/qcaa061","volume":"7","author":"H Dai","year":"2021","unstructured":"Dai H, Zhang Q, Much AA, Maor E, Segev A, Beinart R, et al. Global, regional, and national prevalence, incidence, mortality, and risk factors for atrial fibrillation, 1990\u20132017: results from the global burden of Disease Study 2017. Eur Heart Journal-Quality Care Clin Outcomes. 2021;7(6):574\u201382.","journal-title":"Eur Heart Journal-Quality Care Clin Outcomes"},{"key":"2444_CR2","unstructured":"Bahendeka Silver GD, Mutungi Gerald K, Ronald KR, Ronald W. Report on non-communicable disease risk factors STEPS Survey 2023. Kampala, Uganda Ministry of Health; 2023."},{"issue":"11","key":"2444_CR3","doi-asserted-by":"publisher","first-page":"1951","DOI":"10.1111\/jch.14039","volume":"22","author":"M Gavriilaki","year":"2020","unstructured":"Gavriilaki M, Anyfanti P, Nikolaidou B, Lazaridis A, Gavriilaki E, Douma S, et al. Nighttime dipping status and risk of cardiovascular events in patients with untreated hypertension: a systematic review and meta-analysis. J Clin Hypertens. 2020;22(11):1951\u20139.","journal-title":"J Clin Hypertens"},{"issue":"9","key":"2444_CR4","doi-asserted-by":"publisher","first-page":"818","DOI":"10.1056\/NEJMoa1311890","volume":"371","author":"S Yusuf","year":"2014","unstructured":"Yusuf S, Rangarajan S, Teo K, Islam S, Li W, Liu L, et al. Cardiovascular risk and events in 17 low-, middle-, and high-income countries. N Engl J Med. 2014;371(9):818\u201327.","journal-title":"N Engl J Med"},{"key":"2444_CR5","unstructured":"Kikule E, Mukooza EK, Mugarura E, Semujju S, Kusiima M, Ubomba-Jaswa P et al. The Health and Socio-Economic Status of the Buvuma Main Island Community in Buvuma District, Uganda."},{"issue":"249","key":"2444_CR6","first-page":"61","volume":"1","author":"ZA Bhutta","year":"2010","unstructured":"Bhutta ZA, Lassi ZS, Pariyo G, Huicho L. Global experience of community health workers for delivery of health related millennium development goals: a systematic review, country case studies, and recommendations for integration into national health systems. Global Health Workforce Alliance. 2010;1(249):61.","journal-title":"Global Health Workforce Alliance"},{"key":"2444_CR7","doi-asserted-by":"crossref","unstructured":"Lewin S, Munabi-Babigumira S, Glenton C, Daniels K, Bosch\u2010Capblanch X, van Wyk BE et al. Lay health workers in primary and community health care for maternal and child health and the management of infectious diseases. Cochrane Database Syst Reviews. 2010(3).","DOI":"10.1002\/14651858.CD004015.pub3"},{"issue":"9","key":"2444_CR8","doi-asserted-by":"publisher","first-page":"1538","DOI":"10.1377\/hlthaff.2015.0349","volume":"34","author":"T Gaziano","year":"2015","unstructured":"Gaziano T, Abrahams-Gessel S, Surka S, Sy S, Pandya A, Denman CA, et al. Cardiovascular disease screening by community health workers can be cost-effective in low-resource countries. Health Aff. 2015;34(9):1538\u201345.","journal-title":"Health Aff"},{"issue":"9","key":"2444_CR9","doi-asserted-by":"publisher","first-page":"e556","DOI":"10.1016\/S2214-109X(15)00143-6","volume":"3","author":"TA Gaziano","year":"2015","unstructured":"Gaziano TA, Abrahams-Gessel S, Denman CA, Montano CM, Khanam M, Puoane T, et al. An assessment of community health workers\u2019 ability to screen for cardiovascular disease risk with a simple, non-invasive risk assessment instrument in Bangladesh, Guatemala, Mexico, and South Africa: an observational study. Lancet Global Health. 2015;3(9):e556\u201363.","journal-title":"Lancet Global Health"},{"issue":"15","key":"2444_CR10","doi-asserted-by":"publisher","first-page":"1897","DOI":"10.1016\/j.jacc.2019.08.003","volume":"74","author":"R Vedanthan","year":"2019","unstructured":"Vedanthan R, Kamano JH, DeLong AK, Naanyu V, Binanay CA, Bloomfield GS, et al. Community health workers improve linkage to hypertension care in Western Kenya. J Am Coll Cardiol. 2019;74(15):1897\u2013906.","journal-title":"J Am Coll Cardiol"},{"issue":"9754","key":"2444_CR11","doi-asserted-by":"publisher","first-page":"1775","DOI":"10.1016\/S0140-6736(10)61514-0","volume":"376","author":"M Cecchini","year":"2010","unstructured":"Cecchini M, Sassi F, Lauer JA, Lee YY, Guajardo-Barron V, Chisholm D. Tackling of unhealthy diets, physical inactivity, and obesity: health effects and cost-effectiveness. Lancet. 2010;376(9754):1775\u201384.","journal-title":"Lancet"},{"issue":"4","key":"2444_CR12","doi-asserted-by":"publisher","first-page":"431","DOI":"10.1016\/j.gheart.2014.11.003","volume":"9","author":"W Checkley","year":"2014","unstructured":"Checkley W, Ghannem H, Irazola V, Kimaiyo S, Levitt NS, Miranda JJ, et al. Management of NCD in low-and middle-income countries. Global Heart. 2014;9(4):431\u201343.","journal-title":"Global Heart"},{"key":"2444_CR13","unstructured":"UBOS UBoS. Projected Population for 146 districts and cities in Uganda. Uganda Bureau of Statistics; 2023."},{"issue":"11","key":"2444_CR14","doi-asserted-by":"publisher","first-page":"e0142312","DOI":"10.1371\/journal.pone.0142312","volume":"10","author":"G Musinguzi","year":"2015","unstructured":"Musinguzi G, Bastiaens H, Wanyenze RK, Mukose A, Van Geertruyden J-P, Nuwaha F. Capacity of health facilities to manage hypertension in Mukono and Buikwe districts in Uganda: challenges and recommendations. PLoS ONE. 2015;10(11):e0142312.","journal-title":"PLoS ONE"},{"key":"2444_CR15","volume-title":"Is there a doctor in the house? Medical worker absence in India","author":"K Muralidharan","year":"2011","unstructured":"Muralidharan K, Chaudhury N, Hammer J, Kremer M, Rogers FH. Is there a doctor in the house? Medical worker absence in India. Washington, DC: World Bank; 2011."},{"key":"2444_CR16","unstructured":"WHO. World Health Organisation. Section\u00a03: guide to physical measurements (Step 2). Geneva; 2008."},{"issue":"4","key":"2444_CR17","doi-asserted-by":"publisher","first-page":"e62236","DOI":"10.1371\/journal.pone.0062236","volume":"8","author":"G Musinguzi","year":"2013","unstructured":"Musinguzi G, Nuwaha F. Prevalence, awareness and control of hypertension in Uganda. PLoS ONE. 2013;8(4):e62236.","journal-title":"PLoS ONE"},{"key":"2444_CR18","doi-asserted-by":"crossref","unstructured":"Musinguzi G, Anthierens S, Nuwaha F, Van Geertruyden J-P, Wanyenze RK, Bastiaens H. Factors influencing compliance and health seeking behaviour for hypertension in Mukono and Buikwe in Uganda: a qualitative study. International journal of hypertension. 2018;2018.","DOI":"10.1155\/2018\/8307591"},{"key":"2444_CR19","unstructured":"WHO, ILO. Post-exposure prophylaxis to prevent HIV infection: Joint WHO\/ILO guidelines on post-exposure prophylaxis (PEP) to prevent HIV infection. World Health Organization\/International Labour Organization Geneva; 2007."},{"issue":"2","key":"2444_CR20","doi-asserted-by":"publisher","first-page":"145","DOI":"10.1097\/00004872-200018020-00003","volume":"18","author":"R Edwards","year":"2000","unstructured":"Edwards R, Unwin N, Mugusi F, Whiting D, Rashid S, Kissima J, et al. Hypertension prevalence and care in an urban and rural area of Tanzania. J Hypertens. 2000;18(2):145\u201352.","journal-title":"J Hypertens"},{"issue":"9","key":"2444_CR21","doi-asserted-by":"publisher","first-page":"796","DOI":"10.1136\/jech-2018-211185","volume":"73","author":"P-P Zhao","year":"2019","unstructured":"Zhao P-P, Xu L-W, Sun T, Wu Y-Y, Zhu X-W, Zhang B, et al. Relationship between alcohol use, blood pressure and hypertension: an association study and a mendelian randomisation study. J Epidemiol Community Health. 2019;73(9):796\u2013801.","journal-title":"J Epidemiol Community Health"},{"issue":"1","key":"2444_CR22","doi-asserted-by":"publisher","first-page":"31302","DOI":"10.3402\/gha.v9.31302","volume":"9","author":"SN Kabwama","year":"2016","unstructured":"Kabwama SN, Ndyanabangi S, Mutungi G, Wesonga R, Bahendeka SK, Guwatudde D. Alcohol use among adults in Uganda: findings from the countrywide non-communicable diseases risk factor cross-sectional survey. Global Health Action. 2016;9(1):31302.","journal-title":"Global Health Action"},{"issue":"9","key":"2444_CR23","doi-asserted-by":"publisher","first-page":"e0138991","DOI":"10.1371\/journal.pone.0138991","volume":"10","author":"D Guwatudde","year":"2015","unstructured":"Guwatudde D, Mutungi G, Wesonga R, Kajjura R, Kasule H, Muwonge J, et al. The epidemiology of hypertension in Uganda: findings from the national non-communicable diseases risk factor survey. PLoS ONE. 2015;10(9):e0138991.","journal-title":"PLoS ONE"},{"key":"2444_CR24","unstructured":"Wamala JF, Karyabakabo Z, Ndungutse D, Guwatudde D. Prevalence factors associated with hypertension in Rukungiri district, Uganda-a community-based study. Afr Health Sci. 2009;9(3)."},{"issue":"29","key":"2444_CR25","doi-asserted-by":"publisher","first-page":"2309","DOI":"10.1093\/eurheartj\/ehx273","volume":"38","author":"RS Patel","year":"2017","unstructured":"Patel RS, Masi S, Taddei S. Understanding the role of genetics in hypertension. Eur Heart J. 2017;38(29):2309\u201312.","journal-title":"Eur Heart J"},{"key":"2444_CR26","doi-asserted-by":"publisher","first-page":"55","DOI":"10.2147\/PRBM.S40490","volume":"6","author":"ND White","year":"2013","unstructured":"White ND, Lenz TL, Smith K. Tool guide for lifestyle behavior change in a cardiovascular risk reduction program. Psychol Res Behav Manage. 2013;6:55.","journal-title":"Psychol Res Behav Manage"},{"issue":"10","key":"2444_CR27","doi-asserted-by":"publisher","first-page":"909","DOI":"10.1093\/qjmed\/hct121","volume":"106","author":"K Matsumura","year":"2013","unstructured":"Matsumura K, Arima H, Tominaga M, Ohtsubo T, Sasaguri T, Fujii K, et al. Impact of antihypertensive medication adherence on blood pressure control in hypertension: the COMFORT study. QJM: Int J Med. 2013;106(10):909\u201314.","journal-title":"QJM: Int J Med"},{"issue":"4","key":"2444_CR28","doi-asserted-by":"publisher","first-page":"756","DOI":"10.1161\/HYPERTENSIONAHA.109.135178","volume":"54","author":"L Aucott","year":"2009","unstructured":"Aucott L, Rothnie H, McIntyre L, Thapa M, Waweru C, Gray D. Long-term weight loss from lifestyle intervention benefits blood pressure? A systematic review. Hypertension. 2009;54(4):756\u201362.","journal-title":"Hypertension"},{"issue":"1","key":"2444_CR29","doi-asserted-by":"publisher","first-page":"e000566","DOI":"10.1136\/bmjgh-2017-000566","volume":"3","author":"PM Newman","year":"2018","unstructured":"Newman PM, Franke MF, Arrieta J, Carrasco H, Elliott P, Flores H, et al. Community health workers improve disease control and medication adherence among patients with diabetes and\/or hypertension in Chiapas, Mexico: an observational stepped-wedge study. BMJ Global Health. 2018;3(1):e000566.","journal-title":"BMJ Global Health"},{"issue":"6","key":"2444_CR30","doi-asserted-by":"publisher","first-page":"883","DOI":"10.7326\/0003-4819-105-6-883","volume":"105","author":"D HOLLANDER","year":"1986","unstructured":"Hollander D, Vadheim CM, Brettholze P, Delahunty GM, Rotter T. Increased intestinal permeability in patients with Crohn\u2019s disease and their relatives: a possible etiologic factor. Ann Intern Med. 1986;105(6):883\u20135.","journal-title":"Ann Intern Med"},{"issue":"11","key":"2444_CR31","doi-asserted-by":"publisher","first-page":"1016","DOI":"10.1001\/jama.2017.11358","volume":"318","author":"J He","year":"2017","unstructured":"He J, Irazola V, Mills KT, Poggio R, Beratarrechea A, Dolan J, et al. Effect of a community health worker\u2013led multicomponent intervention on blood pressure control in low-income patients in Argentina: a randomized clinical trial. JAMA. 2017;318(11):1016\u201325.","journal-title":"JAMA"},{"issue":"1","key":"2444_CR32","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1186\/s12889-019-7261-8","volume":"19","author":"F Limbani","year":"2019","unstructured":"Limbani F, Goudge J, Joshi R, Maar MA, Miranda JJ, Oldenburg B, et al. Process evaluation in the field: global learnings from seven implementation research hypertension projects in low-and middle-income countries. BMC Public Health. 2019;19(1):1\u201311.","journal-title":"BMC Public Health"},{"issue":"1","key":"2444_CR33","doi-asserted-by":"publisher","first-page":"142","DOI":"10.1007\/s11606-019-05396-7","volume":"35","author":"L Boulware","year":"2020","unstructured":"Boulware L, Ephraim PL, Hill-Briggs F, Roter DL, Bone LR, Wolff JL, et al. Hypertension self-management in socially disadvantaged African americans: the achieving blood pressure control together (ACT) randomized comparative effectiveness trial. J Gen Intern Med. 2020;35(1):142\u201352.","journal-title":"J Gen Intern Med"},{"issue":"6","key":"2444_CR34","doi-asserted-by":"publisher","first-page":"632","DOI":"10.1016\/j.jacc.2019.11.055","volume":"75","author":"FJ He","year":"2020","unstructured":"He FJ, Tan M, Ma Y, MacGregor GA. Salt reduction to prevent hypertension and cardiovascular disease: JACC state-of-the-art review. J Am Coll Cardiol. 2020;75(6):632\u201347.","journal-title":"J Am Coll Cardiol"}],"container-title":["BMC Primary Care"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12875-024-02444-y.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s12875-024-02444-y\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12875-024-02444-y.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,5,28]],"date-time":"2024-05-28T18:25:43Z","timestamp":1716920743000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmcfampract.biomedcentral.com\/articles\/10.1186\/s12875-024-02444-y"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,5,28]]},"references-count":34,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2024,12]]}},"alternative-id":["2444"],"URL":"https:\/\/doi.org\/10.1186\/s12875-024-02444-y","relation":{},"ISSN":["2731-4553"],"issn-type":[{"value":"2731-4553","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,5,28]]},"assertion":[{"value":"21 February 2023","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"22 May 2024","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"28 May 2024","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The study received ethical approval from Kampala Internal University, Research, and Ethics Committee (KIU-2021-37). We also obtained permission from the Ministry of Health (MOH) and sought administrative clearance from District Health Officers to conduct this evaluation. The Office of Science, U.S. Centers for Disease Control and Prevention, determined that the primary intent of this evaluation was public health practice and not research.We sought verbal informed consent from all respondents before data collection. Written informed consent was not obtained to minimize the risk of spreading COVID-19 infection, since MOH Standard Operating Procedures (SOPs) discouraged exchange of materials by hand. The Office of Science, U.S. Centers for Disease Control and Prevention approved this form of consent. Participants were told that their participation was voluntary and that there would be no negative consequences if they refused to participate. During data collection, respondents were assigned unique identifiers instead of names to protect their confidentiality. All methods were performed in accordance with WMA Declaration of Helsinki, ethical principles for medical research involving human subjects. Participants who were found to have high blood pressure were referred to clinical health workers. Information was stored in password-protected computers and was not shared with anyone outside the investigation team.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare that they have no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"191"}}