Enhancing Public Knowledge of Risk Factors and Warning Signs for Stroke and Heart Attack Through Home-Based Community Health Worker Interventions: A Cluster Randomized Trial

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Abstract
Enhancing community knowledge about risk factors and warning signs for stroke and heart attack is important for effective prevention and control. This study evaluated the effects of home-based health education and healthy lifestyle interventions delivered by community health workers (CHWs) on knowledge of risk factors and warning signs for stroke and heart attack. We conducted a 1:1 cluster-randomized trial in twelve villages in rural Morogoro, Tanzania. Participants in the intervention received monthly home-based health education and healthy lifestyle promotion from CHWs for 6 months, followed by bi-monthly follow-up visits until 12 months. Participants in the control group followed the standard of care. Knowledge regarding risk factors and warning signs for stroke and heart attack was assessed through two independent cross-sectional surveys, one before and another after the intervention. The analyses were adjusted for baseline factors. Both intervention and control groups experienced an increase in mean knowledge scores between baseline and evaluation survey, with a significant increase in the intervention group. Mean knowledge for risk factors increased by 4.0 (SD 2.7) in the intervention compared to 2.5 (SD 3.1) in the control group. That of warning signs increased by 3.1 (SD 2.4) in the intervention group compared to 2.4 (SD 2.8) in the control group. Overall, mean knowledge of risk factors and warning signs increased by 7.1 (SD 4.3) in the intervention group and by 4.9 (SD 5.3) in the control group. After adjusting for selected baseline characteristics, participants in the intervention group experienced a 2.1 greater increase in mean knowledge of risk factors and warning signs [difference in differences 2.1 (95% CI, 1.4 to 2.8)]. CHWs’ home-delivered health education and healthy lifestyle promotion interventions resulted in a significant enhancement in knowledge of risk factors and warning signs for stroke and heart attack. These findings provide insight into the potential of CHW-led interventions in the prevention and control of stroke and heart attacks in Tanzania. Pan African Clinical Trial Registry (PACTR201801002959401).

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