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| Name | Class |
|---|---|
| The George Institute | OTHER |
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We will evaluate an e_Prescription intervention can be integrated into an electronic screening program, which together exploit: (i) reach - the adult population has 100% mobile phone ownership and 92% internet national coverage; and (ii) behavioral change - the intervention can teach verbally and visually, thus bypassing literacy challenges, to allow simple, low-cost, repetition messaging for habit reinforcement. Uptake of the program through the various stages will be evaluated in ~2000 adults of a large representative suburban district of Karachi: As well as before-and-after physiological measures, including blood pressure (BP) and blood glucose, a random sample of 30-40 participants will be invited for interview to assess success and failure of the program. This is a pragmatic feasibility intervention implementation study.
The goal of this pilot study is to demonstrate feasibility of a scalable , population-wide, approach to early detection and management of people at high-risk of CVD using electronic screening, referral, treatment and lifestyle modification based on health theory and considerable background research for local applicability.
It is a mixed method, feasibility study based in Malir District of Karachi, the largest city in Pakistan, to demonstrate uptake, participation and response of our mHealth intervention.
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| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| SELECT mHealth Program | Behavioral | Individuals will be screened via the telephone, using a mobile-based algorithm that prompts questions about hypertension, risk of Diabetes Mellitus, use of smokeless tobacco and smoking, level of physical activity, and main nutritional choices. These questions are based on tools that have been validated in studies undertaken in this population and will be directly administered by trained research staff of Aga Khan University. Screening will prompt triage into three categories: "high" - referred to the conveniently located integrated medical center for a medical teleconsultation and fasting glucose test; "medium" - receive fasting glucose test and BP measurement; and "low" risk. All subjects in each category will be enrolled in an e_Prescription intervention for lifestyle change tailored to their individual risk profile. |
| Measure | Description | Time Frame |
|---|---|---|
| Health Service Delivery of Intervention Outreach via Short Text Messages | The success rate in delivery of SMS intervention to target community 1. Number of SMS sent successfully to target Population | 3 to 6 months |
| Health Service Delivery of Intervention Outreach via Interactive Voice Recording | Number of IVR ( Interactive Voice Recording ) sent to target Population | 3 to 6 months |
| Health Service Measures of Intervention Uptake | Proportion of referred participants enrolled in e_Prescription education program | 3 to 6 months |
| Community Participation and Uptake of Intervention | Number of participants responded to the IVR and SMS call | 3 to 6 months |
| Early Impact Measure of Intervention for Prompt Referral | Proportion of referred participants from screened participants referred | 3 to 6 months |
| Early Impact Measure of Intervention for Detection | Proportion of participants in each of risk strata (low, medium and high risk) as defined by the presence of stroke and/or MI ( High ), DM and / or HTN ( Medium), or poor lifestyle choices ( Low Risk) by the SELECT algorithm | 3 to 6 months |
| Measure | Description | Time Frame |
|---|---|---|
| Change in Physiological Characteristics of Intervention Participants - Blood Pressure | Mean difference in systolic and diastolic Blood Pressure before and after intervention in mm Hg. | 0, 3 to 6 months |
| Change in Physiological Characteristics of Intervention Participants - Weight |
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Inclusion Criteria:
Exclusion Criteria:
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The pilot study will be undertaken in the Malir area (80,000 persons), one of the largest districts of Karachi (population 120 million), with urban, urban slum, and rural urban areas, and includes all ethnicities and economic strata of Pakistan. In this location, the Aga Khan University Health System, one of the major health systems of Pakistan, has integrated medical centers (IMSs) with laboratory testing, resident physicians, and ability to triage and refer people to a main tertiary hospital.
| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Ayeesha Kamal, MD | Contact | +9221-34930051 | 4669 | ayeesha.kamal@aku.edu |
| Adeel Khoja, MSc | Contact | +9221-34930051 | 4993 | adeel.khoja@aku.edu |
| Name | Affiliation | Role |
|---|---|---|
| Ayeesha Kamal, MD | Aga Khan University | Principal Investigator |
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| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 23684257 | Background | Jafar TH, Haaland BA, Rahman A, Razzak JA, Bilger M, Naghavi M, Mokdad AH, Hyder AA. Non-communicable diseases and injuries in Pakistan: strategic priorities. Lancet. 2013 Jun 29;381(9885):2281-90. doi: 10.1016/S0140-6736(13)60646-7. Epub 2013 May 17. | |
| 26818913 | Background | Kamal AK, Khoja A, Usmani B, Muqeet A, Zaidi F, Ahmed M, Shakeel S, Soomro N, Gowani A, Asad N, Ahmed A, Sayani S, Azam I, Saleem S. Translating knowledge for action against stroke--using 5-minute videos for stroke survivors and caregivers to improve post-stroke outcomes: study protocol for a randomized controlled trial (Movies4Stroke). Trials. 2016 Jan 27;17:52. doi: 10.1186/s13063-016-1175-x. |
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| ID | Term |
|---|---|
| D002318 | Cardiovascular Diseases |
| D002544 | Cerebral Infarction |
| D000075222 | Essential Hypertension |
| ID | Term |
|---|---|
| D020520 | Brain Infarction |
| D002545 | Brain Ischemia |
| D002561 | Cerebrovascular Disorders |
| D001927 | Brain Diseases |
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Mean difference in weight before and after intervention in kg |
| 0, 3 to 6 months |
| Change in Physiologic Characteristics of Intervention Participants- Height | Height in metres to determine Body Mass Index ( BMI ) | 0, 3 to 6 months |
| Change in Physiological Characteristics of Intervention Participants - BMI | Mean difference in BMI before and after intervention in kg/m2 | 0, 3 to 6 months |
| Change in Physiological Characteristics of Intervention Participants - Physical Activity | Increase in number of hours in physical activity from baseline (self-reported) measured by the IPAQ Short scale self reported version ( International Physical Activity Questionnaire) which will report low medium and high levels of physical activity based on 600 MET minutes /week ( Moderate),1500- 3000 MET minutes /week ( High), and low as any value less than the above. | 0, 3 to 6 months |
| 16334618 | Background | Mohan V, Deepa R, Deepa M, Somannavar S, Datta M. A simplified Indian Diabetes Risk Score for screening for undiagnosed diabetic subjects. J Assoc Physicians India. 2005 Sep;53:759-63. |
| 12900694 | Background | Craig CL, Marshall AL, Sjostrom M, Bauman AE, Booth ML, Ainsworth BE, Pratt M, Ekelund U, Yngve A, Sallis JF, Oja P. International physical activity questionnaire: 12-country reliability and validity. Med Sci Sports Exerc. 2003 Aug;35(8):1381-95. doi: 10.1249/01.MSS.0000078924.61453.FB. |
| 25440346 | Background | Khan M, Kamal AK, Islam M, Azam I, Virk A, Nasir A, Rehman H, Arif A, Jan M, Akhtar A, Mawani M, Razzak JA, Pasha O. Can trained field community workers identify stroke using a stroke symptom questionnaire as well as neurologists? Adaptation and validation of a community worker administered stroke symptom questionnaire in a peri-urban Pakistani community. J Stroke Cerebrovasc Dis. 2015 Jan;24(1):91-9. doi: 10.1016/j.jstrokecerebrovasdis.2014.07.030. Epub 2014 Oct 16. |
| 23438610 | Background | Rahman MA, Spurrier N, Mahmood MA, Rahman M, Choudhury SR, Leeder S. Rose Angina Questionnaire: validation with cardiologists' diagnoses to detect coronary heart disease in Bangladesh. Indian Heart J. 2013 Jan-Feb;65(1):30-9. doi: 10.1016/j.ihj.2012.09.008. Epub 2012 Sep 12. |
| D002493 |
| Central Nervous System Diseases |
| D009422 | Nervous System Diseases |
| D020521 | Stroke |
| D014652 | Vascular Diseases |
| D007238 | Infarction |
| D007511 | Ischemia |
| D010335 | Pathologic Processes |
| D013568 | Pathological Conditions, Signs and Symptoms |
| D009336 | Necrosis |
| D006973 | Hypertension |