Cardiovascular diseases are increasing throughout the developing world and are the cause of almost 16.7 million deaths each year, of which 80% occur in low and middle-income countries. As more than three fourth of the global burden of cardiometabolic diseases are related to risk factors connected with lifestyles or behaviors, such as smoking, unhealthy eating, low physical activity, and harmful consumption of alcohol. This burden could be dramatically reduced by changing individual behaviors. This study is focused on interventions that are aimed to improve the adherence to treatment in cardiovascular disease (hypertension), based on a Behavioral Economics approach. Most of public policies targeted to tackle Noncommunicable diseases utilize a rational economic model of behavior. Behavioral economics, by using insights from cognitive psychology and other social sciences, has drawn a lot of attention for its potential to increase healthy behaviors. Interventions informed by Behavioral economics principles seek to rearrange the social or physical environment in such a way to 'nudge' people towards healthier choices and behaviors. This is an individual controlled randomized trial which will be conducted to assess whether the implementation of two strategies, blood pressure self-monitoring plus signing a "contract of commitment", and peer mentoring are effective to reduce blood pressure values over a period of 3 months, compared to usual care. This randomized trial will enroll 430 patients from 10 public primary care clinics in Argentina.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
HEALTH_SERVICES_RESEARCH
Masking
NONE
Enrollment
442
Peers will be assigned to participants according to common socio-demographic characteristics. Each peer will be assigned up to 5 participants.
Along with providing patients with a BP monitor, a "commitment contract" will be signed, in which participants commit themselves to measure their blood pressure at home at least once a week during the 3 months of the intervention. Each participant will be given a form to weekly recording their blood pressure values.
Centro Asistencial Modelo Don Bosco
Quilmes, Buenos Aires, Argentina
Policlínico Julio Méndez
Quilmes, Buenos Aires, Argentina
UAP Illia
Vicente López, Buenos Aires, Argentina
UAP Sargento Cabral
Vicente López, Buenos Aires, Argentina
CAPS 1 Simeon Payba
Paso de los Libres, Corrientes Province, Argentina
CAPS 10 Plurianual
Paso de los Libres, Corrientes Province, Argentina
Centro de Atención Primaria de la Salud Dr. Balbastro
Corrientes, Argentina
Centro de Atención Primaria de la Salud N°15 Illia
Corrientes, Argentina
Centro de Salud nº 60 - El Mirador
Salta, Argentina
Centro de Salud Santa Ana
Salta, Argentina
Blood pressure
Net change in blood pressure levels from baseline to the end of follow-up in in each group.
Time frame: 3 months
Controlled hypertension
Proportion of patients with controlled hypertension (Systolic blood pressure \<140 mm Hg and diastolic blood pressure \<90 mm Hg)
Time frame: 3 months
Adherence to antihypertensive medication
Proportion of patients who had adhered to antihypertensive medication according to the Morisky Green Scale.
Time frame: 3 months
Intensification of antihypertensive medication
Proportion of patients who increased the number of antihypertensive medications or increase the dose of their antihypertensive medication.
Time frame: 3 months
Visits to the clinic
Number of visits to the clinic over the 3 month period of follow-up.
Time frame: 3 months
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