A Pilot Project on a Community-Supported Approach to Blood Pressure Management to Improve Sustainability in a Rural Community in Bangladesh

Abstract Background: This paper presents a pilot project that applied ethnographic research and facilitation of community organization to promote community support for sustainable chronic disease management in Khoriapara, a marginalized community in Bangladesh. Methods: Our multidisciplinary approach comprised ethnographic research, community organization, screening, and monitoring. Ethnographic research was utilized to describe the community and identify resources. Facilitation of community organization involved forming the health and inclusion committee by going door to door and selecting workers via key informant preference. All individuals over age 30 within the resident-defined boundary were screened. BP was measured twice at three-minute intervals using an automatic bicep cuff. Hypertension was defined as a consistent systolic ≥140 or diastolic ≥90 measured both times. Self-efficacy scales were administered to identify care gaps and facilitate social support for hypertension patients. The screened-positive patient’s blood pressure was monitored and intervened with medications and social support every two weeks via an internet-based system utilizing local resources. We will present results from March 2020 to December 2022. Findings: Ethnography research showed that while the residents face barriers to accessing health, education, and nutrition, the community has a distinct identity and can offer resources such as technological knowledge, interpersonal networks, and space to conduct health-related activities. The health and inclusion committee selected via door-to-door approach received acceptance and helped navigate initial conflicts that ensued due to the preferential approach to selecting workers. 260 individuals were screened. Eighteen individuals met the hypertension screening criteria. From October 2020 to December 2022, the mean change in systolic blood pressure decreased by 27 mmHg, and diastolic blood pressure decreased by 9.9 mmHg (p<.05). Resources identified in ethnography have been used to sustain the project with the support of community organization. The pilot project was done in a single community, which limits generalizability. Interpretation: The project highlights the role of ethnography and a door-to-door approach to community organization in developing sustainable chronic disease management in resource-limited settings.