Does home-based screening and health information provision improve hypertension diagnosis, treatment, and control? A regression discontinuity analysis in urban India

BackgroundIn India, several state governments are implementing or considering home-based hypertension screening programs to improve population-wide diagnosis and blood pressure (BP) control rates. However, there is limited evidence on the effectiveness of home-based screening programs in India. MethodsUsing six waves of population-representative cohort data (N = 15,573), we estimate the causal effect of a home-based hypertension screening intervention on diagnosis, treatment, and BP using a novel application of the Regression Discontinuity Design. FindingsWe find that screening individuals BP in their homes and providing health information and a referral to those with elevated BP did not meaningfully improve hypertension diagnosis (0.1, p-value: 0.82), treatment (-0.2, p-value: 0.49), or BP levels (systolic: -1.8, p-value: 0.03; diastolic: 0.5, p-value: 0.39). This null effect is robust across subpopulations and alternative specifications. InterpretationOur findings suggest that a lack of knowledge of ones hypertension status might not be the primary reason for low diagnosis and treatment rates in India, where other structural and behavioral barriers may be more relevant. Adapting screening efforts to address these additional barriers will be essential for translating Indias screening efforts into improved population health. FundingThis study received no funding. Research in context: Evidence before this studyO_LIIndian state governments are implementing and scaling-up large home-based screening programs to address the growing burden of cardiometabolic diseases C_LIO_LIStudies evaluating home-based screening activities in China and Malawi find that they lead to modest improvements in blood pressure levels C_LIO_LIHowever, studies from South Africa and Germany find null effects of home-based screening on blood pressure and long-term cardiometabolic outcomes C_LI Added value of this studyO_LIWe provide the first evaluation of home-based hypertension screening in India using data representative of adults aged 30 years and older in two of Indias largest cities. C_LIO_LIIn addition to blood pressure level, we investigate the effect of screening on diagnosis and treatment initiation to identify the effects of screening across the continuum of care. C_LIO_LIWe find that home-based hypertension screening did not improve hypertension outcomes suggesting that a lack of knowledge of ones hypertension status is not the main barrier to health care seeking and achievement of hypertension control. C_LI Implications of all the available evidenceO_LIThe mere provision of information on an individuals hypertension status does not seem to increase hypertension diagnosis and treatment initiation. C_LIO_LIOther barriers, such as health literacy and inadequate communication strategies, need to be considered when designing home-based hypertension screening programs. C_LIO_LIBefore scaling up existing home-based screening programs, health communication needs to be adapted to local needs and their effectiveness evaluated. C_LI