Hypertension management and lifestyle changes following screening for hypertension in an Asian low socioeconomic status community: a prospective study.

INTRODUCTION: This study investigated the effect of an access-enhanced intervention on hypertension screening and management, as well as on health behaviours among newly diagnosed hypertensives, in a multi-ethnic low socioeconomic status (SES) community. Factors associated with hypertension screening, treatment, and control in the community were also determined. MATERIALS AND METHODS: The study involved all residents aged ≥40 years in 2 public rental housing precincts (low SES), between 2009 and 2011, who were followed-up prospectively for 1 year after a 6-month community-based intervention comprising a 3-month access-enhanced screening component and a 3-month follow-up (outreach) component. Blood pressure was measured at baseline and follow-up. Multivariate Cox regression determined predictors of hypertension management at follow-up. RESULTS: The follow-up rate was 80.9% (467/577). At baseline, 60.4% (282/467) were hypertensive; 53.5% (151/282) were untreated; 54.2% (71/131) uncontrolled. One year later, postintervention, 51.6% (78/151) of untreated hypertensives were treated; combined with treated hypertensives previously uncontrolled, 53.0% (79/149) achieved control. Older age independently predicted treatment (adjusted relative risk, aRR = 1.98, CI, 1.08 to 3.65); majority ethnicity (aRR = 1.76, CI, 1.05 to 2.96), employment (aRR = 1.85, CI, 1.26 to 2.80) and newly treated hypertension (aRR=1.52, CI, 1.01 to 2.32) predicted control. A total of 52.4% (97/185) were irregularly screened at baseline; at follow-up 61.9% (60/97) were regularly screened. Cost and misperceptions were common barriers to screening and treatment. Newly diagnosed hypertensives were also less likely to go for additional cardiovascular screening (aRR = 0.54, CI, 0.29 to 0.99). CONCLUSION: An access-enhanced intervention had some success in improving hypertension management within low SES communities; however, it was less successful in improving cardiovascular risk management, especially in encouraging lifestyle changes and additional cardiovascular screening amongst newly diagnosed hypertensives.

Screening for cardiovascular disease risk factors in an urban low-income setting at baseline and post intervention: a prospective intervention study.

BACKGROUND: Not all segments of society might have equal access to screening. We determined predictors for regular cardiovascular health screening at baseline amongst those of low socioeconomic status (SES) and evaluated the effectiveness of a 6-month intervention on screening in this group compared to a high-SES group. METHODS: The study population involved all residents aged ≥ 40 years in two housing estates comprising owner-occupied housing (high SES) and rental flats (low SES) in Singapore. From 2009 to 2011, residents not being screened regularly at baseline for hypertension, diabetes, and dyslipidaemia were offered free and convenient blood pressure, fasting blood glucose, and lipid testing over 6 months. Chi-squared and multi-level logistic regression identified predictors of regular screening at baseline; likelihood ratio and Cox regression analysis identified predictors of screening participation post intervention. RESULTS: Participation was 78.2% (1081/1383). At baseline, in the low-SES group, 41.7% (150/360), 38.8% (177/456), and 30.8% (128/416) had gone for regular hypertension, diabetes, and dyslipidaemia screening, respectively; compared with higher numbers in the high-SES group. Sociodemographic factors predicting regular screening in the low-SES community included being married and not smoking. Post intervention, screening rates rose significantly (p < 0.001) by similar proportions in both communities. Staying in a lower-SES community (adjusted relative risk (aRR) 0.61, 95% CI 0.37-0.99, p = 0.048) and having hypertension (aRR 0.45, 95% CI 0.18-0.98, p = 0.049) was associated with lower take-up; Chinese ethnicity (aRR 1.84, 95% CI 1.00-3.43, p = 0.050) and employment associated with higher take-up (aRR 1.57, 95% CI 1.03-2.60, p = 0.040). CONCLUSION: Participation in cardiovascular health screening was poor amongst those of low SES; a 6-month intervention programme improved participation in this population.

Socioeconomic factors affecting colorectal, breast and cervical cancer screening in an Asian urban low-income setting at baseline and post-intervention.

BACKGROUND: Inequalities in cancer screening are little studied in Asian societies. We determined whether area and individual measures of socio-economic status (SES) affected cancer screening participation in Singapore and prospectively evaluated an access-enhancing community-based intervention. METHODS: The study population involved all residents aged >40 years in two housing estates comprising of owner-occupied (high-SES area) and rental (low-SES area) flats. From 2009 to 2011, non-adherents to regular screening for colorectal/breast/cervical cancer were offered free convenient screening over six months. Pre- and post-intervention screening rates were compared with McNemar's test. Multi-level logistic regression identified factors of regular screening at baseline; Cox regression analysis identified predictors of screening post-intervention. RESULTS: Participation was 78.2% (1081/1383). In the low-SES area, 7.7% (33/427), 20.4% (44/216), and 14.3% (46/321) had regular colorectal, cervical and breast cancer screening respectively. Post-intervention, screening rates in the low-SES area rose significantly to 19.0% (81/427), 25.4% (55/216), and 34.3% (74/216) respectively (p<0.001). Area SES was more consistently associated with screening than individual SES at baseline. Post-intervention, for colorectal cancer screening, those with higher education were more likely to attend (p=0.004); for female cancer screening, the higher-income were less likely to attend (p=0.032). CONCLUSIONS: Access-enhancing community-based interventions improve participation among disadvantaged strata of Asian societies.