ABSTRACT
Cardiovascular diseases account for almost half of all deaths from noncommunicablediseases, and almost 80% of these deaths occur in low- and middle-incomecountries such as India. The PrePAre (Primary pREvention strategies at thecommunity level to Promote treatment Adherence to pREvent cardiovasculardisease) trial was a primary prevention trial of community health workers aimedat improving adherence to prescribed pharmacological and nonpharmacologicaltherapies in cardiovascular diseases. It was conducted at three geographically,culturally and linguistically diverse sites across India, comprising 28 villages and5699 households. Planning and implementing large-scale community-based trialsis filled with numerous challenges that must be tackled, while keeping in mind thelocal community dynamics. Some of the challenges are especially pronouncedwhen the focus of the activities is on promoting health in communities wheretreating disease is considered a priority rather than maintaining health. This reportexamines the challenges that were encountered while performing the differentphases of the trial, along with the solutions and strategies used to tackle thosedifficulties. We must strive to find feasible and cost-effective solutions to thesechallenges and thereby develop targeted strategies for primary prevention ofcardiovascular diseases in resource-constrained rural settings.
