Youth as catalysts: A novel approach to addressing hypertension awareness and detection

Abstract

Hypertension is a major contributor to global morbidity and mortality, yet it largely remains undiagnosed, especially in low- and middle-income countries like India. To address this gap, we implemented a novel, community-based project that utilized youth as catalysts for hypertension screening. A total of 466 students from urban and rural schools in Ludhiana were trained at a tertiary care center to take blood pressure (BP) measurements accurately. Under the supervision of trained healthcare professionals, they screened 10,888 adults during parent–teacher meetings. High BP readings were recorded in 2306 individuals (21%), leading to actionable follow-ups in nearly half of the newly detected cases. By empowering students as change agents, this approach raises community awareness and promotes preventive health behaviors in the long term. Due to its simplicity and scalability, this approach can easily be adapted across various healthcare settings to address noncommunicable diseases.

INTRODUCTION

Hypertension is one of the leading causes of morbidity and mortality worldwide. It is commonly referred to as the “silent killer” due to its long latent period and lack of obvious symptoms.[1] Despite the availability of effective management options, a substantial number of people, especially in low- and middle-income countries, remain undiagnosed.[2] In India, as lifestyle-related risk factors are increasing with the growing urban population, the prevalence of hypertension is also increasing proportionately. Therefore, there is a need for innovative community-based strategies to improve hypertension awareness and early detection in India.

Our study leverages the energy and influence of youth to bridge the gap in hypertension awareness and screening. By educating school students about hypertension and training them to take accurate blood pressure (BP) measurements, we equip them to serve as agents of change in their communities.

METHODS AND MATERIALS

During the preimplementation phase, a situational analysis was conducted to identify any necessary adaptations to ensure a smooth execution. A population survey was conducted to understand the hypertension cascade, including awareness, screening, diagnosis, treatment, and BP control rates. The findings revealed that various factors influenced compliance with antihypertensive treatment, including healthcare limitations, cultural beliefs, and socioeconomic barriers. This highlighted the significance of combining health education with culturally sensitive communication and behavior change strategies. Based on these insights, we designed our project around youth as a key force in preventing and detecting hypertension.

The methodology involved training higher secondary students from 18 schools, located in both urban and rural areas of Ludhiana. These students were distributed into teams of 20. They were trained at DMCH, Ludhiana, Punjab, using audiovisual aids, practical demonstrations, and interactive sessions. Hypertension was defined according to the WHO and Indian guidelines, as systolic BP of more than 140 mmHg and diastolic BP of more than 90 mmHg.[2,3] Schools were provided with digital sphygmomanometers, depending on the number of volunteers. Students were educated about the importance of a balanced diet and physical activity, as well as the harmful impact of smoking and other drugs. Education material on hypertension risk factors and lifestyle modification was also provided to display at parent–teacher meetings. Each student screened approximately 20 adults during these meetings, supervised by healthcare professionals. The trained faculty cross-checked every third screened individual.

RESULTS

We trained 466 students, and they screened 10,888 adults, out of which high BP measurements were recorded for 2306 people (21%). The mean age of the adults screened was 38.1 ± 16.63. The measurements taken by the students demonstrated excellent agreement with those of healthcare professionals, as evidenced by an intra-class correlation coefficient of 0.99 and 0.96 for systolic and diastolic BP, respectively. This project raised awareness and promoted community involvement, resulting in actionable follow-ups for 598 newly detected cases. Approximately 40% of them followed up with their primary physician; for others, follow-up was done by phone calls or in-person visits [Table 1 and Flowchart 1].

Table 1.

Summary of parameters and outcomes from the youth-led hypertension awareness and screening initiative

Parameter	Value
Total number of students trained	466
Total number of adults screened	10,888
Mean age of adults screened (years)	38.1±16.63
Intra-class correlation coefficient	0.99 (systolic), 0.96 (diastolic)
Number of adults with high BP measurements	2306
Number of patients with newly detected hypertension	1194
Number of patients who followed up	598

BP: Blood pressure

Flowchart 1.

Number of students trained and total number of adults screened. BP: Blood pressure, HTN: Hypertension

DISCUSSION

The success of this project underscores the importance of adopting innovative strategies in addressing public health challenges. Earlier, the Kumarakom project also highlighted the significant impact of utilizing community-based volunteers in Kerala on hypertension awareness and control using mercury manometers.[4,5] In the present study, we utilized digital sphygmomanometers instead of mercury manometers because of their ease of use and smaller learning curve. This enabled a simplified method of recording BP, thereby bypassing the training requirement for using a stethoscope. To our knowledge, this study is among the first school–student-based initiatives started in India. A few other initiatives, such as a study protocol by Mundra et al., have also been launched to utilize school students and community volunteers to raise awareness about noncommunicable diseases.[6]

As India continues to emerge as the youngest nation, leveraging the influence of its youth presents a pivotal opportunity for mitigating the hypertension epidemic. Integrating health activities and awareness sessions within the education system can not only promote health literacy among students but also expand the reach of primary healthcare services. Due to its simplicity, this approach can be easily adapted and implemented across different healthcare settings. Further models can be modified to include additional aspects, such as anthropometric measures such as height, weight, and waist circumference.

We hope our findings contribute to the ongoing discourse on innovative, community-based interventions in tackling public health challenges.

Conflicts of interest

There are no conflicts of interest.

Funding Statement

Nil.