None listed
Conditions
Brief summary
This study aims to test whether a new, co-designed program delivered by Community Health Workers (CHWs) can help adults in eastern Nepal who live with multiple long-term conditions such as high blood pressure, diabetes, and chronic lung disease. Local health workers will be trained to provide home visits, health education, symptom monitoring, and support for healthy living. The study will compare this approach to usual care to see if it improves people’s health and self-management skills. The trial also looks at how well this program can be put into practice in real-world communities.
Interventions
The study will implement a Codesigned Integrated Multimorbidity Management by Community Health Workers (CIMM-CHW) intervention.
Co-design of CIMM-CHW intervention: Diverse stakeholders, including individuals with multimorbidity, family members, CHWs, clinicians, community leaders, and policymakers, will engage in a 16-month co-design process. A three-day workshop with 15-20 stakeholders, with 3-4 representatives from
each stakeholder category, will be conducted.
Day 1 will involve 2.5hr roun
The study will implement a Codesigned Integrated Multimorbidity Management by Community Health Workers (CIMM-CHW) intervention. Co-design of CIMM-CHW intervention: Diverse stakeholders, including individuals with multimorbidity, family members, CHWs, clinicians, community leaders, and policymakers, will engage in a 16-month co-design process. A three-day workshop with 15-20 stakeholders, with 3-4 representatives from each stakeholder category, will be conducted. Day 1 will involve 2.5hr roundtable discussion to map ongoing multimorbidity programs in Nepal. Day 2 will involve full day (6 hrs workshop) focus on core intervention components, including training manuals, implementation plans, and evaluation strategies, emphasising modifications for cultural appropriateness. On day 3, On day 3, stakeholders will identify individual and system-level barriers and facilitators for the intervention's implementation plan and develop risk-mitigating strategies. The key features of CIMM-CHW intervention are: What CIMM-CHW intervention involves: Training and revitalising CHWs: They receive ~80–100 hours of training on multimorbidity management, patient education, behaviour change counselling, monitoring symptoms, and culturally appropriate care. Patient-centred self-management support: CHWs provide monthly 1 hr home visits for symptom monitoring (blood glucose, blood pressure, COPD symptoms). counselling on healthy behaviours, and health literacy. CHWs will also educate patients and their families on multimorbidity, its implications, and selfmanagement strategies for additional 1 hr. Peer-supported lifestyle interventions: CHWs work with trained peer leaders to run monthly 2-hr community sessions on healthy eating, smoking cessation, alcohol moderation, and physical activity. Case management and referrals: CHWs coordinate care, refer patients to higher-level health facilities when needed, and help patients navigate social support services. Who delivers it: Trained Community Health Workers (CHWs) — including auxiliary health workers, community medical assistants, and Female Community Health Volunteers within Nepal’s primary healthcare system. Model of delivery: Interactive hands-on structured. workshop Frequency of training: CHWs will be trained for multimorbidity management over 4 weeks with breaks and quarterly refresher training sessions for CHWs will be considered periodically to reinforce skills and update knowledge on the latest guidelines and practices Who receives it: Adults aged 30–70 with two or more chronic conditions (hypertension, diabetes, and/or COPD) in eastern Nepal, especially disadvantaged groups (Indigenous people, Dalits, Madhesis). Duration and format: The intervention is delivered over an 18-month period through home visits, group sessions, and community events. Control group: Usual care through the existing health system without the enhanced CIMM-CHW support. This co-designed, culturally adapted approach aims to improve health literacy, patient self-management, and health outcomes for people with multiple chronic conditions.
Sponsors
NHMRC
Study design
Allocation
Randomised controlled trial
Intervention model
Parallel
Primary purpose
Prevention
Masking
Open (masking not used)
Eligibility
Sex/Gender
All
Age
30 Years to 70 Years
Healthy volunteers
No
Inclusion criteria
Participants are adults aged 30 to 70 years with multimorbidity — so the lower limit is 30. participants clinically diagnosed two or more chronic conditions. The protocol does not restrict by sex and aims to include adults from disadvantaged communities regardless of gender. The study targets adults with two or more chronic conditions — so healthy volunteers are not eligible.
Exclusion criteria
Individuals physically or cognitively incapable of participating in intervention activities due to severe illness or functional limitations. People who do not have at least two clinically diagnosed chronic conditions (hypertension, diabetes, COPD). Individuals under 30 years or over 70 years of age. People who cannot provide informed consent due to significant cognitive impairment. Anyone with an acute medical condition requiring hospitalisation at enrolment.
Outcome results
None listed