Rationale and design of the Rural Andhra Pradesh Cardiovascular Prevention Study (RAPCAPS): a factorial, cluster-randomized trial of 2 practical cardiovascular disease prevention strategies developed for rural Andhra Pradesh, India.
BACKGROUND
Developing countries are experiencing increasing levels of cardiovascular disease (CVD). Although there is a good understanding of how to deliver CVD prevention programs in developed countries, there are few data regarding strategies for CVD prevention in resource-poor settings. This study aimed to implement and evaluate a CVD prevention program in a rural area of India.


METHODS
The 2 strategies of CVD prevention to be investigated are an algorithm-based care approach and a health-promotion campaign. A factorial, cluster-randomized trial design will be used to evaluate these, in which villages will be exposed to one, both, or neither of the interventions for a period of about 12 months. Surveys of households in every village will be used to assess outcomes in all high-risk individuals and a sample of the general adult population.


RESULTS
The primary outcome of the algorithm-based component of this study will be the percentage of high-risk individuals that have been "identified"-defined as having received a cardiovascular-risk assessment in the last 12 months. The primary outcome for the health-promotion component will be the percentage of the adult population with correct knowledge about the effects of 6 behavioral determinants of cardiovascular risk (green-leafy vegetables, fruits, oily foods, salt, smoking, physical activity). Secondary outcomes include a range of measures defining uptake of different preventive strategies.


CONCLUSIONS
This study will provide evidence about the effectiveness of a simple practical mechanism of CVD preventive care specifically designed for delivery in a resource-poor area in India.
Chow
Clara K
CK
The George Institute for International Health, University of Sydney, Sydney, Australia.
Joshi
Rohina
R
Gottumukkala
Arun K
AK
Raju
Krishnam
K
Raju
Rama
R
Reddy
Srinath
S
Macmahon
Stephen
S
Neal
Bruce
B
D000328:Adult; D000465:Algorithms; D002318:Cardiovascular Diseases / Q000517:prevention & control*; D002985:Clinical Protocols; D003906:Developing Countries; D015438:Health Behavior; D006293:Health Promotion; D006801:Humans; D007194:India; D012107:Research Design; D018570:Risk Assessment; D012307:Risk Factors; D040242:Risk Reduction Behavior; D012424:Rural Population