title: Task shifting of frontline community health workers for cardiovascular risk reduction: design and rationale of a cluster randomised controlled trial (DISHA study) in India.
abstract: BACKGROUND
  Effective task-shifting interventions targeted at reducing the global cardiovascular disease (CVD) epidemic in low and middle-income countries (LMICs) are urgently needed.
  
  
  METHODS
  DISHA is a cluster randomised controlled trial conducted across 10 sites (5 in phase 1 and 5 in phase 2) in India in 120 clusters. At each site, 12 clusters were randomly selected from a district. A cluster is defined as a small village with 250-300 households and well defined geographical boundaries. They were then randomly allocated to intervention and control clusters in a 1:1 allocation sequence. If any of the intervention and control clusters were <10 km apart, one was dropped and replaced with another randomly selected cluster from the same district. The study included a representative baseline cross-sectional survey, development of a structured intervention model, delivery of intervention for a minimum period of 18 months by trained frontline health workers (mainly Anganwadi workers and ASHA workers) and a post intervention survey in a representative sample. The study staff had no information on intervention allocation until the completion of the baseline survey. In order to ensure comparability of data across sites, the DISHA study follows a common protocol and manual of operation with standardized measurement techniques.
  
  
  CONCLUSIONS
  Our study is the largest community based cluster randomised trial in low and middle-income country settings designed to test the effectiveness of 'task shifting' interventions involving frontline health workers for cardiovascular risk reduction.
  
  
  BACKGROUND
  CTRI/2013/10/004049 . Registered 7 October 2013.
authors.affiliation: Centre for Control of Chronic Conditions, Public Health Foundation of India, New Delhi, India.|Centre for Chronic Disease Control, Sector 44, Plot 47, Gurgaon, Haryana, India.
authors.forename: Panniyammakal
authors.identifier: http://orcid.org/0000-0003-4172-4307
authors.initials: P
authors.lastname: Jeemon
authors.affiliation: Centre for Chronic Disease Control, Sector 44, Plot 47, Gurgaon, Haryana, India.
authors.forename: Gitanjali
authors.initials: G
authors.lastname: Narayanan
authors.affiliation: Centre for Chronic Disease Control, Sector 44, Plot 47, Gurgaon, Haryana, India.
authors.forename: Dimple
authors.initials: D
authors.lastname: Kondal
authors.affiliation: Centre for Chronic Disease Control, Sector 44, Plot 47, Gurgaon, Haryana, India.
authors.forename: Kashvi
authors.initials: K
authors.lastname: Kahol
authors.affiliation: Rajendra Prasad Government Medical College, Tanda, Himachal Pradesh, India.
authors.forename: Ashok
authors.initials: A
authors.lastname: Bharadwaj
authors.affiliation: Pondicherry Institute of Medical Sciences, Puducherry, India.
authors.forename: Anil
authors.initials: A
authors.lastname: Purty
authors.affiliation: Indira Gandhi Medical College, Shimla, India.
authors.forename: Prakash
authors.initials: P
authors.lastname: Negi
authors.affiliation: Aga Khan Health Services, Mumbai, India.
authors.forename: Sulaiman
authors.initials: S
authors.lastname: Ladhani
authors.affiliation: Sri Aurbindo Institute of Medical Sciences, Indore, India.
authors.forename: Jyoti
authors.initials: J
authors.lastname: Sanghvi
authors.affiliation: Sri Aurbindo Institute of Medical Sciences, Indore, India.
authors.forename: Kuldeep
authors.initials: K
authors.lastname: Singh
authors.affiliation: Centre for Chronic Disease Control, Sector 44, Plot 47, Gurgaon, Haryana, India.
authors.forename: Deksha
authors.initials: D
authors.lastname: Kapoor
authors.affiliation: Centre for Chronic Disease Control, Sector 44, Plot 47, Gurgaon, Haryana, India.
authors.forename: Nidhi
authors.initials: N
authors.lastname: Sobti
authors.affiliation: Centre for Chronic Disease Control, Sector 44, Plot 47, Gurgaon, Haryana, India.
authors.forename: Dorothy
authors.initials: D
authors.lastname: Lall
authors.affiliation: Centre for Chronic Disease Control, Sector 44, Plot 47, Gurgaon, Haryana, India.|National Centre for Disease Informatics and Research, ICMR, Bangalore, India.
authors.forename: Sathyaprakash
authors.initials: S
authors.lastname: Manimunda
authors.affiliation: Indian Council of Medical Research, New Delhi, India.
authors.forename: Supriya
authors.initials: S
authors.lastname: Dwivedi
authors.affiliation: Indian Council of Medical Research, New Delhi, India.
authors.forename: Gurudyal
authors.initials: G
authors.lastname: Toteja
authors.affiliation: Centre for Control of Chronic Conditions, Public Health Foundation of India, New Delhi, India. dprabhakaran@ccdcindia.org.|Centre for Chronic Disease Control, Sector 44, Plot 47, Gurgaon, Haryana, India. dprabhakaran@ccdcindia.org.
authors.forename: Dorairaj
authors.initials: D
authors.lastname: Prabhakaran
mesh_terms: D002318:Cardiovascular Diseases / Q000517:prevention & control*; D003150:Community Health Workers / Q000458:organization & administration*; D003430:Cross-Sectional Studies; D006801:Humans; D007194:India / Q000453:epidemiology; D012107:Research Design; D012307:Risk Factors; D040242:Risk Reduction Behavior
keywords: Cardio-vascular disease; India; Low and middle-income countries; Task shifting interventions