Behavioral Science Strategies to Increase Hypertension Diagnosis and Treatment

Project Summary Elevated blood pressure is a leading risk factor for mortality worldwide, yet much of this mortality is preventable through early diagnosis and sustained use of available treatments. Low and middle-income countries face a disproportionate burden of hypertension, as they account for over 80% of people living with hypertension. Increasing the diagnosis, treatment, and control of hypertension is therefore essential for improving health outcomes. In the world's largest country, India, hypertension prevalence among adults remains high and a vast majority of those with hypertension are undiagnosed or not receiving care. Although some Indian states have launched home-based screening programs in which health workers perform blood pressure measurements, linkage to care has been low among high-risk individuals. Barriers to clinic-based confirmatory blood pressure measurement and subsequent linkage to care include incorrect beliefs about the need for treatment as well as costs and inconveniences associated with care-seeking. This project will utilize insights from behavioral science to address important barriers to clinic-based confirmatory blood pressure measurement and linkage to hypertension care. The project will test behavioral strategies that help individuals form correct beliefs about the need for treatment and that offset the costs associated with care-seeking. Building on our expertise in behavioral science research and our extensive prior work in India, the BETTER HEART study (Behavioral Science Strategies to Increase Hypertension Diagnosis and Treatment) will use a randomized controlled trial with a factorial design to determine the effectiveness of two promising and scalable behavioral science strategies to increase uptake of clinic-based hypertension care in a large Indian state. Based on strong engagement with key stakeholders, the study will have these specific aims: Aim 1: Adapt pressure and refine promising user-centered strategies for promoting clinic-based confirmatory blood measurement for the Indian context using participatory prototyping and survey experiments. Aim 2: Determine the effectiveness of enhanced hypertension counseling and financial incentives for increasing clinic-based confirmatory blood pressure measurement. Aim 3: Conduct a qualitative evaluation to contextualize the effectiveness data and inform future implementation of strategies on a larger scale. Findings from this study will (a) strengthen our understanding of how to adapt behavioral science strategies to local settings and (b) advance the scientific evidence on behavioral strategies to address the growing burden of hypertension in India and other LMICs.