A systematic literature review searching effectiveness of peers and community health workers in individual nutritional, smoking, or physical activity changes for cardiovascular primary prevention: a beneficial addition.

Delphine Le Goff, Marie Barais, Gabriel Perraud, Floriane Colin, Arnaud Dossat, Jean-Yves Le Reste

Keywords: Primary Prevention, Heart Disease Risk Factors, Community Support

Background:

In 2019, cardiovascular diseases (CVD) were the leading cause of death worldwide. CVD’s Primary prevention (CVDPP) is problematic because of low drug effectiveness and high cost while involving expensive Healthcare. To circumvent these difficulties peers and community health workers (CHWs) could be involved to implement behavioral changes for CVDPP in smoking, physical activity or nutrition.

Research questions:

The aim of this review was to assess peers and CHWs effectiveness in behavioral changes for CVDPP worldwide.

Method:

Systematic literature review following the PRISMA statements. Randomized controlled trials (RCTs), systematic reviews and meta-analysis of RCTs were searched in Pubmed, Scopus, Embase and Cochrane databases till November 2021. Studies were selected if they implemented behavorial changes and if their primary outcome was a behavioral or biological cardiovascular endpoint. Studies were selected independently by two researchers using Rayyan software. Biases were evaluated using the Rob2 software. Results were organized by type of peer or CHWs and by type of CVD risk factor.

Results:

25 studies, including seven reviews and two meta-analyses were selected. Studies used fasting blood glucose, glycated hemoglobin, HDLc, LDLc, BMI, weight, waist circumference, nutritional behaviors, physical activity as primary outcomes. Peer exposure improved glycated hemoglobin and increased smoking cessation in adult smokers. Peer effectiveness increased with duration to their exposure. Additionally, CHWs were more effective than peers. Study biases were moderate to high, related to randomisation and elevated numbers of loss to follow-up. Populations involved were mainly vulnerable American and Latin American populations.

Conclusions:

Peers and CHWs were partly effective. Generalization was limited due to included populations. Integrating peers to prevention strategies seems to be a gainful complementary option for CVDPP.

Points for discussion:

Efficacy of current current CVDPP strategies

Tasks delegation

Relevant cardiovascular outcome

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