Participatory Action for Optimizing Health Literacy and Access to Manage Hypertension: Pre-post Evaluation in a Marginalized Community of India

We used a participatory action research (PAR) strategy for optimizing health literacy and access (Ophelia) to improve hypertension (HTN) management in a peri-urban village of Chandigarh (India). We used an embedded mixed method design for development, implementation, and evaluation. Through community consultations and vignettes created from interviews with population sub-groups and input from healthcare providers, we co-designed the intervention. Volunteers facilitated community-based awareness activities like door-to-door interaction, mobile messages, posters, collaboration with healthcare providers, and free blood pressure monitoring services. At the health facility, we improved communication by re-orienting healthcare providers and introducing medication adherence charts after identifying gaps through patients’ journeys. We measured changes in health literacy, HTN knowledge, risk factors, medication adherence, and HTN control in a sample of 510 randomly selected adults in pre and post-intervention design using chi-square and t -test. A checklist assessed community capacity and multivariable regression adjusted the effect of confounders. Health literacy significantly improved across most scales (beta range 0.17 to 0.76, p