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Community health worker-led interventions for cardio-metabolic diseases in India: Evidence from a systematic review and meta-analysis
For correspondence: Dr Rambha Pathak, Department of Community Medicine, Government Institute of Medical Sciences, Greater Noida 201 014, Uttar Pradesh, Indiae-mail: rambha_p@yahoo.com
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Received: ,
Accepted: ,
How to cite this article: Mandal S, Virdi P, Singh K, Pathak R. Community health worker-led interventions for cardio-metabolic diseases in India: Evidence from a systematic review and meta-analysis of interventional studies. Indian J Med Res. 2026;164:241-51. doi: 10.25259/IJMR_3058_2025
Abstract
Background and objectives
Cardio-metabolic diseases are leading cause of disability-adjusted life years (DALYs) in India. Community health workers’ (CHW) local proximity and contextual understanding enable low-cost, and sustainable health interventions. This systematic review and meta-analysis of interventional studies aimed to identify types of CHW-led interventions and their effect on cardio-metabolic diseases.
Methods
Studies done in India (2000-2024) were searched from PubMed, Embase and Scopus databases. Screening of studies, followed by risk of bias assessment, data extraction was done and pooled mean difference (MD), 95% confidence interval (CI) was estimated by the random effect model. Subgroup, sensitivity analysis, and meta-regression was performed along with certainty assessment using grading of recommendations assessment, development and evaluation (GRADE).
Results
Thirteen studies (10 randomised trial and 3 pre-post studies) involving adults (mean age ranging from 45 to 65 yr) with hypertension, diabetes, stroke, and overweight were included in systematic review and 9 studies were included in meta-analysis. The CHW-led intervention significantly reduced systolic blood pressure (n=7,114; MD −5.5 mm Hg, 95% CI −9.0 to −1.9; P=0.041; I2=79.3%), with higher effect among people with hypertension (MD −7.5 mm Hg) and body mass index (MD −0.63 kg/m2; P=0.038) in intervention group. No significant change was observed in diastolic blood pressure, fasting blood glucose, glycated haemoglobin, and lipid profiles. Sensitivity analysis revealed no differential effect, and meta-regression showed no significant covariates. GRADE certainty of evidence was low to very low for outcome variables.
Interpretation and conclusions
CHW-led interventions in an Indian community setting showed beneficial effect on cardiometabolic outcomes, particularly blood pressure and body mass index, though the strength of evidence ranged from weak to moderate.
Keywords
Community based intervention
Community health worker led
India
Non-communicable disease
Cardiometabolic diseases like type-2 diabetes mellitus, hypertension, stroke, heart disease, obesity etc. lead to a substantial proportion of disability-adjusted life years (DALYs) and premature deaths.1,2
These are largely preventable through early detection and lifestyle modifications.3 This has necessitated a paradigm shift toward community-based models that emphasise prevention, early intervention, and continuity of care in day-to-day disease management.
Community health workers (CHWs) act as vital actors in implementing decentralised, people-centric healthcare models. CHWs are uniquely positioned to deliver culturally appropriate, low-cost, and sustainable interventions owing to their trust-based relationships with local populations and understanding of sociocultural determinants of health.4 Task-shifting to CHWs also offers a cost-effective approach to expand healthcare coverage without overburdening specialist providers.5
Studies from India and other low- and middle-income countries (LMICs) have demonstrated effectiveness of CHW-led interventions in improving cardiometabolic outcomes. These include home-based education, lifestyle counselling, screening, and monitoring of blood pressure and blood glucose, peer-support for medication adherence, and referrals to higher centres.6-8
Despite increasing reliance on CHWs for management of cardiometabolic diseases in India, evidence remains fragmented. Some randomised controlled trials and implementation studies have reported significant improvements in clinical and behavioural outcomes, such as reductions in systolic and diastolic blood pressure, improved glycaemic control, and increased treatment adherence—while other studies have shown mixed or limited results, raising questions about consistency, quality, and generalisability of these interventions.9,10 Existing reviews on CHW-led interventions are global or regional in scope, making it difficult to isolate findings relevant to Indian health system. One study in 2018 reviewed evidence in the Indian context but was limited to a systematic review of mixed observational and interventional studies without estimating pooled effect or certainty of evidence.11
We conducted this systematic review and meta-analysis to synthesise country-specific available evidence on effectiveness of CHW-led interventions in managing cardiometabolic diseases in India. Specifically, objectives were to: identify and describe types of CHW-led interventions for control of cardiometabolic disease in India; assess their impact on clinical outcomes such as blood pressure, blood glucose levels, lipid profile, and body mass index (BMI); and assess quality of included studies and potential sources of bias along with assessing certainty of evidence.
Methods
The study design and registration
This systematic review and meta-analysis, was conducted between March 2025 to August 2025. The review was registered in the PROSPERO (CRD420250654054).12 The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were adhered to for conducting and reporting.
Eligibility criteria
We included studies meeting these criteria - (1) adult population (aged 18 yr or above); (2) living with hypertension and/or diabetes mellitus and/or dyslipidaemia and/or prehypertensive and/or pre-diabetes and/or obesity and/or overweight; (3) community health worker-led interventions provided as individual or group-based therapy in terms of lifestyle modification, health education, health promotion, improving self-efficacy, behaviour change therapy or empowering patients to improve management of their chronic diseases provided at least for 3 months; (4) compared with ‘no intervention’ or ‘standard care’; (5) outcome variables as blood pressure, fasting blood glucose, glycated haemoglobin, lipid profile, BMI; (6) experimental study design: randomised controlled trial (RCT) or cluster randomised trial (cluster RCT) or pre-post design; (7) articles published in English language; (8) conducted in India; and (9) published between years of 2000-2024.
We excluded studies: (1) without a clear description about intervention; (2) hospital-based study; (3) case studies, editorials, opinions, reviews, or any non-empirical research articles; (4) studies without outcome data or lacking methodology description, abstracts-only papers, conference presentations, or unpublished manuscripts.
Description of community health worker (CHW), CHW-led intervention, and standard care
The operational definition of community health worker (CHW) was a trusted community member, paid or volunteer, who shares cultural and linguistic familiarity, is acceptable to the community and provide emotional, practical support at individual and group level for day to day disease management.13-16 We included following members under CHW: multipurpose worker (MPW), community health volunteer, accredited social health activist (ASHA), self-help group leader, peer-group leader, and community health worker from project etc.
CHW-led interventions were defined as package of services delivered at individual or group level to support and empower people with cardiometabolic diseases.
The standard care was defined as routine support and health services received outside any specific programme.17
Search strategy
Three databases (PubMed, Embase, Scopus) were searched using Boolean operators. Keywords were compiled from available studies, discussions with experts, and controlled vocabularies were selected from MeSH and Emtree sub-database of PubMed and Embase. A detailed search strategy is mentioned in Supplementary Table I.
Study screening
It was conducted in two phases by three independent authors (PV, SM, and KS) using Rayyan software. In phase I, titles and abstracts were screened, and articles included by all three authors were screened for full text in phase II. Disagreements were resolved by a senior author (RP). Full text articles were retrieved from online databases or by contacting corresponding authors and were collectively assessed by all four authors.
Data extraction
Data were extracted into Microsoft Excel by PV, SM and KS. Information pertaining to study 144 identifier, study location, details of the intervention groups, study design, participants, sample size, mean age, details of the post intervention outcome were compiled. Missing data (e.g., mean, post-intervention SD) were sought from corresponding authors. Data were cross-checked and finalised by RP.
Study quality assessment
Study quality was independently assessed by all four authors with the Cochrane risk of bias 2 tool for RCTs and cluster RCTs, whereas for non-randomised pre-post-trial, the National Institutes of Health (NIH) quality assessment tool was used.18,19
For parallel group RCT, five domains were assessed: (i) bias arising from randomisation process, (ii) deviations from intended interventions, (iii) missing outcome data, (iv) outcome measurement, and (v) selection of reported result. For cluster RCTs, an additional domain assessing bias from identification or recruitment of individuals within clusters, was evaluated. Overall risk of bias was categorised as low, some concern, or high. Pre-post studies were assessed across 12 domains, and final assessment was categorised as poor, fair or good. Results were presented via a traffic light diagram (RCTs) or tables (pre-post). Publication bias was assessed using funnel plots and Egger’s test.
Data analysis
Data were analysed by using the web-based software Meta-analysis-Online.20 Pooled mean difference (MD) between intervention and control group along with 95% confidence interval (CI) was estimated and presented with forest plot. Raw standard deviations (SD) for cluster RCTs were adjusted using intra-cluster correlation coefficient (ICC) and cluster number before being included in analysis along with other randomised study.21
Random effect model was adopted due to anticipated high heterogeneity which was assessed by Cochrane-Q statistics, I2 statistic. I2 of >75% considered as high heterogeneity, warranting subgroup, sensitivity analysis and meta-regression. Sensitivity analysis was done by leave-one-out approach and by excluding studies with high risk of bias and very small or large sample size. To further explore potential reason of high heterogeneity, meta-regression analyses were performed using moderators: mean age, intervention duration (≤6 vs. >6 months), study design (RCT vs. CRCT), and disease category (hypertension vs diabetes mellitus).
Assessment of certainty of evidence
The certainty of evidence of pooled result was assessed by grading of recommendations assessment, development and evaluation (GRADE) tool, separately for all outcomes.22 Assessment was done across five domains—risk of bias, inconsistency, indirectness, imprecision, and publication bias and categorised as high, moderate, low, or very low.
Results
Search result
Total 3638 records were extracted (PubMed: 1108, Scopus: 1535, Embase: 995). After removing 604 duplicates, 3034 records were eligible for title and abstract screening, and 38 records were shortlisted for full text screening. Two records could not be retrieved, and 13 articles meeting eligibility criteria were finally included for systematic review. After data extraction, 9 articles for blood pressure, 5 articles for fasting blood glucose (FBG) and glycated haemoglobin (HbA1c), and 3 articles for lipid profile and BMI were included in meta-analysis ( Fig. 1).
Study characteristics
Included studies consisted of 6 cluster RCTs, 4 parallel group RCTs and 3 pre-post design. Studies were conducted across various regions of India- eastern (West Bengal), western (Gujarat, Maharashtra), northern (Punjab, Haryana), and southern (Kerala, Tamil Nadu), ensuring representation from majority of Indian demographic landscape. The mean age of participants in both intervention and control group ranged from 45 to 65 yr ( Table).23-35
| Author, yr | Study location | Study design | Population (age group, health condition) | Intervention codes# | Control | Intervention setting and provider | Intervention duration (in months) | Sample size vs control | Key findings |
|---|---|---|---|---|---|---|---|---|---|
| Kundapur et al,23 2023 | Coastal Karnataka | RCT | ≥ 18 yr, DM/HTN | a, b | Usual care | Community by CHW | 10 | 100 vs 100 (HTN 70 vs. 70, DM 30 vs. 30) | Significant decrease of diastolic blood pressure and glycated haemoglobin % (21 mmHg and 2.1%; P<0.001) in intervention group |
| Kate et al,24, 2023 | Ludhiana, Punjab | RCT | ≥ 18 yr, with first onset of stroke | b, c, g | Usual care | Household by ASHA | 6 | 59 vs. 63 | Lower SBP level in the intervention group compared to the control group (145±17.2 mmHg) and (166.6± 25.7 mmHg) respectively (P<0.0001) |
| Suseela et al,25 2022 | Kochi, Kerala | Cluster RCT | ≥ 18 yr, HTN | a, b, c, e, f | Usual care | Mixed, by trained self-help member | 6 | 917 vs. 920 |
Mean SBP decreased by 6.26 mm Hg (SE 0.69) in intervention group compared with 2.16 mm Hg (SE 0.70) in control group; and net difference was 4.09 (95% CI 2.15 to 4.09), P<0.001. |
| Baviskar et al,31 2021 | Mumbai, Maharashtra | RCT | 35 to 65 yr with DM | a, b, d, f, g | Usual care | Community by MSW | 6 | 40 vs. 40 | Significant reduction of mean HbA1c% in intervention group (8.44, SD=1.8 and 7.56, SD=1.87) as compared with the control group (8.4, SD=1.87 and 8.19, SD=1.7) |
| Kapoor et al,27 2020 | Trivandrum, Kerala | Cluster RCT | 30 - 60 yr with DM | a, b, f | Handbook distribution | Community by peer leaders | 24 | 159 vs. 133 | Significantly reduced systolic blood pressure in intervention arm [125.45 (19.16)] compared to control arm [126.76 (18.53], P=0.02 |
| Gamage et al,38 2020 | Trivandrum of Kerala, Chittoor Andra Pradesh, and Western Godavari in Telangana | Cluster RCT | ≥ 18 yr, HTN | a, b, d | Usual care | Mixed by CHW | 3 | 459 vs. 1011 | Higher reduction of SBP in the intervention than control group (−5.0 mm Hg, 95% CI −7.1 to −3.0; P < 0.001) and DBP (−2.1 mm Hg, 95% CI −3.6 to −0.6; P < 0.006) |
| Khetan et al,32 2019 | Dalkhola, West Bengal | Cluster RCT | 35-70 yr with HTN, DM | a, b, d, e | Usual care | Household by CHW | 24 | 618 vs. 376 |
SBP change at 2 yr was −12.2±19.5 mm Hg in the intervention group as compared with −6.4±26.1 mm Hg in the control group. The FBG change was −43.0±83.5 mg/dl in intervention group and −16.3±77.2 mg/dl in control group, |
| Jain et al,30 2018 | Rural Maharashtra | RCT | ≥ 18 yr with T2DM | a, b, c, d, g | Usual care | Household by CHW | 6 | 151 vs. 139 | The mean FBS in intervention group (148.33 mg/dl) was lower than that control group (153.40 mg/dl) though not statistically different. The mean HbA1c% was similar between two groups: 7.64% (control) vs. 7.63% (intervention) |
| Thankappan et al,28 2018 | Trivandrum, Kerala | Cluster RCT | 30-60 yr, pre-DM | a, b, f | One booklet | Community by peer leaders | 24 | 463 vs. 456 | No significant difference of SBP, DBP, FBS, HbA1c% or lipid profile between two groups |
| Tian et al,29 2015 | Ballabgarh, Faridabad, Haryana | Cluster RCT | ≥ 40 yr of age with a self-reported history of (1) coronary heart disease, (2) stroke, (3) diabetes mellitus, and/or (4) measured systolic blood pressure (SBP) ≥160 mm Hg were included in the study. | a, b, c, d | Usual care | Household by CHW | 12 | 538 vs. 512 | Intervention group had SBP reduction by 10.6 mmHg and in Control 9.8 mmHg). The between-group difference was not statistically significant (P=0.83). |
| Thankappan et al39 2013 | Kottayam, Kerala | Pre-post | ≥ 30 yr, with HTN | a, b, c, e, f | NA | Mixed by community volunteer | 7 | 2263 | The hypertension prevalence of 34.9% (CI 33.8–36.1) was reduced to 31.0% (CI 29.1–32.9) in follow up on age adjusted analysis. |
| Balagopal et al,26 2012 | Gujarat | Pre-post | ≥ 18 yr, with DM | a, b, c | NA | Household by CHW | 6 | 1638 | Significantly lower blood glucose levels by 5.7 and 14.9 mg/dL among people with prediabetes and diabetes, and SBP and DBP by 8 mm Hg and 4 mm Hg, respectively. |
| Balagopal et al,40 2008 | Gandhigram, Tamil Nadu | Pre-post | ≥ 18 yr, pre-DM, and DM | a, b | NA | Household by Project CHW | 7 | IFG 30, DM 703 | Lowered FBG levels in pre-diabetic people by 11%, in pre-diabetic youth by 17%, and in type 2 diabetic adults by 25%. |
#Intervention Code: a) Lifestyle changes (diet, physical activity, tobacco/alcohol); b) Health education/behaviour Change Communication (BCC); c) Monitoring (blood pressure/blood glucose); d) Medication adherence support; e) Referral/health system linkage; f) Peer support/Self-help group (SHG)/social support; g) Telephonic follow up
RCT, randomised controlled trial; DM, diabetes mellitus; HTN, hypertension; IFG, impaired fasting glucose; FPG, fasting blood glucose; CHW, community health worker; ASHA, accredited social health activist; SBP, systolic blood pressure; DBP, diastolic blood pressure; SD, standard deviation; CI, confidence interval; NA, not available
Intervention characteristics
Interventions were delivered by community-based providers: Accredited Social Health Activists (ASHAs), Community Health Volunteers, Community Health Workers, peer-leaders, and medical social workers representing a mix of regular health system staff and volunteer cadres.
Intervention were provided both at individual and group level for a median of 6 months (range 3 to 72 months). Key domains addressed included dietary modifications, smoking and alcohol cessation, physical activity, medication adherence, disease monitoring, and referral support. All the studies adopted multicomponent interventions, with most common combination of lifestyle change (diet, physical activity, substance use), education and monitoring. Additionally, studies involving peer leaders and self-help group demonstrated provision of group-based social and behavioural support. Thus, the broader and long-term interventions were done with mixed provider ( Table).
Quality of studies
Majority of cluster RCTs demonstrated low risk of bias or some concerns due to insufficient information regarding allocation concealment, probable deviation of interventions, and lack of blinding due to inherent nature of the interventions. ( Fig. 2).
Except one, all parallel group randomised studies had low to some concerns in randomisation process, while in domain of outcome measurement, risk of bias was low (Supplementary Fig. 1). One study calculated sample size using a prevalence-based formula instead of effect size-based estimation raising issue of study power. However, calculation showed sufficient power for systolic blood pressure (84%) and diastolic blood pressure (100%).23 Three pre-post studies were assessed as having good to fair quality.
Qualitative result
Cardiovascular outcome
The reported variables were SBP, DBP, BMI and lipid profile (total cholesterol, triglyceride, LDL and HDL level). Five studies reported a substantial reduction in DBP among individuals with diabetes and/or hypertension after lifestyle intervention.23-27 Three studies reported a non-significant reduction of both.28-30 The magnitude of reduction was better among people with already raised blood pressure. Regarding BMI, only one study with smaller sample size had significant reduction while other two could not find significant changes. Similarly, only three studies reported lipid profiles, showing minor within-group improvement but no significant between-group differences.27,28,30
Diabetes
Out of five studies, one reported a significant decline in FBG after the intervention31 while others found no significant difference.27,28,30,32 Significant reductions in HbA1c were reported by two RCTs (mean HbA1c change -2.1 in intervention versus +1.4 in control)23 and (intervention group: 7.56, SD=1.87 vs. control group: 8.19, SD=1.77),31 whereas the remaining studies showed no significant reduction.
Quantitative result
Systolic blood pressure
Nine studies were analysed (3427 participants in intervention and 3687 in control group). The pooled mean difference (MD) was -5.5 mm Hg (95% CI: -9.0 to -1.9, P: 0.041, Q statistic P: <0.001, I2: 79.3%) indicating significantly lower SBP among intervention group ( Fig. 3).
Effect size was more in subgroup population having only hypertension, with MD of -7.5 mm Hg (95% CI: -12.7 to -2.3, P: 0.049). However, no significant difference was observed across study designs (P: 0.232) or intervention duration (≤ 6 months vs. > 6 months) (P: 0.683).
DBP
Seven studies (3 RCTs and 4 cluster RCTs) with 2271 participants in the intervention group and 2799 in the control group showed a pooled mean difference of -3.6 mm Hg (95% CI: -8.6 to 1.3, P: 0.150, I2: 89.9%) (Supplementary Fig. 2). Subgroup analysis by study design, intervention duration, and disease type showed no differential effect.
Lipid profile
Three studies (766 participants in intervention group and 735 in control group) reported the following mean differences: triglyceride -08.1 mg/dl (95% CI: -25.3 to 9.2, P: 0.359), LDL -0.2 mg/dl (95% CI: -4.7 to 4.3, P: 0.935), and total cholesterol -0.2 mg/dl (95% CI: -5.5 to 5.2, P: 0.92) (Supplementary Figs. 3-5).
Fasting blood glucose (FBG)
Five studies including 1424 participants in intervention and 1151 in control group had mean difference of -6.5 mg/dl (95% CI: -14.2 to 1.3, P: 0.101, I2: 69%). Subgroup analysis for duration (≤6 months and >6 months) or disease type yielded no differential effect (P: 0.125 and 0.125) (Supplementary Fig. 6).
Glycated haemoglobin% (HbA1c%)
Five studies including 836 participants in interventional and 805 in control group had pooled mean difference of -0.05% (95% CI: -0.13 to 0.03, p: 0.201, I2: 27.7%). Subgroup analysis also did not reveal any differential result (P: 0.209 and 0.514) (Supplementary Fig. 7).
Body mass index
Three studies including 828 participants in intervention and 1276 in control group were analysed showing statistically significant reduction of BMI with a mean difference of -0.63 kg/m2 (95% CI: -1.23 to -0.03, P: 0.038, I2: 26.7%) ( Fig. 4).
Publication bias
Though for few outcome variable, funnel plot was asymmetric, the Eagers test did not indicate any possible publication bias or small study effect (Eagers test P value >0.05) ( Fig. 5).
Sensitivity analysis
The sensitivity analysis for SBP showed MD varying from -3.87mm Hg to -5.78 mm without changing direction of effect. Heterogeneity (I2) also varied from 56% to 78%. Two studies with relatively larger effect size had contributed disproportionately to heterogeneity. Similar effect was noted for DBP (MD: -1.35 mm Hg to -2.68 mm Hg) with direction of effect consistently towards favourable side.
Meta-regression
The meta-regression model with four covariates showed no statistically significant influence (F = 0.96; P = 0.516) indicating that these factors did not explain the between-study variance (Adj R2 = –9.5%). Heterogeneity remained high (I2 = 78.8%; τ2 = 27.4) (Supplementary Table II).
Certainty of evidence
Certainty of evidence was low for SBP, FBG, HbA1c, triglyceride, LDL and BMI. However, it was very low for DBP and total cholesterol (Supplementary Fig. 8).
Discussion
CHW-led interventions implemented in community settings in India demonstrated beneficial effects on cardiometabolic outcomes, particularly blood pressure and body mass index. Although the certainty of evidence ranged from low to moderate, the direction of effect consistently favoured improvement. In addition, most studies inadequately reported CHW training, intervention content, and remuneration—key determinants of workforce performance.
Our findings highlight various components of community-based interventions and their beneficial effects. Included studies showed variation in regional context, intervention type, provider type, and target populations, reflecting real-world condition in India. Yet the interventions were possible to be grouped based on their community-based delivery and service packages. The common principles across studies were the use of locally acceptable, dedicated community worker delivering comprehensive, multi-component interventions tailored to patient’s need. Pooled estimates showed beneficial effect on hypertension and BMI, with a greater effect on SBP among individuals with pre-existing elevated blood pressure, though the certainty of evidence was low and heterogeneity was high. Meta-regression indicated consistent effect across population subgroups and study designs, suggesting that other unmeasured factors may explain the heterogeneity.
A systematic review on 10 studies conducted in India reported similar effects.11 Another review found significant reductions in both systolic and diastolic blood pressure, particularly in low- and middle-income countries (LMIC). It also revealed significant reduction of HbA1c, and triglycerides but not in BMI and low density lipoproteins (LDL).36 Few studies have reported significant changes of HDL, TGL, LDL. Our estimate was non-significant and certainty of evidence for lipid profile was ‘low’ or ‘very low’.
Our analysis demonstrated modest reduction in fasting blood glucose (FBG) and glycated haemoglobin (HbA1c); however, these effects were not statistically significant and were supported by low certainty of evidence. Prior reviews from LMIC have reported favourable effect of CHW-led interventions, while a systematic review from India identified certain interventions as effective in individual studies.7,11,37 Although the overall direction of effect generally favoured improvement, the level of statistical significance varied considerably across studies.38,39 To our knowledge, no meta-analysis has exclusively synthesised evidence from Indian studies. In the present review, significant improvements in glycaemic outcomes was observed in some trials. This may be attributed to small-study effects, as larger and methodologically robust studies generally reported non-significant findings.28,32 Although two earlier meta-analyses reported modest but statistically significant reductions in HbA1c, their inclusion of heterogeneous, multi-country populations limits the direct applicability of these findings in Indian context.36,40
This review was confined to community-based interventions implemented within the Indian context and assessed the certainty of evidence using the GRADE framework. However, several limitations merit consideration. The included studies involved heterogeneous populations and varying cadres of intervention providers, with limited evidence on the long-term effects of interventions. The review also did not address related cardiometabolic risk states such as pre-hypertension and pre-diabetes, and reporting on participant adherence was inadequate. For lipid outcomes, the small number of eligible studies and the disproportionate influence of a single study may have led to imprecise effect estimates, necessitating cautious interpretation. In addition, implementation outcomes, and cost-effectiveness of the intervention could not be assessed due to our limited scope.
The overall evidence from this systematic review and meta-analysis suggests beneficial effect of CHW-led interventions, albeit with variability in magnitude of effect. The range of interventions identified in this review may inform the selection and development of context specific, tailored intervention packages suited to local health system capacity and community need. However, the observed effectiveness, appears to be context dependent. Well-designed studies are required to strengthen the certainty of evidence before broader implementation and practice recommendations.
Acknowledgment
Authors acknowledge the Multidisciplinary Research Unit (MRU) of Government Institute of Medical Sciences (GIMS) and the Department of Health Research-Indian Council of Medical Research (DHR-ICMR), Ministry of Health and Family Welfare (MOHFW) for cooperation and mentorship.
Author contributions
SM: Concepts, design, intellectual content, literature search, data acquisition, statistical analysis, manuscript writing; PV: Design, intellectual content, literature search, data acquisition, manuscript writing; KS: Design, intellectual content, literature search, data acquisition, manuscript writing; RP: Concepts, design, intellectual content, literature search, manuscript writing. All authors have read and approved the final printed version of the manuscript.
Financial support and sponsorship
None.
Conflicts of Interest
None.
Use of Artificial Intelligence (AI)-Assisted Technology for manuscript preparation
The authors confirm that there was no use of AI-assisted technology for assisting in the writing of the manuscript and no images were manipulated using AI.
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