A Pilot Project on a Community-Supported Approach to Blood Pressure Management to Improve Sustainability in a Rural Community in Bangladesh

Background: The long-term nature of chronic diseases, such as hypertension, necessitates exploring sustainable approaches to management in resource-limited settings. Objectives: The objective of the pilot study is to apply design ethnography and door-to-door community organization strategy to facilitate community support for sustainable hypertension management. Methods: Design ethnography facilitated describing the community and identifying local resources. Community organization involved forming health and inclusion committees through a door-todoor approach, with health workers selected based on key informant preferences. All residents aged ≥30 years within the community boundary were screened for hypertension, defined as systolic blood pressure ≥140 mmHg or diastolic ≥90 mmHg on two readings taken three minutes apart using an automatic bicep cuff. Screen-positive individuals received biweekly follow-up via an internet-based system using local resources and committee support. Results: Ethnographic insights highlighted limited access to healthcare, education, and nutrition while identifying resources, such as technological familiarity, interpersonal networks, and community spaces. The inclusion committee played an important role in resolving early conflicts associated with preferential worker selection. A total of 260 individuals were screened, of whom 20 met the hypertension criteria. From October 2020 to December 2022, mean systolic blood pressure decreased by 27 mmHg and diastolic by 9.9 mmHg (both p < 0.05). The resources and committees supported the ongoing project implementation. Conclusions: This project underscores the value of integrating ethnography and door-to-door community organization to foster sustainable hypertension management in resource-limited settings.