Trial reportBMJ global health2021
Why do strategies to strengthen primary health care succeed in some places and fail in others? Exploring local variation in the effectiveness of a community health worker managed digital health intervention in rural India.
Trial report in BMJ global health, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 13 papers.
What it found
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The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
13 citing papers in PubMed, 20 citations in OpenAlex.
- Integration of Cardiovascular Disease Services within Primary Health Care Systems: Insights from South Asia.Current atherosclerosis reports · 2026Review
- Evaluation of a synchronous training program on common primary care medications for community health workers in Karnataka, India.BMC health services research · 2026Article
- Contribution of health system governance in delivering primary health care services for universal health coverage: A scoping review.PloS one · 2025Article
- Task-sharing for non-communicable disease prevention and control in low- and middle-income countries in the context of health worker shortages: A systematic review.PLOS global public health · 2025Article
- The coupling coordination between digital village construction and rural healthcare service efficiency in China: dynamic evolution, spatial difference and driving factors.Frontiers in public health · 2025Article
- Factors Associated With Digital Capacity for Health Promotion Among Primary Care Workers: Cross-Sectional Survey Study.Journal of medical Internet research · 2024Article
- Barriers and facilitators for the use of telehealth by healthcare providers in India-A systematic review.PLOS digital health · 2024Article
- Improving the management of type 2 diabetes in China using a multifaceted digital health intervention in primary health care: the SMARTDiabetes cluster randomised controlled trial.The Lancet regional health. Western Pacific · 2024Article
- Barriers to and enablers of quality improvement in primary health care in low- and middle-income countries: A systematic review.PLOS global public health · 2024Article
- Assessing a digital technology-supported community child health programme in India using the Social Return on Investment framework.PLOS digital health · 2023Article
- Digital Health Interventions to Improve Access to and Quality of Primary Health Care Services: A Scoping Review.International journal of environmental research and public health · 2023Article
- Transfer or tailor? Implementing a technology-supported intervention for noncommunicable diseases across contexts.Health care science · 2023Article
- Protocol for a process and implementation evaluation of the SMARThealth pregnancy hybrid type 2 cluster randomised controlled trial.Women's health (London, England)Article
Corrections and comments
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Authors and funding
12 authors at 5 institutions in 3 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
introductionDigital health interventions (DHIs) have huge potential as support modalities to identify and manage cardiovascular disease (CVD) risk in resource-constrained settings, but studies assessing them show modest effects. This study aims to identify variation in outcomes and implementation of SMARTHealth India, a cluster randomised trial of an ASHA-managed digitally enabled primary healthcare (PHC) service strengthening strategy for CVD risk management, and to explain how and in what contexts the intervention was effective.
methodsWe analysed trial outcome and implementation data for 18 PHC centres and collected qualitative data via focus groups with ASHAs (n=14) and interviews with ASHAs, PHC facility doctors and fieldteam mangers (n=12) Drawing on principles of realist evaluation and an explanatory mixed-methods design we developed mechanism-based explanations for observed outcomes.
resultsThere was substantial between-cluster variation in the primary outcome (overall: I
conclusionLocal contextual factors were significant influences on the effectiveness of this DHI-enabled PHC service strategy intervention. Local adaptions need to be planned for, monitored and responded to over time. By identifying plausible explanations for variation in outcomes between clusters, we identify potential strategies to strengthen such interventions.
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