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Role for social workers in tackling Cardiovascular disease in India

Posted on 17 July 2020

Social factors, such as poverty and access to community networks, combined with depression and anxiety, have been found to increase the risk for cardiovascular disease in Kerala, India.

Social work needed

Research conducted by SPSW researchers and published in the open access journal BMC Cardiovascular Disease suggests that there may be a role for social workers in tackling the growing problem of cardiovascular disease in India.

UKIERI project

These findings come from a catchment area community survey conducted as part of a UK-India Education and Research Initiative-funded project, which researchers from the International Centre for Mental Health Social Research (ICMHSR) have undertaken with Rajagiri College of Social Sciences in Cochin, Kerala.

Principal Investigator, Professor Martin Webber, said: “For the last three years we have been working with collaborators at the World Health Organisation and the University of Melbourne to train and develop a team of researchers at Rajagiri College in research methods, data collection and analysis. Our first two papers have just been published, which highlight the potential for social workers to become involved in tackling the growing epidemic of cardiovascular disease in India.”

Scoping review

The project began with a scoping review of studies presenting data on the major social risk factors which are associated with diabetes, hypertension and the comorbid conditions of depression and anxiety in India. The findings of this review was recently published by BMJ Open.

Only ten studies met the inclusion criteria for this review, which highlights the lack of research in this field. The synthesis of studies included in the review found six groups of social risk factors: demographic factors, economic aspects, social networks, life events, health barriers and health risk behaviours.

This review concluded that previous research on cardiovascular disease in India has paid insufficient attention to robustly measuring social factors.

Community survey

To contribute evidence about the potential role of social factors in increasing risk for cardiovascular disease, the researchers conducted a catchment area survey in Keezhumadu, Kerala. This used a range of valid and reliable measures of potential social risk factors alongside biological measures of blood pressure and blood glucose levels to explore their association in adults over the age of 30.

As this was a capacity-building project ICMHSR researchers cascaded training to postgraduate social work students to collect data in the door-knock survey, under the supervision of trained researchers.

997 people participated in the survey and several important findings emerged.

Firstly, the prevalence of high blood pressure and blood glucose was 33% and 26% respectively. The prevalence of probable cases of depression and anxiety was 16% and 21% respectively. These rates are high for India, and comparable to many high-income countries.

Next, the researchers found that people with high blood pressure or high levels of blood glucose (both risk factors for cardiovascular disease) experienced distinct clusters of risk factors.

Smoking and drinking alcohol were the predominant risk factors for one group in the sample, who were predominantly employed and married men. However, distinct risk factors became apparent for a group of older women who were mostly not married, had low income and were physically inactive. This group experienced high life stress, poor connections with their community and disintegrated social networks.

Furthermore, a path analysis revealed that depression and anxiety contributed to the social risk factors to increase the risk of high blood pressure and high blood glucose.

The focus of public health interventions is currently predominantly on increasing exercise to combat obesity, and to support people to reduce smoking and drinking. However, data from this survey revealed that there is a cluster of social risk factors which are not being addressed.

“Social workers are trained in a ‘medical and psychiatry specialism’ in India, but are frequently employed in hospitals or clinics,” said Professor Webber. “Very few work in the community addressing social issues which compound health or mental health. Our survey has identified that social work is needed in communities throughout India to address modifiable risk factors for cardiovascular disease.”

Further reading

Our findings can be found in these two open access papers:

Madavanakadu Devassy., S., Webber, M., Scaria, L., A. Thiyagarajan, J., Fendt-Newlin, M., Joubert, J., Benny, A., Nannatt, A. & Joubert, L. (2020) Social and behavioural risk factors in the prevention and management of cardiovascular disease in Kerala, India: a catchment area population survey, BMC Cardiovascular Disorders, 20, 327, doi:10.1186/s12872-020-01595-x.

Madavanakadu Devassy., S., Benny, A., Scaria, L., Nannatt, A., Fendt-Newlin, M., Joubert, J., Joubert, L. & Webber, M. (2020) Social factors associated with chronic non-communicable disease and comorbidity with mental health problems in India: a scoping review, BMJ Open, 10:e035590. doi: 10.1136/bmjopen-2019-035590.

The capacity-building process has been described in our chapter in the Routledge Handbook of Social Work Practice Research:

Madavanakadu Devassy, S., Fendt-Newlin, M., Joubert, L. and Webber, M. (2020) ‘International capacity-building for practice research in India’ in Joubert, L. & Webber, M. (eds) The Routledge Handbook of Social Work Practice Research, Abingdon, Routledge, 276-285.