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H&tlth Briefs

The Role of Community Volunteers inHealth Interventions:

A Hypertension Screening and Follow-up Program

CHRISTINE J. COOKE, PHD, AND ANDREW MEYERS, PHD

Abstract: Volunteers from a resident health committeein an apartment complex community carried out door-to-door blood pressure screening of residents. Their resultswere compared with those from a community where aresident health committee conducted central site screeningsand with those of a community where nonresident research-ers manned a central screening site. Door-to-door screeningby community volunteers was significantly more effectivethan the two central site screening methods which did notdiffer from each other. Follow-up measures increased thenumber of hypertensives who reported seeking treatment by100 per cent. (Am J Public Health 1983; 73:193-194.)

The majority of hypertension screening programs in-volve central site screening at a location selected for theconvenience of participants and screeners. Studies havecompared such central site screening to door-to-door screen-ing and have found that door-to-door screening is significant-ly more effective. 2 The high cost of paid home screeners,however, makes their widespread use unlikely.

We aimed to minimize cost of door-to-door screening byusing community volunteers. Efforts were made to ensureacceptance by residents and access to volunteers by meansof pre-intervention community organization: interested resi-dents were aided in forming a community health committeewhose primary function was the planning and implementa-tion of various health maintenance activities such as screen-

Address reprint requests to Christine J. Cooke, PsychologyDepartment, Virginia Commonwealth University, Richmond, VA23284. Dr. Meyers is with the Department of Psychology, MemphisState University, Memphis, TN. This paper, submitted to theJournal December 3, 1981, was revised and accepted for publicationJuly 7, 1982.

C) 1983 American Journal of Public Health

ing projects, smoking reduction clinics, and weight lossprograms.

The volunteer-staffed door-to-door screening programwas compared to programs in two other communities: inone, experimental research assistants conducted screeningat a central site within the community; in the other, centralsite screening was conducted by volunteers from a residenthealth committee set up in that community.

We also evaluated the follow-up of individuals identifiedas hypertensive in the community screening programs. One-half of the hypertensives received follow-up phone calls andletters encouraging treatment compliance while the remain-ing individuals received no follow-up contacts.

Method

Three apartment complexes were selected for the ex-periment based on similar rental fees and distance fromdowntown. The apartment complexes were randomly as-signed to three experimental conditions: Resident Door-to-Door screening; Resident Central Site screening; and Non-resident Central Site Screening.

Notices were distributed to all units in two communitiesinforming residents that a community health committee wasbeing organized. In the initial meetings of interested resi-dents, experimenters aided committee members in electingleaders, establishing guidelines for meetings, and planningactivities. The specific tasks of the blood pressure screeningproject were described, and then the request for volunteerswas made.

In the Resident Door-to-Door community, five volun-teers successfully completed training. Two additional resi-dents were members of the health committee but did notparticipate in the hypertension screening project. In theResident Central Site community, four volunteers completedtraining for the hypertension project and one other resident

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PUBLIC HEALTH BRIEFS

TABLE 1-Initial Screening Results

Resident Resident NonresidentDoor-to-Door Central Site Central Site

Number of apartmentsscreened 116 29 23

Per cent of occupiedapartments screened 48.9% 14.5% 11.55%

Number of residentsscreened 204 32 29

Per cent of residentsscreened 43.0% 8.0% 8.0%

Time expended for sur-vey (hours) 48.5 38.0 38.0

was a committee member but not a screener. Eleven of the12 volunteers were female and all were White.

Volunteers and research assistants were trained individ-ually (two 45-minute sessions) or in small groups (three 45-minute sessions) to take blood pressure readings and makeappropriate referrals. The Resident Door-to-Door communi-ty volunteers were given two additional 45-minute trainingsessions which focused on the elements of successful door-to-door interview and screening techniques. The screenersin both the Resident and Nonresident Central Site communi-ties received one 45-minute session of training in answeringpatient questions and in providing patient education informa-tion.

Each volunteer in the Resident Door-to-Door communi-ty was given a list of 53 apartment addresses and a three-week period in which to screen them. Central Site screeningin the two remaining apartment complexes was conductedduring the same three-week period. The centrally locatedscreening sites were manned for 14 hours weekly, includingweekend and evening hours. The total number of hours inwhich the central sites were open for screening was approxi-mately equal to the number of hours necessary for comple-tion of the door-to-door screening. Notices regarding thescreening service were distributed by research assistants inthe Nonresident Central Site community and by healthcommittee volunteers in the Resident Central Site communi-ty on the first and fifteenth day of the program. The timeinvolvement for distribution of notices was approximatelyfour hours per complex.

All subjects with two or more diastolic blood pressurereadings equal to or exceeding 95 mm Hg were rescreenedwithin one month following the initial screening. Thosewhose diastolic readings were 95mm or higher upon re-screening comprised the group of subjects designated asuncontrolled hypertensives. Rescreening was conducted inthe subjects' homes by the appropriate community volun-teers or research assistants.

All persons with uncontrolled hypertension from boththe experimental and control communities were randomlyassigned to either a contact or control group. The subjects inthe contact group were mailed a letter one week after referralfor treatment encouraging them to seek treatment. Twoweeks later, they were contacted by phone by the experi-

menter and asked if they had seen a physician. If not, theywere again urged to do so. All subjects were phoned by theexperimenter one week later to ascertain whether they hadas yet sought treatment. The 11 subjects in the control groupreceived no additional follow-up but were contacted byphone by the experimenter four weeks after referral fortreatment to ascertain status.

Approximately three months after referral, all hyperten-sives were visited in their homes by an experimenter and hadtheir blood pressures remeasured.

Results

Initial screening results are presented in Table 1.A chi-square test conducted on the proportion of apart-

ments screened in each of the three communities demon-strated a significant difference, X2 (2) = 99.51, p < .001.Further chi-square tests indicated significant differencesbetween the Resident Door-to-Door community and theResident Central Site community, X2 (1) = 70.13, p < .001. Achi-square test on the two central site screening communitiesdemonstrated no significant differences between them. Simi-lar findings were obtained from analyses of the estimatednumber of residents screened.

One hypertensive subject from each of the contact andcontrol groups had moved at the three-month follow-up. Allten of the available hypertensives in the Contact Groupreported having seen a physician by the three-month follow-up. Five of the ten hypertensives in the Control Groupreported visiting a physician at the time of the three-monthfollow-up.

Discussion

The present experiment replicated other demonstrationsof door-to-door screening effectiveness but utilized commu-nity volunteers to reduce program costs. Equipment andmailing costs in this experiment totaled $340.

The failure to find differences between the two centralsite programs suggests that community organization did notcontribute to screening effectiveness. A previous study thatemployed resident door-to-door screeners without priorcommunity organizing3 screened fewer residents, however,suggesting an interaction between community organizationand door-to-door screening. Finally, the evidence presentedhere suggests that a simple follow-up procedure can improvepatient compliance with referral to treatment.

REFERENCES1. Wilber JA, Barrow JG: Hypertension-A community problem.Am J Med 1972; 52:653-663.

2. Stahl SM, Lawrie T, Neill P, et al: Motivational intervention incommunity hypertension screening. Am J Public Health 1977;67:345-352.

3. Artz L, Cooke CJ, Meyers AW, et al: Community change agentsand health interventions: Hypertension screening. Am J CommPsychol 1981; 9:361-370.

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