Journal of Medicine and Health Research

Background: Diabetes and hypertension are the main causes of mortality and morbidity in the world, and they have great public health and economic impacts. Community-based interventions represent a promising population-level strategy for preventing these conditions; however, evidence regarding their effectiveness has been inconsistently synthesized in the literature.

Objectives: The purpose of this systematic review was to synthesize the evidence regarding the effectiveness of community-based interventions in the primary prevention of type 2 diabetes and hypertension, determine factors of intervention implementation that influence the success of the implementation, and determine their potential in meeting health equity issues.

Methods: Systematic review was done in line with PRISMA guidelines. Electronic databases (PubMed, EMBASE, Web of Science and Cochrane Library) were conducted a search between January 2010 and December 2023. They were randomized controlled trials or quasi-experimental studies that assessed community-based interventions to prevent diabetes or hypertension. The Cochrane Risk of Bias tool was used to evaluate the quality of the study. Narrative synthesis and meta-analytical methods were used to synthesize data where viable.

Results: The inclusion criteria were 42 studies that had more than 85,000 participants in different geographical and socioeconomic settings. Community based interventions resulted in small yet clinically significant changes in systolic blood pressure (mean difference: -3.5 mmHg; 95% CI: -5.2, -1.8) and in Fasting glucose (mean difference: -2.1 mg/dL; 95% CI: -3.4, -0.8). Interventions that were multicomponent, which included education, physical activity promotion and dietary modification were more effective compared to single-component interventions. Community involvement, cultural adaptation and long-term funding were linked to implementation success to a large extent. Interventions were shown to be of varied effectiveness in diverse socioeconomic and ethnic groups, and there is little evidence of the equitable outcome of the interventions.

Conclusions: The prevention of type 2 diabetes and hypertension by community-based interventions can be effectively done, but the effectiveness is moderate and is heavily dependent on the quality of implementation and the context. The findings directly respond to the objectives of the review: multicomponent interventions are superior to single-component interventions, the quality of implementation is a moderating variable, and there are still significant health equity disparities. Effectiveness-implementation hybrid trials, more intensive community involvement, and more rigorous health equity measurement should be prioritized in future research.