Assessing the Feasibility of Multimedia Interventions to Reduce Blood Pressure in Marginalized Hypertensive Communities of Karachi, Pakistan

This study utilizes the I-Change Model to empower individuals in literacy-limited settings, where the majority of the population is illiterate. By leveraging multimedia tools-such as an educational video and a pictorial infographic-we aim to promote self-care practices among individuals suffering from hypertension. Through these tailored interventions, we seek to enhance awareness, improve hypertension management, and encourage behavioral change, even in low-literacy communities

Study Overview

• Status: Not yet recruiting
• Conditions: Hypertension; Self Care; Cardio Vascular Disease; Educational Intervention; Video Streaming
• Intervention / Treatment: Other: Behavior Change through Education intervention

Detailed Description

This study is grounded in the I-Change Model, a behavioral change framework that emphasizes awareness, motivation, and ability as key drivers for adopting healthier lifestyles. Recognizing the barriers posed by low literacy in many underserved communities, particularly in urban slums, we aim to implement context-sensitive interventions that empower individuals with hypertension to take charge of their health. In these settings, traditional written health education materials often fail to reach or resonate with the population due to widespread illiteracy and limited health literacy. To address this gap, our study introduces two key multimedia tools: an educational video, designed with simple language and culturally relevant visuals to demonstrate self-care techniques; and a pictorial infographic that visually conveys essential information about hypertension management, medication adherence, dietary habits, and physical activity. By combining these tools with physician consultations, we hope to strengthen patient understanding, increase engagement with self-care practices, and ultimately improve blood pressure control. This multimedia-based, patient-centered approach offers a scalable and cost-effective strategy for promoting behavioral change in marginalized, low-literacy populations.

• Study Type: Interventional
• Enrollment (Estimated): 150
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: Hina Sharif, PharmD,MSPH; Phone Number: 03373305666; Email: hina.shf19@gmail.com
• Study Contact Backup: Name: Sana S Sheikh, MSc. MPH; Email: sanshf4@gmail.com

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

• Participants will be hypertension patients with an active primary healthcare clinic registration from eight chosen clinics situated in Karachi, Pakistan's slums.
• Anyone between the ages of 21 and 70 who has been diagnosed with hypertension at one of SINA's participating clinics in the last 30 days is eligible to participate.
• Participants will be required to take medicine to control their blood pressure,
• sign an informed consent form,
• attend primary healthcare clinic on a regular basis, and
• have proficiency in five local languages: Urdu, Sindhi, Balochi, Pashto, or Punjabi.

Exclusion Criteria:

• a patient's pregnancy or lactation status, a history of cancer that may necessitate medication changes,
• a blood pressure reading greater than 220/120 mmHg,
• a disability that prevents the patient from reading, writing, communicating, or watching television, and participation in any other study.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Supportive Care
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Double

Number of Arms

4

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
No Intervention: Control Arm: Standardized clinic care with Doctor Advice; In this arm, patient will receive all doctor's consultation and standardized care provided in the clinic setting.
Experimental: Intervention :" Educational Intervention through pictorial infographs"; Standardized clinic care + pictorial info-graphs distribution at every follow-up visit	Other: Behavior Change through Education intervention; The I-Change Model We used behavior alteration theory to identify areas of thinking or conduct that might potentially lead to issues in the process of collecting or consuming medicine. Subsequently, we proceeded to create and improve the substance of the message, and we aligned the messages with a standardized classification of evidence-based strategies for modifying behavior. Unclear or confusing information in infographics and television videos was revised, while information that was deemed unhelpful or insignificant by both patients and clinicians was eliminated. Patients' feedback was used to create fresh material for television videos and infographics.; Encourage patients about routine clinic appointments; Provide relevant health-related information.; Help participants plan and organize various treatment adherence behaviors including medication collection and taking, diet, and exercise; Support positive adherence-related behaviors
Experimental: Intervention : "Education intervention through video of self-care in LCD"; Standardized clinic care + hypertension care enhanced Video message in the local language at the waiting area through fastening LCD of the designated cluster.	Other: Behavior Change through Education intervention; The I-Change Model We used behavior alteration theory to identify areas of thinking or conduct that might potentially lead to issues in the process of collecting or consuming medicine. Subsequently, we proceeded to create and improve the substance of the message, and we aligned the messages with a standardized classification of evidence-based strategies for modifying behavior. Unclear or confusing information in infographics and television videos was revised, while information that was deemed unhelpful or insignificant by both patients and clinicians was eliminated. Patients' feedback was used to create fresh material for television videos and infographics.; Encourage patients about routine clinic appointments; Provide relevant health-related information.; Help participants plan and organize various treatment adherence behaviors including medication collection and taking, diet, and exercise; Support positive adherence-related behaviors
Experimental: Intervention: Education intervention through video of self-care in LCD + pictorial infograph; Standardized clinic care + Hypertension care enhanced pictorial infographic pamphlet distribution at every follow-up visit + hypertension care enhanced Video message at waiting area through fastened LCD of the designated cluster	Other: Behavior Change through Education intervention; The I-Change Model We used behavior alteration theory to identify areas of thinking or conduct that might potentially lead to issues in the process of collecting or consuming medicine. Subsequently, we proceeded to create and improve the substance of the message, and we aligned the messages with a standardized classification of evidence-based strategies for modifying behavior. Unclear or confusing information in infographics and television videos was revised, while information that was deemed unhelpful or insignificant by both patients and clinicians was eliminated. Patients' feedback was used to create fresh material for television videos and infographics.; Encourage patients about routine clinic appointments; Provide relevant health-related information.; Help participants plan and organize various treatment adherence behaviors including medication collection and taking, diet, and exercise; Support positive adherence-related behaviors

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Change in Systolic and/or Diastolic Blood Pressure	Change in Systolic and/or Diastolic Blood Pressure from baseline to follow-up	3, 6, 9 months post intervention

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Change in hypertension knowledge score	From baseline to post intervention, knowledge about self-care among interventional arms	at 3, 6, 9 months post intervention
Adherence to antihypertensive medication	The Hill bone-scale, comprising 14 items, assesses medication self-efficacy in managing Hypertension (chronic diseases) and appears suitable for individuals with limited literacy skills	at 3, 6, 9 months post intervention
Dietary modifications (e.g., reduced salt intake)	Dietary modifications (e.g., reduced salt intake)	at 3, 6, 9 months post intervention
Number of clinic visits or follow-up consultations	Number of clinic visits or follow-up consultations	3, 6, 9 months post intervention
BMI management in Kg/m2	weight control according to height in kg/m2	3,6,9 months post intervention
Smoking control (number of cigarettes per day)	Smoking control starting from reduction in number of cigarettes per day to complete cessation	3, 6, 9 months post intervention
Physical activity	time in minutes which shows physically active in a day (in term of walking, yoga, exercise)	3, 6, 9 months intervention

Collaborators and Investigators

• Sponsor: SINA Health Education and Welfare Trust
• Collaborators: Aga Khan University

Study record dates

Study Major Dates

• Study Start (Estimated): December 15, 2025
• Primary Completion (Estimated): December 15, 2026
• Study Completion (Estimated): December 30, 2026

Study Registration Dates

• First Submitted: August 4, 2025
• First Submitted That Met QC Criteria: August 12, 2025
• First Posted (Actual): August 20, 2025

Study Record Updates

• Last Update Posted (Actual): August 20, 2025
• Last Update Submitted That Met QC Criteria: August 12, 2025
• Last Verified: August 1, 2025

More Information

Terms related to this study

• Keywords: hypertension; self-care; high blood pressure; educational intervention; I-changed model; marginalized population
• Additional Relevant MeSH Terms: Hypertension; Cardiovascular Diseases; Vascular Diseases
• Other Study ID Numbers: 00007

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO
• IPD Plan Description: There is confidently matter and Organization will not allow to share

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No
• product manufactured in and exported from the U.S.: No