Teaching the Teacher: A Cross-Cultural Project for Training Health Personnel
in Methods of Patient Education for Hypertension*

Dr. Arun Chockalingam
The WHO/WHL Patient Education Project (PEP) was a 3-year multinational cross-cultural study of the training of health personnel in methods of patient education for hypertension.

The study evaluated the applicability and effectiveness of models for patient education in various sociocultural settings. The study included 1,197 adult hypertensive patients, at baseline, of all ages and both genders, 61 physicians, 31 nurses, and 18 allied health workers from the participating clinics. They were assigned either to the educational group or the routine group in pilot centres from six countries, developed and developing, in five WHO regions. The data collected comprised patient identification, patient/health personnel interrelation and satisfaction, quality of hypertension care, compliance with medical prescriptions, measurement of relevant variables, and problems and solutions during the study period.

It shows how the staff at the primary health care level can be reached and trained to deliver patient education, through collaboration with scientific/university hospital-based services in countries at different stages of development.

Patient education, as applied in this study, provides a cost-effective way of improving the quality of care and patient adherence to long-term treatment, not only for hypertension, but also for other cardiovascular and chronic noncommunicable diseases. The PEP strategy is applicable in various socioeconomic and cultural settings and in different health care delivery systems.

Based on the experience, the study made the following recommendations:

  1. PEP pilot centres should continue to apply the PEP strategy in the routine/refrence areas and promote its extension to other areas.
  2. The PEP experience can be integrated as a simple service-oriented activity into the health care system of interested centres and countries as a cost-effective way of improving the quality of care and encouraging patient adherence to long-term treatment, not only for hypertension, but for other cardiovascular (CVD) and chronic noncommunicable diseases (NCD).
  3. The PEP experience can be applied as part of the country strategy for prevention and control of CVD and other NCD.
  4. The PEP experience should be integrated into the regular curriculums of medical students and other trainee health professionals.
  5. Physicians should prescribe nonpharmacological treatment to patients as a first approach, and prescribe available, effective and affordable drugs when they are needed.
  6. WHO and WHL should continue to provide leadership in hypertensive patient education activities.
  7. WHO and WHL should continue to monitor patient education activities in countries around the world and facilitate networking between countries.

WHL/WHO PEP Sites and Key Personnel

Key Personnel
St. John's, Newfoundland, Canada Memorial University of Newfoundland & Canadian Coalition for High BP Prevention and Control Dr. Arun Chockalingam
Professor George Fodor
Beijing, China Peking Union Medical College & Cardiovascular Institute and Fu Wai Hospital, Chinese Academy of Medical Science

Professor Liu Lisheng
Professor J. Xie

Havana, Cuba Cuban Institute of Cardiology Dr. A. Duenas
Dr. G. Debs-Perez
Accra, Ghana Department of Medicine & Therapeutics, University of Ghana Medical School Professor Silas Dodu
Professor J. Kpodonu
Budapest, Hungary Hungarian Institute of Cardiology Dr. Jeno Duba
Dr. Julia Kishegyi
New Delhi, India All India Heart Foundation & National Heart Institute

Dr. S. Padmavati

PEP Co-ordinating/Management Centre
World Hypertension League (WHL) Dr. Tom Strasser (until 1995) Dr. Arun Chockalingam
(1995 and after)
CVD Programme, WHO Dr. Ivan Gyarfs (until 1996) Dr. Porfirio Nordet
(1996 and after)

* The PEP results are published in:
1. WHO/CVD/98.2
2. CVD Prevention, 1999; 2(1).

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