Effects of community health worker-led interventions on cardiometabolic outcomes in vulnerable populations: A systematic review and meta-analysis
In brief
Community health workers lower systolic blood pressure by about 4 mmHg in vulnerable groups
A meta-analysis of 30 randomized trials (15,295 participants) found CHW-led programs reduced systolic pressure by roughly 3.7 mmHg and diastolic pressure by 2.2 mmHg, with larger drops (≈5 mmHg) seen in low- and middle-income countries. Effects on BMI, HbA1c and LDL were modest or non-significant, and evidence certainty was low, so further high-quality trials are needed.
- Journal
- PLOS global public health (Q1)
- Published
- 26 August 2026
- Study design
- Systematic review / meta-analysis of RCTs
- Evidence level
- Level 1, High (CEBM 1a)
- Authors
- Ismaila Ajayi Yusuf, Ihesiulo Alozie, Micah Nnabuko Okwah, Vikash Kumar, Zubeda Idris-Saeed, Hakeem Popoola, et al.
- PMID
- 42647526
- DOI
- 10.1371/journal.pgph.0007191
Why clinicians should know about it
- Picked for Critical Care and Intensive Care Medicine (top studies of the week, 30 August 2026): CHW interventions for cardiometabolic outcomes
- Picked for Family Practice (top studies of the week, 30 August 2026): Systematic review of RCTs on community health worker interventions for
Abstract
UNLABELLED: Cardiometabolic diseases (CMDs) disproportionately affect vulnerable populations worldwide. Community health worker (CHW)-led interventions may reduce risk and improve preventive care, but their effectiveness remains unclear. This systematic review and meta-analysis evaluated their effectiveness on cardiometabolic outcomes in vulnerable groups. A comprehensive search of PubMed/MEDLINE, Scopus, Embase, ClinicalTrials.gov, and Cochrane Library was performed from January 1, 2000 to December 20, 2025, for randomized trials of CHW-led interventions on cardiometabolic outcomes. Primary outcomes were systolic and diastolic blood pressure; secondary outcomes were body mass index (BMI), glycosylated hemoglobin (HbA1c), and low-density lipoprotein cholesterol (LDL-C). Outcomes were pooled as mean differences using the generic inverse variance method; heterogeneity was assessed using I2. Thirty randomized trials (15,295 participants) were included. CHW-led interventions significantly improved systolic blood pressure (WMD = -3.72 mmHg; 95% CI: -5.94 to -1.51; I2 = 99.1%) and diastolic blood pressure (WMD = -2.22 mmHg; 95% CI: -3.50 to -0.95; I2 = 98.6%); 95% prediction intervals crossed the null for all five outcomes (e.g., SBP: -15.12 to 7.67 mmHg), indicating uncertainty at a new site. BMI and HbA1c improved modestly but were attenuated to non-significance by trim-and-fill analysis, suggesting publication bias; LDL-cholesterol effects were not significant. SBP reductions were significant in low- and middle-income countries (LMICs) (WMD = -5.09 mmHg; 95% CI: -7.57 to -2.60) but not high-income countries (HICs), with the largest effects in Africa. GRADE certainty was low for blood pressure, moderate for BMI, very low for HbA1c, and low for LDL-cholesterol. CHW-led interventions modestly improve cardiometabolic outcomes in vulnerable populations, with low-to-very-low certainty evidence for blood pressure and glycemic control and moderate certainty for BMI, supporting a potential role in cardiovascular risk-reduction strategies, particularly in LMICs. However, wide prediction intervals and non-significant meta-regression for intervention design features (contact frequency, duration, delivery format) warrant cautious, hypothesis-generating interpretation pending higher-quality trials. SYSTEMATIC REVIEW REGISTRATION: Registration Number: PROSPERO 2025 CRD420251248842.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.