The analysis of a student-led university screening and testing programme for cardiovascular disease and diabetes

Abstract

Non-communicable diseases (NCDs) have become the primary cause of both mortality and morbidity globally. Due to their insidious progression, regular screening and monitoring is imperative. The notable surge in these diseases may be attributed to the ongoing global and epidemiological transitions, leading to changes in people’s behaviours and lifestyles. Typically, these diseases remain undetected until they manifest clinically, often leaving limited opportunity for prevention or reversal of damage. Hence, the goal is to prevent, delay the onset and treat these diseases before irreversible end-organ damage occurs. As NCDs typically develop over decades, the presymptomatic phase is often undetected by individuals, with individuals unknowingly exacerbating their conditions through lifestyle choices, such as physical inactivity, unhealthy diets, tobacco consumption and harmful use of alcohol. The university environment, with its academic demands and stressors, often fosters these habits, thus contributing to the proliferation of NCDs. To address this NCD epidemic, empowering students to conduct screening and health promotion initiatives within the academic environment could prove beneficial in building a health enabling environment. Providing students with opportunities to practice their clinical skills and complement their theoretical knowledge with practical experience through work- based learning initiatives could be mutually beneficial to the public and the students. Students gain valuable skills and experience, while the public receives free screening, lifestyle advice, and early detection of CVD risk factors. This study aims to identify the occurrence of CVD related risk factors at a student-led screening event. The Wits university clinical pharmacy department initiated a work-based learning program for the fourth-year pharmacy students to improve their clinical skill set. After training in the clinical skills required to conduct Point-Of-Care Testing (POCT) services, understanding the clinical threshold values and the lifestyle advice regarding each condition, the students underwent competency assessment before participating in the screening event. There were 767 participants in this study, with their medical histories and demographical information collected using a questionnaire, followed by relevant tests such as blood pressure, blood glucose, blood cholesterol and their anthropometric measurements. Additional tests such as the glycated haemoglobin A1c (HbA1c) test and full lipid panel testing was offered to some viii participants. Following the screening, results were explained to the participants, who were then referred or offered appropriate lifestyle education. Those that were referred for CVD-related risk factors, were telephonically surveyed about their clinical findings and their interventions post-screening. The occurrence of self -reported hypertension (6.5%), diabetes (2.09%), cholesterol (2.87%) and obesity (3.91%) were lower in comparison to the measured results. Screening results show that there were 18.25% abnormal blood pressure readings, 2.83% had hyperglycaemia, and 11.36% had high cholesterol readings. Control levels amongst participants with self-reported diagnosed conditions were suboptimal, with 56% potentially having uncontrolled hypertension, 18.75% uncontrolled diabetes, 18.18% uncontrolled cholesterol and 50% confirmed obesity. In this sample, tobacco and alcohol consumption did not significantly influence CVD risk factors. However, the age and designation were significantly (P < 0.05) associated with disease occurrence, while obesity was strongly associated with all demographic characteristics (gender, ethnicity, age range and designation). Follow-up surveys revealed significant findings among 35% of the participants. Among them, three participants (43%) were diagnosed with hypertension or diabetes, two participants (29%) had uncontrolled conditions which required upscaling treatment and the remaining two participants were advised to monitor their conditions and implement lifestyle modifications to prevent disease progression. Most participants cited reasons such as the lack of perceived need, cost, and time constraints for not pursuing routine screening. Those who utilized this service appreciated the convenience offered by a screening event held at their working and study environment. It was found that most people are unlikely to pursue screening services unless they are offered screening at their education and working environment. This highlights the importance of creating a health enabling environment, encouraging proactive health behaviours among participants.