# Enhancing knowledge of hypertension among general practitioners in Pakistan through a Train-The-Trainer initiative

## TL;DR

A training program for doctors in Pakistan significantly improved their knowledge of diagnosing and managing hypertension, which could help improve patient care in low- and middle-income countries.

## Contribution

The study demonstrates the effectiveness of a Train-The-Trainer model in improving hypertension knowledge among general practitioners in Pakistan.

## Key findings

- Before training, 92% of GPs scored less than 50 on a hypertension knowledge test.
- After training, 38.5% of GPs achieved moderate or high knowledge scores (≥50).
- Significant improvements were observed across all demographic groups, including female and younger GPs.

## Abstract

Hypertension (HTN) affects over a billion people worldwide, with most cases in low- and middle-income countries (LMICs) where awareness and control remain low. In Pakistan, general practitioners (GPs) are usually the initial contact for hypertensive patients. Through the Train the Trainer (TTT) initiative, a group of consultant cardiologists were trained as master trainers to conduct training for GPs across Pakistan. This study aimed to assess the effectiveness of the TTT initiative regarding knowledge of GPs about the diagnosis and management of HTN.

This study included 540 GPs from all over Pakistan. Participants attended HTN training workshops run by Master Trainers under the TTT model and completed a structured online questionnaire in relation to knowledge of HTN before and 1–3 months after training. Knowledge scores were derived from correct responses for 19 items.

Pre-training GPs demonstrated low HTN knowledge scores with a median of 26.3 [IQR: 15.8–36.8] and 92% scoring less than 50. In contrast, post-training medians increased significantly to 42.1 [IQR: 31.6–63.2], with 38.5% of GPs achieving moderate or high knowledge scores ≥50 (p < 0.001). Overall, gains were observed across all demographic groups; significant improvement was observed among female and younger GPs.

The TTT initiative effectively improved knowledge in both the diagnosis and management of hypertension among GPs, thus standing to potentially improve the current gaps in HTN care in many LMICs through similar models. Further studies are warranted to document the long-term clinical impact of this kind of training on patient outcomes and hypertension control.