Community Health Workers Improve Linkage to Hypertension Care in Western Kenya

JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY

卷:74

Article

Vedanthan, Rajesh¹  Kamano, Jemima H.²  DeLong, Allison K.³  Naanyu, Violet²  Binanay, Cynthia A.⁴  Bloomfield, Gerald S.⁴  Chrysanthopoulou, Stavroula A.³  Finkelstein, Eric A.⁴  Hogan, Joseph W.³  Horowitz, Carol R.⁵  Inui, Thomas S.⁶  Menya, Diana²  Orango, Vitalis⁷  Velazquez, Eric J.⁸  Were, Martin C.⁹  Kimaiyo, Sylvester²  Fuster, Valentin⁵ 

[1] NYU, Sch Med, 180 Madison Ave,8th Floor, New York, NY 10016 USA

[2] Moi Univ, Coll Hlth Sci, Eldoret, Kenya

[3] Brown Univ, Sch Publ Hlth, Providence, RI 02912 USA

[4] Duke Univ, Durham, NC USA

[5] Icahn Sch Med Mt Sinai, New York, NY 10029 USA

[6] Indiana Univ Sch Med, Indianapolis, IN 46202 USA

[7] Acad Model Providing Access Healthcare, Eldoret, Kenya

[8] Yale Univ, New Haven, CT USA

[9] Vanderbilt Univ, 221 Kirkland Hall, Nashville, TN 37235 USA

关键词: community health workers;    hypertension;    Kenya;    linkage to care;    smartphone technology;    tailored behavioral communication;   

DOI  :  10.1016/j.jacc.2019.08.003

来源: Elsevier

【 摘 要 】

BACKGROUND Elevated blood pressure (BP) is the leading global risk factor for mortality. Delay in seeking hypertension care is associated with increased mortality. OBJECTIVES This study investigated whether community health workers, equipped with behavioral communication strategies and smartphone technology, can increase linkage of individuals with elevated BP to a hypertension care program in western Kenya and significantly reduce BP. METHODS The study was a cluster randomized trial with 3 arms: 1) usual care (standard training); 2) paper-based (tailored behavioral communication, using paper-based tools); and 3) smartphone (tailored behavioral communication, using smartphone technology). The co-primary outcomes were: 1) linkage to care; and 2) change in systolic BP (SBP). A covariate-adjusted mixed-effects model was used, adjusting for differential time to follow-up. Bootstrap and multiple imputation were used to handle missing data. RESULTS A total of 1,460 individuals (58% women) were enrolled (491 usual care, 500 paper-based, 469 smartphone). Average baseline SBP was 159.4 mm Hg. Follow-up measures of linkage were available for 1,128 (77%) and BP for 1,106 (76%). Linkage to care was 49% overall, with significantly greater linkage in the usual care and smartphone arms of the trial. Average overall follow-up SBP was 149.9 mm Hg. Participants in the smartphone arm experienced a modestly greater reduction in SBP versus usual care (-13.1 mm Hg vs. -9.7 mm Hg), but this difference was not statistically significant. Mediation analysis revealed that linkage to care contributed to SBP change. CONCLUSIONS A strategy combining tailored behavioral communication and mobile health (mHealth) for community health workers led to improved linkage to care, but not statistically significant improvement in SBP reduction. Further innovations to improve hypertension control are needed. (Optimizing Linkage and Retention to Hypertension Care in Rural Kenya [LARK]; NCT01844596) (C) 2019 by the American College of Cardiology Foundation.

【 授权许可】

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