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Randomized Controlled Trial
. 2019 Oct 15;74(15):1897-1906.
doi: 10.1016/j.jacc.2019.08.003. Epub 2019 Sep 2.

Community Health Workers Improve Linkage to Hypertension Care in Western Kenya

Rajesh Vedanthan  1 , Jemima H Kamano  2 , Allison K DeLong  3 , Violet Naanyu  2 , Cynthia A Binanay  4 , Gerald S Bloomfield  4 , Stavroula A Chrysanthopoulou  3 , Eric A Finkelstein  4 , Joseph W Hogan  3 , Carol R Horowitz  5 , Thomas S Inui  6 , Diana Menya  2 , Vitalis Orango  7 , Eric J Velazquez  8 , Martin C Were  9 , Sylvester Kimaiyo  2 , Valentin Fuster  5
Affiliations
Randomized Controlled Trial

Community Health Workers Improve Linkage to Hypertension Care in Western Kenya

Rajesh Vedanthan et al. J Am Coll Cardiol. .

Abstract

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).

Keywords: Kenya; community health workers; hypertension; linkage to care; smartphone technology; tailored behavioral communication.

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Figures

Figure 1.
Figure 1.. LARK linkage flow diagram.
Figure illustrates the different categories of linkage to hypertension care for participants in the study.
Central Illustration.
Central Illustration.. LARK participant Flow and Systolic Blood Pressure Outcomes.
The figure illustrates both participant flow through enrollment and follow-up, as well as the fully adjusted SBP outcomes analysis including mediation. Vertical bars indicate 95% confidence intervals (Table 3). SBP = systolic blood pressure
See this image and copyright information in PMC

Comment in

  • Finding Hay in the Haystack.
    Rader F, Blyler CA. Rader F, et al. J Am Coll Cardiol. 2019 Oct 15;74(15):1907-1909. doi: 10.1016/j.jacc.2019.08.1001. J Am Coll Cardiol. 2019. PMID: 31601370 No abstract available.

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