Community health workers improve linkage to hypertension care in western Kenya

Abstract

BACKGROUNDElevated blood pressure (BP) is the leading global risk factor for mortality. Delay in seekinghypertension care is associated with increased mortality.OBJECTIVESThis study investigated whether community health workers, equipped with behavioral communicationstrategies and smartphone technology, can increase linkage of individuals with elevated BP to a hypertension careprogram in western Kenya and significantly reduce BP.METHODSThe 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 multipleimputation were used to handle missing data.RESULTSA 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 for1,106 (76%). Linkage to care was 49% overall, with significantly greater linkage in the usual care and smartphone arms ofthe trial. Average overall follow-up SBP was 149.9 mm Hg. Participants in the smartphone arm experienced a modestlygreater reduction in SBP versus usual care ( 13.1 mm Hg vs. 9.7 mm Hg), but this difference was not statisticallysignificant. Mediation analysis revealed that linkage to care contributed to SBP change.CONCLUSIONSA strategy combining tailored behavioral communication and mobile health (mHealth) for communityhealth 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 HypertensionCare in Rural Kenya [LARK];NCT01844596) (J Am Coll Cardiol 2019;74:1897–906) © 2019 by the American College ofCardiology Foundation.