Abstract:
In sub-Saharan Africa (SSA), cardiovascular disease (CVD) is the leading cause of death among
individuals over the age of 30. Hypertension, a major risk factor for CVD, contributes
significantly to the CVD burden in SSA. In order to address the human resource challenge of
managing hypertension in low- and middle-income countries (LMICs), task-shifting hypertension
care from physicians to nurses has been proposed. To support this task-shifting strategy, the
Academic Partnership Providing Access to Healthcare (AMPATH) has developed an Android
tablet-based electronic Decision Support and Integrated Record-Keeping (DESIRE) tool to record
patient data and assist with clinical decision-making. We investigated the usability of the DESIRE
tool in the setting of nurse management of hypertension in rural western Kenya through the use of
“mock patient” encounters and “think aloud” exercises. Fiftyseven critical incidents were
identified and twenty-three design changes were suggested. Optimization of the tool has the
potential to broadly impact treatment of non-communicable diseases in LMICs by providing a
model of electronic decision-support in task shifting.