Author + information
- Received July 23, 2019
- Revision received August 5, 2019
- Accepted August 5, 2019
- Published online September 2, 2019.
- Rajesh Vedanthan, MD, MPHa,∗ (, )@rvedanthan,
- Jemima H. Kamano, MDb,
- Allison K. DeLong, MSc,
- Violet Naanyu, PhDb,
- Cynthia A. Binanay, MA, BSNd,
- Gerald S. Bloomfield, MD, MPHd,
- Stavroula A. Chrysanthopoulou, PhDc,
- Eric A. Finkelstein, PhDd,
- Joseph W. Hogan, PhDc,
- Carol R. Horowitz, MD, MPHe,
- Thomas S. Inui, ScM, MDf,
- Diana Menya, MD, PhDb,
- Vitalis Orango, BSg,
- Eric J. Velazquez, MDh,
- Martin C. Were, MDi,
- Sylvester Kimaiyo, MDb and
- Valentin Fuster, MD, PhDe
- aNew York University School of Medicine, New York, New York
- bMoi University College of Health Sciences, Eldoret, Kenya
- cSchool of Public Health, Brown University, Providence, Rhode Island
- dDuke University, Durham, North Carolina
- eIcahn School of Medicine at Mount Sinai, New York, New York
- fIndiana University School of Medicine, Indianapolis, Indiana
- gAcademic Model Providing Access to Healthcare, Eldoret, Kenya
- hYale University, New Haven, Connecticut
- iVanderbilt University, Nashville, Tennessee
- ↵∗Address for correspondence:
Dr. Rajesh Vedanthan, New York University School of Medicine, 180 Madison Avenue, 8th Floor, New York, New York 10016.
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)
- community health workers
- linkage to care
- smartphone technology
- tailored behavioral communication
Research reported in this publication was supported by the National Heart, Lung, and Blood Institute of the National Institutes of Health under award number 1U01HL114200. Dr. Hogan has provided statistical consulting for the New England Journal of Medicine. Dr. Velazquez has received research grants from, is on the Advisory Board of, and has provided consulting for Novartis. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. Florian Rader, MD, served as Guest Associate Editor for this paper.
- Received July 23, 2019.
- Revision received August 5, 2019.
- Accepted August 5, 2019.
- 2019 American College of Cardiology Foundation
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