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Community Health Workers Improve Linkage to Hypertension Care in Western Kenya.

Publication ,  Journal Article
Vedanthan, R; Kamano, JH; DeLong, AK; Naanyu, V; Binanay, CA; Bloomfield, GS; Chrysanthopoulou, SA; Finkelstein, EA; Hogan, JW; Horowitz, CR ...
Published in: J Am Coll Cardiol
October 15, 2019

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).

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Published In

J Am Coll Cardiol

DOI

EISSN

1558-3597

Publication Date

October 15, 2019

Volume

74

Issue

15

Start / End Page

1897 / 1906

Location

United States

Related Subject Headings

  • Telemedicine
  • Systole
  • Smartphone
  • Risk Factors
  • Middle Aged
  • Medication Adherence
  • Male
  • Kenya
  • Hypertension
  • Humans
 

Citation

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Vedanthan, R., Kamano, J. H., DeLong, A. K., Naanyu, V., Binanay, C. A., Bloomfield, G. S., … Fuster, V. (2019). Community Health Workers Improve Linkage to Hypertension Care in Western Kenya. J Am Coll Cardiol, 74(15), 1897–1906. https://doi.org/10.1016/j.jacc.2019.08.003
Vedanthan, Rajesh, Jemima H. Kamano, Allison K. DeLong, Violet Naanyu, Cynthia A. Binanay, Gerald S. Bloomfield, Stavroula A. Chrysanthopoulou, et al. “Community Health Workers Improve Linkage to Hypertension Care in Western Kenya.J Am Coll Cardiol 74, no. 15 (October 15, 2019): 1897–1906. https://doi.org/10.1016/j.jacc.2019.08.003.
Vedanthan R, Kamano JH, DeLong AK, Naanyu V, Binanay CA, Bloomfield GS, et al. Community Health Workers Improve Linkage to Hypertension Care in Western Kenya. J Am Coll Cardiol. 2019 Oct 15;74(15):1897–906.
Vedanthan, Rajesh, et al. “Community Health Workers Improve Linkage to Hypertension Care in Western Kenya.J Am Coll Cardiol, vol. 74, no. 15, Oct. 2019, pp. 1897–906. Pubmed, doi:10.1016/j.jacc.2019.08.003.
Vedanthan R, Kamano JH, DeLong AK, Naanyu V, Binanay CA, Bloomfield GS, Chrysanthopoulou SA, Finkelstein EA, Hogan JW, Horowitz CR, Inui TS, Menya D, Orango V, Velazquez EJ, Were MC, Kimaiyo S, Fuster V. Community Health Workers Improve Linkage to Hypertension Care in Western Kenya. J Am Coll Cardiol. 2019 Oct 15;74(15):1897–1906.
Journal cover image

Published In

J Am Coll Cardiol

DOI

EISSN

1558-3597

Publication Date

October 15, 2019

Volume

74

Issue

15

Start / End Page

1897 / 1906

Location

United States

Related Subject Headings

  • Telemedicine
  • Systole
  • Smartphone
  • Risk Factors
  • Middle Aged
  • Medication Adherence
  • Male
  • Kenya
  • Hypertension
  • Humans