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

BACKGROUND: Elevated blood pressure (BP) is the leading global risk factor for mortality. Delay seeking hypertension care is associated with increased mortality.

OBJECTIVE: We 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: We conducted a cluster randomized trial with three 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: 1460 individuals (58% women) were enrolled (491 usual care, 500 paper-based, 469 smartphone). Average baseline SBP was 159.4 mmHg. Follow-up measures of linkage were available for 1128 (77%) and BP for 1106 (76%). Linkage to care was 49% overall, with significantly greater linkage in the usual care and smartphone arms. Average overall follow-up SBP was 149.9 mmHg. Participants in the smartphone arm experienced a modestly greater reduction in SBP vs. usual care (-13.1 mmHg vs. -9.7), 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 mHealth for CHWs led to improved linkage to care, but not statistically significant improvement in SBP reduction. Further innovations to improve hypertension control are needed.