Primary research aim
The objective of this project is to utilize a multi-disciplinary implementation research approach to address the challenge of linking and retaining hypertensive individuals to a hypertension management program.
Research objectives and methodology
Identify the facilitators and barriers to linking and retaining individuals with high blood pressure to a hypertension care delivery program, using a combination of qualitative research methods:
- Using identified facilitators and barriers, develop a tailored behavioral communication strategy guided by the Health Belief Model.
- Using identified facilitators and barriers, develop a smartphone-based tool linked to the AMPATH Medical Record System (AMRS) to be used by CHWs to optimize linkage and retention of hypertensive patients to the care program, and evaluate the usability and feasibility of this tool.
- Evaluate the effectiveness of CHWs equipped with a tailored behavioral communication strategy and a smartphone-based tool in improving linkage and reducing blood pressure among hypertensive patients, by conducting a cluster randomized trial comparing:
- Usual care (CHWs with standard training on recruitment of individuals with any chronic condition).
- CHWs with an additional tailored behavioral communication strategy.
- CHWs with a tailored behavioral communication strategy and also equipped with smartphone-based tool linked to the AMRS.
- Evaluate the incremental cost-effectiveness of each intervention arm of the cluster randomized trial. The co-primary outcome measures will be:
- Documented linkage to care following home-based testing.
- One year change in systolic blood pressure among hypertensive individuals.
Aim 1: Barriers and Facilitators to Linkage and Retention
- All research related activities are complete
- Manuscript published in the Journal of General Internal Medicine in 2016
Aim 1.1: Behavioral Assessment and Communication Strategy
- Content validity complete
- Manuscript is in preparation
Aim 1.2: Smartphone-based Tool
- Study databases/servers (Virtual Machine, AMRS & Redcap) launched
- Field implementation of smartphone-based tool underway
- Enrollment complete
- 12-month follow-up visits ongoing
- Process evaluation complete
- CHW and CHEW training complete
- Data Management ongoing
Aim 2: Cluster RCT
Aim 3: Cost-effectiveness analysis
- Administration of Costing Questionnaire at 12-month follow-up ongoing
- Cost-tracking for intervention delivery ongoing
Icahn School of Medicine at Mount Sinai, New York, USA:
- Valentin Fuster
- Rajesh Vedanthan
Moi Teaching and Referral Hospital, Eldorey, Kenya:
- Jemima Kamano
- Sylvester Kimaiyo
- Naanyu V, Vedanthan R, Kamano JH, Rotich J, Lagat K, Kiptoo P, Kofler C, Mutai K, Menya D, Kimaiyo S, Fuster V, Horowitz C, Inui T. Barriers Influencing Linkage to Hypertension Care in Kenya: Qualitative Analysis from the LARK Hypertension Study. Journal of General Internal Medicine. 2016;31(3):304-14. doi: 10.1007/s11606-015-3566-1.
- Vedanthan R, Kamano JH, Naanyu V, Delong AK, Were MC, Finkelstein EA et al. Optimizing linkage and retention to hypertension care in rural Kenya (LARK hypertension study): study protocol for a randomized controlled trial. Trials. 2014;15(1):143. doi:10.1186/1745-6215-15-143.
- Blank E, Tuikong N, Misoi L, Kamano J, Hutchinson C, Kimaiyo S et al. Usability of implementing a tablet-based decision support and integrated record- keeping (DESIRE) tool in the nurse management of hypertension in rural Kenya. Stud Health Technol Inform. 2013;192:1002.