Vedanthan Rajesh, Kamano Jemima H, Naanyu Violet, Delong Allison K, Were Martin C, Finkelstein Eric A, Menya Diana, Akwanalo Constantine O, Bloomfield Gerald S, Binanay Cynthia A, Velazquez Eric J, Hogan Joseph W, Horowitz Carol R, Inui Thomas S, Kimaiyo Sylvester, Fuster Valentin
Icahn School of Medicine at Mount Sinai, One Gustave L, Levy Place, Box 1030, 10029 New York, USA.
Trials. 2014 Apr 27;15:143. doi: 10.1186/1745-6215-15-143.
Hypertension is the leading global risk factor for mortality. Hypertension treatment and control rates are low worldwide, and delays in seeking care are associated with increased mortality. Thus, a critical component of hypertension management is to optimize linkage and retention to care.
METHODS/DESIGN: This study investigates whether community health workers, equipped with a tailored behavioral communication strategy and smartphone technology, can increase linkage and retention of hypertensive individuals to a hypertension care program and significantly reduce blood pressure among them. The study will be conducted in the Kosirai and Turbo Divisions of western Kenya. An initial phase of qualitative inquiry will assess facilitators and barriers of linkage and retention to care using a modified Health Belief Model as a conceptual framework. Subsequently, we will conduct a cluster randomized controlled trial with three arms: 1) usual care (community health workers with the standard level of hypertension care training); 2) community health workers with an additional tailored behavioral communication strategy; and 3) community health workers with a tailored behavioral communication strategy who are also equipped with smartphone technology. The co-primary outcome measures are: 1) linkage to hypertension care, and 2) one-year change in systolic blood pressure among hypertensive individuals. Cost-effectiveness analysis will be conducted in terms of costs per unit decrease in blood pressure and costs per disability-adjusted life year gained.
This study will provide evidence regarding the effectiveness and cost-effectiveness of strategies to optimize linkage and retention to hypertension care that can be applicable to non-communicable disease management in low- and middle-income countries.
This trial is registered with (NCT01844596) on 30 April 2013.
高血压是全球死亡的主要风险因素。全球范围内高血压的治疗和控制率较低，就医延迟与死亡率增加相关。因此，高血压管理的一个关键组成部分是优化与医疗服务的联系及持续参与度。
方法/设计：本研究调查配备了量身定制的行为沟通策略和智能手机技术的社区卫生工作者是否能够提高高血压患者与高血压护理项目的联系及持续参与度，并显著降低他们的血压。该研究将在肯尼亚西部的科西拉伊和图尔博分区进行。定性探究的初始阶段将使用改良的健康信念模型作为概念框架，评估与医疗服务联系及持续参与度的促进因素和障碍。随后，我们将进行一项有三个组别的整群随机对照试验：1）常规护理（接受标准水平高血压护理培训的社区卫生工作者）；2）配备额外量身定制行为沟通策略的社区卫生工作者；3）配备量身定制行为沟通策略且还配备智能手机技术的社区卫生工作者。共同主要结局指标为：1）与高血压护理的联系；2）高血压患者收缩压的一年变化。将根据每单位血压降低的成本和每获得一个伤残调整生命年的成本进行成本效益分析。
本研究将提供有关优化高血压护理联系及持续参与度策略的有效性和成本效益的证据，这些证据可应用于低收入和中等收入国家的非传染性疾病管理。
本试验于2013年4月30日在（NCT01844596）注册。
