New York University School of Medicine, New York, New York.
Moi University College of Health Sciences, Eldoret, Kenya.
J Am Coll Cardiol. 2019 Oct 15;74(15):1897-1906. doi: 10.1016/j.jacc.2019.08.003. Epub 2019 Sep 2.
Elevated blood pressure (BP) is the leading global risk factor for mortality. Delay in seeking hypertension care is associated with increased mortality.
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.
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.
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.
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).
高血压是全球导致死亡的首要风险因素。高血压患者延迟寻求治疗与死亡率增加有关。
本研究旨在调查配备行为沟通策略和智能手机技术的社区卫生工作者是否可以增加肯尼亚西部血压升高者与高血压治疗方案的联系，并显著降低血压。
这是一项 3 臂的群组随机试验：1）常规护理（标准培训）；2）“基于纸张”（使用基于纸张的工具进行量身定制的行为沟通）；3）“智能手机”（使用智能手机技术进行量身定制的行为沟通）。主要转归指标为：1）纳入治疗；2）收缩压（SBP）变化。采用协变量调整的混合效应模型，根据随访时间的差异进行调整。采用自举法和多重插补处理缺失数据。
共纳入 1460 名参与者（58%为女性）（491 名常规护理、500 名基于纸张、469 名智能手机）。平均基线 SBP 为 159.4mmHg。可获得 1128 名（77%）参与者的纳入治疗的随访测量值和 1106 名（76%）参与者的血压测量值。总体纳入治疗率为 49%，常规护理和智能手机组的纳入治疗率显著更高。平均总体随访 SBP 为 149.9mmHg。智能手机组参与者的 SBP 下降幅度略高于常规护理组（-13.1mmHg 与-9.7mmHg），但差异无统计学意义。中介分析显示，纳入治疗与 SBP 变化有关。
结合社区卫生工作者的量身定制行为沟通和移动医疗（mHealth）策略可提高纳入治疗率，但不能显著改善 SBP 降低。需要进一步创新以改善高血压控制。（肯尼亚农村优化高血压治疗的纳入和保留试验[LARK]；NCT01844596）。
