Duffy Sean, Valley Taryn McGinn, Chavez Alejandro, Aguilar Valerie, Villalobos Juan Aguirre, Tetreault Kaitlin, Chen Guanhua, White Elizabeth, Bermudez-Cañete Alvaro, Dang Do, Cornfield Julie, Letona Yoselin, Tun Rafael
University of Wisconsin-Madison School of Medicine and Public Health Madison, Wisconsin, US.
Department of Anthropology, University of Wisconsin-Madison, Madison, WI, US.
Glob Heart. 2025 Apr 17;20(1):39. doi: 10.5334/gh.1423. eCollection 2025.
Hypertension is a leading global cause of morbidity and mortality and is increasing in low- and middle-income countries, where unawareness of hypertension is a primary obstacle to management. Community health workers (CHWs) in combination with mobile health (mHealth) tools are increasingly used in LMIC health systems to strengthen primary care infrastructure. In this study, we applied this care model to hypertension in rural Guatemala by comparing the accuracy of CHWs equipped with an mHealth clinical decision support application in diagnosing hypertension to concurrent physician evaluation.
We performed a prospective diagnostic accuracy study in which adults from rural Guatemalan communities were assessed independently by a CHW aided by a mHealth application and a physician. Assessment included medical history; measurement of blood pressure, height and weight; and determination of hypertension status. CHW-physician agreement on hypertension status and past medical history elements was assessed by Kappa analysis and proportional agreement, with thresholds of Kappa = 0.61 and agreement of 90%. Agreement on patient measurements was evaluated using Bland-Altman and regression analyses.
Of 359 participants enrolled, 47 (13%) were confirmed to have hypertension and another 11 (3%) had possible hypertension. CHW-physician agreement was high for hypertension diagnosis, with Kappa = 0.8 (95% CI = 0.72, 0.88) and overall agreement 92.8% (95% CI = 90.1%, 95.4%). Bland-Altman analysis showed small biases toward lower systolic blood pressure, higher height, and lower BMI measurements by CHWs. Most patient history characteristics showed moderate to almost perfect (Kappa: 0.41-1) agreement between physicians and CHWs.
In this study based in rural Guatemala, CHWs using a mHealth clinical decision support application were found to screen adult patients for hypertension with similar accuracy to a physician. This approach could be adapted to other low-resource settings to reduce the burden of undiagnosed and untreated hypertension.
高血压是全球发病和死亡的主要原因，在低收入和中等收入国家中呈上升趋势，而高血压未被察觉是管理方面的主要障碍。社区卫生工作者（CHW）与移动健康（mHealth）工具相结合，越来越多地用于低收入和中等收入国家的卫生系统，以加强初级保健基础设施。在本研究中，我们通过比较配备mHealth临床决策支持应用程序的社区卫生工作者诊断高血压的准确性与同期医生评估的准确性，将这种护理模式应用于危地马拉农村地区的高血压患者。
我们进行了一项前瞻性诊断准确性研究，其中来自危地马拉农村社区的成年人由一名借助mHealth应用程序的社区卫生工作者和一名医生独立进行评估。评估内容包括病史、血压、身高和体重测量以及高血压状态的确定。通过Kappa分析和比例一致性评估社区卫生工作者与医生在高血压状态和既往病史要素方面的一致性，Kappa阈值为0.61，一致性阈值为90%。使用Bland-Altman分析和回归分析评估患者测量结果的一致性。
在纳入的359名参与者中，47名（13%）被确诊患有高血压，另有11名（3%）可能患有高血压。社区卫生工作者与医生在高血压诊断方面的一致性较高，Kappa值为0.8（95%CI = 0.72, 0.88），总体一致性为92.8%（95%CI = 90.1%, 95.4%）。Bland-Altman分析显示，社区卫生工作者在收缩压测量值较低、身高测量值较高和体重指数测量值较低方面存在较小偏差。大多数患者病史特征显示医生与社区卫生工作者之间的一致性为中等至几乎完美（Kappa：0.41 - 1）。
在这项基于危地马拉农村地区的研究中，发现使用mHealth临床决策支持应用程序的社区卫生工作者筛查成年高血压患者的准确性与医生相似。这种方法可适用于其他资源匮乏地区，以减轻未诊断和未治疗高血压的负担。
