Community Health Workers Equipped with an mHealth Application Can Accurately Diagnose Hypertension in Rural Guatemala.

IF 3 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Global Heart Pub Date : 2025-04-17 eCollection Date: 2025-01-01 DOI:10.5334/gh.1423

Sean Duffy, Taryn McGinn Valley, Alejandro Chavez, Valerie Aguilar, Juan Aguirre Villalobos, Kaitlin Tetreault, Guanhua Chen, Elizabeth White, Alvaro Bermudez-Cañete, Do Dang, Julie Cornfield, Yoselin Letona, Rafael Tun

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引用次数: 0

Abstract

Background: 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.

Methods: 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 a priori thresholds of Kappa = 0.61 and agreement of 90%. Agreement on patient measurements was evaluated using Bland-Altman and regression analyses.

Results: 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.

Conclusions: 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.

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配备移动医疗应用程序的社区卫生工作者可以准确诊断危地马拉农村的高血压。

背景：高血压是全球发病率和死亡率的主要原因，并且在低收入和中等收入国家正在增加，在这些国家，对高血压的不了解是管理的主要障碍。社区卫生工作者（chw）与移动卫生（mHealth）工具相结合，越来越多地用于低收入和中等收入国家卫生系统，以加强初级保健基础设施。在这项研究中，我们将这种护理模式应用于危地马拉农村的高血压，通过比较配备了移动健康临床决策支持应用程序的CHWs在诊断高血压方面的准确性与同期医生评估。方法：我们进行了一项前瞻性诊断准确性研究，来自危地马拉农村社区的成年人由CHW在移动健康应用程序和医生的帮助下独立评估。评估包括病史；测量血压、身高、体重；以及高血压状态的测定。通过Kappa分析和比例一致性评估chw -医师对高血压状况和既往病史要素的一致性，先验阈值Kappa = 0.61，一致性为90%。采用Bland-Altman和回归分析评估患者测量结果的一致性。结果：在359名参与者中，47名（13%）被确认患有高血压，另外11名（3%）有可能患有高血压。chw医师对高血压诊断的一致性很高，Kappa = 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，chw的收缩压较低，身高较高，BMI较低。大多数患者的病史特征在医生和chw之间表现出中度至近乎完美的一致性（Kappa: 0.41-1）。结论：在这项以危地马拉农村为基础的研究中，卫生员使用移动健康临床决策支持应用程序筛查成年高血压患者，其准确性与医生相似。这种方法可以适用于其他低资源环境，以减轻未确诊和未经治疗的高血压的负担。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Global Heart Medicine-Cardiology and Cardiovascular Medicine

CiteScore

5.70

自引率

5.40%

发文量

审稿时长

5 weeks

期刊介绍： Global Heart offers a forum for dialogue and education on research, developments, trends, solutions and public health programs related to the prevention and control of cardiovascular diseases (CVDs) worldwide, with a special focus on low- and middle-income countries (LMICs). Manuscripts should address not only the extent or epidemiology of the problem, but also describe interventions to effectively control and prevent CVDs and the underlying factors. The emphasis should be on approaches applicable in settings with limited resources. Economic evaluations of successful interventions are particularly welcome. We will also consider negative findings if important. While reports of hospital or clinic-based treatments are not excluded, particularly if they have broad implications for cost-effective disease control or prevention, we give priority to papers addressing community-based activities. We encourage submissions on cardiovascular surveillance and health policies, professional education, ethical issues and technological innovations related to prevention. Global Heart is particularly interested in publishing data from updated national or regional demographic health surveys, World Health Organization or Global Burden of Disease data, large clinical disease databases or registries. Systematic reviews or meta-analyses on globally relevant topics are welcome. We will also consider clinical research that has special relevance to LMICs, e.g. using validated instruments to assess health-related quality-of-life in patients from LMICs, innovative diagnostic-therapeutic applications, real-world effectiveness clinical trials, research methods (innovative methodologic papers, with emphasis on low-cost research methods or novel application of methods in low resource settings), and papers pertaining to cardiovascular health promotion and policy (quantitative evaluation of health programs.