Critical appraisal of a mHealth-assisted community-based cardiovascular disease risk screening program in rural Kenya: an operational research study. (2nd October 2020)

• Record Type: Journal Article
• Authors: Aw, Michael; Ochieng, Benard Omondi; Attambo, Daniel; Opot, Danet; Aw, James; Francis, Stacy; Hawkes, Michael T.
• Is Part Of: Pathogens and global health. Volume 114:Number 7(2020)
• Page Start: 379
• Page End: 387
• Publication Date: 2020-10-02
• Subjects: Cardiovascular diseases -- public Health -- non-communicable diseases -- telemedicine; Communicable diseases -- Periodicals; Public health -- International cooperation -- Periodicals; World health -- Periodicals; 362.1969
• DOI: 10.1080/20477724.2020.1816286
• Languages: English
• ISSNs: 2047-7724

Abstract

ABSTRACT: Community health workers (CHWs) can participate in the cascade of hypertension and diabetes management in low and middle-income countries (LMICs). Their services may be enhanced with mobile health (mHealth) tools. In this operational research study, we describe the AFYACHAT mHealth-assisted cardiovascular health screening program in rural Kenya. In this study, A CHW screened a convenience sample of adults ≥ 40 years old in rural Kenya for cardiovascular disease (CVD) risk using the two-way AFYACHAT mHealth instrument. AFYACHAT analyzes a patient's age, sex, smoking, diabetes and systolic blood pressure and provides a four-tiered 10-year CVD risk score. User acceptability was assessed by an end-of-study interview with the CWH. Automated error logs were analyzed. Patient satisfaction was measured with a six-question satisfaction questionnaire. Screened participants with high CVD risk were followed-up via telephone to explore any actions taken following screening. In 24 months, one CHW screened 1650 participants using AFYACHAT. The 10-year risk of CVD was <10% for 1611 (98%) patients, 10 to <20% for 26 (1.6%), 20 to <30% in 12 (0.7%), and ≥30% for 1 (0.1%). The point prevalence of hypertension and diabetes was 27% and 1.9%, respectively. Seventy-five percent of participants with elevated CVD risk sought further medical care. There was high acceptability, a 15% miscode error rate, and high participant satisfaction with the screening program. Our operational research outlines how AFYACHAT mHealth tool can assist CHW perform rapid CVD screening; this provides a model framework for non-communicable disease screening in LMICs.