Optimizing linkage and retention to hypertension care in rural Kenya (LARK hypertension study): study protocol for a randomized controlled trial.
Abstract
BACKGROUND: 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. DISCUSSION: 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. TRIAL REGISTRATION: This trial is registered with (NCT01844596) on 30 April
2013.
Type
Journal articleSubject
African Continental Ancestry GroupBlood Pressure
Cell Phones
Clinical Protocols
Communication
Community Health Services
Community Health Workers
Cost-Benefit Analysis
Health Behavior
Health Care Costs
Health Knowledge, Attitudes, Practice
Humans
Hypertension
Kenya
Motivational Interviewing
Patient Compliance
Patients
Professional-Patient Relations
Research Design
Rural Health Services
Time Factors
Treatment Outcome
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https://hdl.handle.net/10161/15036Published Version (Please cite this version)
10.1186/1745-6215-15-143Publication Info
Vedanthan, Rajesh; Kamano, Jemima H; Naanyu, Violet; Delong, Allison K; Were, Martin
C; Finkelstein, Eric A; ... Fuster, Valentin (2014). Optimizing linkage and retention to hypertension care in rural Kenya (LARK hypertension
study): study protocol for a randomized controlled trial. Trials, 15. pp. 143. 10.1186/1745-6215-15-143. Retrieved from https://hdl.handle.net/10161/15036.This is constructed from limited available data and may be imprecise. To cite this
article, please review & use the official citation provided by the journal.
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Show full item recordScholars@Duke
Gerald Bloomfield
Associate Professor of Medicine
Eric Andrew Finkelstein
Professor in Population Health Sciences
Eric J. Velazquez
Adjunct Professor in the Department of Medicine
LeadershipEric J. Velazquez, MD, is a Professor of Medicine with tenure at Duke University.
As section chief for Cardiovascular Imaging in the Division of Cardiology and director
of the Cardiac Diagnostic Unit and Echocardiography Laboratories for Duke University
Health System, he coordinates a high-volume enterprise and an outstanding group of
clinician-investigators and clinical staff who make important contributions across
patient care, research and educational
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