Assessing the Feasibility and Adoption of a Mobile Health Application for Hypertension Management in Community and Primary Health Care Settings in Nepal

Abstract

Background:Hypertension is a growing health challenge in Nepal, contributing significantly to the country’s disease burden. Despite existing public health interventions, many individuals with hypertension remain untreated or poorly managed, particularly in rural areas. Mobile health (mHealth) is increasingly recognized as a promising solution to overcome barriers in hypertension management by providing accessible, scalable, and cost-effective tools. However, its feasibility and effectiveness in the context of Nepal’s primary healthcare system remain largely unexamined.Method:This study aimed to assess the feasibility and adoption of a mHealth intervention for hypertension management in two municipalities in Bagmati Province, Nepal—Panchkhal (urban) and Bethanchok (rural). This study included a physician survey and an implementation study conducted among Female Community Health Volunteers (FCHVs), Frontline Health Workers (FLHWs), community individuals, and health system leaders. The mHealth intervention, adapted from previous studies in China and India, utilized a mobile phone application for blood pressure screening, patient education, and follow-up. We employed a mixed-methods design using the REAIM (Reach, Effectiveness, Adoption, Implementation and Maintenance) framework to evaluate these outcomes. Quantitative data were obtained from a physician survey and the mHealth application backend, while qualitative data were derived from key informant interviews (KIIs) and focus group discussions (FGDs) conducted with stakeholders.Result:While the 25 physicians expressed high acceptance of mHealth for hypertension management, their familiarity with mHealth was limited, particularly in rural settings. In total 42 KIIs and one FGD were conducted in pre-implementation phase, and 30 KIIs and one FGD in post implementation phase. A high adoption rate of the intervention was observed among FCHVs and FLHWs, with 90% of FCHVs (27 out of 30) and 100% of FLHWs (n=21) adopting the intervention for screening and follow-up. The FCHVs referred 176 participants to FLHWs. 179 patients with hypertension were identified among 294 community individuals, with 129 diagnosed cases and 50 new cases. The intervention showed promising effectiveness in implementing the intervention for hypertension management, with significant screening yield, referral rate and positive feedback from both healthcare providers and patients. Barriers identified included limited infrastructure, unstable network connectivity, and inadequate availability of hypertension medications.Conclusion:This study demonstrates that mHealth is a feasible and well-adopted tool for hypertension management in both rural and urban settings in Nepal. The intervention has shown strong adoption by community health workers, including FCHVs, leading to effective hypertension screening and patient management. Future research should focus on improving digital health infrastructure and integrating mHealth into broader health systems to enhance hypertension care in resource-limited settings.