Community Health Workers Equipped with an mHealth Application Can Accurately Diagnose Hypertension in Rural Guatemala
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 increasing...
Saved in:
| Main Authors: | , , , , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Ubiquity Press
2025-04-01
|
| Series: | Global Heart |
| Subjects: | |
| Online Access: | https://account.globalheartjournal.com/index.php/up-j-gh/article/view/1423 |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1849326920360001536 |
|---|---|
| author | 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 |
| author_facet | 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 |
| author_sort | Sean Duffy |
| collection | DOAJ |
| description | 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. |
| format | Article |
| id | doaj-art-349161d6b9da4b5e8b05f2315c007dbc |
| institution | Kabale University |
| issn | 2211-8179 |
| language | English |
| publishDate | 2025-04-01 |
| publisher | Ubiquity Press |
| record_format | Article |
| series | Global Heart |
| spelling | doaj-art-349161d6b9da4b5e8b05f2315c007dbc2025-08-20T03:48:02ZengUbiquity PressGlobal Heart2211-81792025-04-01201393910.5334/gh.14231404Community Health Workers Equipped with an mHealth Application Can Accurately Diagnose Hypertension in Rural GuatemalaSean Duffy0https://orcid.org/0000-0002-1993-7835Taryn McGinn Valley1https://orcid.org/0000-0003-2866-9518Alejandro Chavez2Valerie Aguilar3Juan Aguirre Villalobos4Kaitlin Tetreault5https://orcid.org/0000-0003-3370-359XGuanhua Chen6https://orcid.org/0000-0002-9314-2037Elizabeth White7Alvaro Bermudez-Cañete8https://orcid.org/0009-0007-5122-2016Do Dang9https://orcid.org/0009-0006-7275-3134Julie Cornfield10https://orcid.org/0000-0003-0318-9614Yoselin Letona11Rafael Tun12University of Wisconsin-Madison School of Medicine and Public Health Madison, WisconsinDepartment of Anthropology, University of Wisconsin-Madison, Madison, WIDepartment of Family Medicine and Community Health, University of Wisconsin School of Medicine and Public Health, Madison, WIDepartment of Family Medicine and Community Health, University of Wisconsin School of Medicine and Public Health, Madison, WIDepartment of Family & Community Medicine, Northwestern University Feinberg School of Medicine, Chicago, ILDepartment and Medical Informatics, University of Wisconsin School of Medicine and Public Health, Madison, WIDepartment of Biostatistics and Medical Informatics, University of Wisconsin School of Medicine and Public Health, Madison, WIOperations Research Group, University of Toronto, Toronto, ONStanford University, StanfordDepartment of Family Medicine, University of Maryland Medical Center, Baltimore, MDDepartment of Foreign Languages, Federal University of Sergipe, SergipeHospital Obras Sociales Monseñor Gregorio Schaffer, San Lucas TolimánHospital Obras Sociales Monseñor Gregorio Schaffer, San Lucas TolimánBackground: 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.https://account.globalheartjournal.com/index.php/up-j-gh/article/view/1423hypertensionguatemalacommunity health workersmhealthtask sharing |
| spellingShingle | 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 Community Health Workers Equipped with an mHealth Application Can Accurately Diagnose Hypertension in Rural Guatemala Global Heart hypertension guatemala community health workers mhealth task sharing |
| title | Community Health Workers Equipped with an mHealth Application Can Accurately Diagnose Hypertension in Rural Guatemala |
| title_full | Community Health Workers Equipped with an mHealth Application Can Accurately Diagnose Hypertension in Rural Guatemala |
| title_fullStr | Community Health Workers Equipped with an mHealth Application Can Accurately Diagnose Hypertension in Rural Guatemala |
| title_full_unstemmed | Community Health Workers Equipped with an mHealth Application Can Accurately Diagnose Hypertension in Rural Guatemala |
| title_short | Community Health Workers Equipped with an mHealth Application Can Accurately Diagnose Hypertension in Rural Guatemala |
| title_sort | community health workers equipped with an mhealth application can accurately diagnose hypertension in rural guatemala |
| topic | hypertension guatemala community health workers mhealth task sharing |
| url | https://account.globalheartjournal.com/index.php/up-j-gh/article/view/1423 |
| work_keys_str_mv | AT seanduffy communityhealthworkersequippedwithanmhealthapplicationcanaccuratelydiagnosehypertensioninruralguatemala AT tarynmcginnvalley communityhealthworkersequippedwithanmhealthapplicationcanaccuratelydiagnosehypertensioninruralguatemala AT alejandrochavez communityhealthworkersequippedwithanmhealthapplicationcanaccuratelydiagnosehypertensioninruralguatemala AT valerieaguilar communityhealthworkersequippedwithanmhealthapplicationcanaccuratelydiagnosehypertensioninruralguatemala AT juanaguirrevillalobos communityhealthworkersequippedwithanmhealthapplicationcanaccuratelydiagnosehypertensioninruralguatemala AT kaitlintetreault communityhealthworkersequippedwithanmhealthapplicationcanaccuratelydiagnosehypertensioninruralguatemala AT guanhuachen communityhealthworkersequippedwithanmhealthapplicationcanaccuratelydiagnosehypertensioninruralguatemala AT elizabethwhite communityhealthworkersequippedwithanmhealthapplicationcanaccuratelydiagnosehypertensioninruralguatemala AT alvarobermudezcanete communityhealthworkersequippedwithanmhealthapplicationcanaccuratelydiagnosehypertensioninruralguatemala AT dodang communityhealthworkersequippedwithanmhealthapplicationcanaccuratelydiagnosehypertensioninruralguatemala AT juliecornfield communityhealthworkersequippedwithanmhealthapplicationcanaccuratelydiagnosehypertensioninruralguatemala AT yoselinletona communityhealthworkersequippedwithanmhealthapplicationcanaccuratelydiagnosehypertensioninruralguatemala AT rafaeltun communityhealthworkersequippedwithanmhealthapplicationcanaccuratelydiagnosehypertensioninruralguatemala |