Evidence brief: Patient perceptions and preferences during a community-based telehealth care model for moderate-to-severe hypertension in rural communities in Kenya and Uganda

Abstract

Hypertension is a growing health concern in sub-Saharan Africa, yet access to care can be challenging, especially in rural areas. Overcoming barriers to hypertension care remains a priority. Pairing community health worker (CHW) and telehealth modalities offers one way to extend the reach of hypertension care without overburdening patients or healthcare systems in rural areas.

This qualitative study was nested within the SEARCH Sapphire pilot randomised controlled trial testing hypertension treatment through CHW-facilitated, clinician-driven telehealth (intervention) compared to clinic-based care (control) for adults aged ≥40 years with moderate-severe hypertension in rural western Kenya and southwestern Uganda. We conducted audio-recorded, in-depth, semi-structured interviews with purposively selected healthcare providers (clinicians and CHWs; N = 15) and participants (N = 40) between January-April 2023 to explore hypertension diagnosis and linkage to care; experiences with community hypertension care; family and work contexts; and the integration of telehealth into clinic and CHW workflows.

Overall, participants felt satisfied with community-delivered telehealth care for hypertension. Participants noted community-based care saved on transport costs and reached those who were unwell or who lived far from clinic. Intervention arm participants felt CHWs were suitable for routine hypertension care, worked closely with clinicians, and could increase health literacy within the community. Participants desired a model with clear communication and involvement of the facility-based clinician, CHW, and participant. Providers found telehealth to be of similar quality to clinic-based care for routine hypertension treatment, though noted that clinic-based care is at times needed for more comprehensive clinical evaluation or to provide additional healthcare services.

Participants and providers indicated overall positive attitudes and receptivity to CHW-facilitated telehealth for hypertension care. CHW-delivered telehealth for community-based hypertension care offers one way to improve hypertension treatment outcomes in a manner that prioritizes patient-centeredness and maintains care quality.

NCT04810650 Registered on 2021-03-18.

Background

In an era of simultaneous health system strengthening and funding constraints, new ways to extend the efficiency and reach of clinical care for chronic diseases without compromising quality of care are paramount. One such chronic disease is hypertension (HTN). HTN is highly prevalent in southern, central, and eastern Africa, with a growing burden in rural areas [1,2]. Treatment for HTN in this region is low, despite being a leading contributor to chronic kidney disease and cardiovascular disease (CVD) associated deaths [3,4]. Only about a quarter of the population with HTN know their diagnosis, and as few as 16% of people have achieved HTN control [1,5]. Population-level screening and linkage to clinic-based treatment can improve outcomes, though benefits are limited by challenges retaining patients in clinic-based care due to congested clinics, long travel times, and opportunity costs of frequent clinic appointments [6–8]. In low- and middle-income countries, the use of community health workers (CHWs) and telehealth visits to broadly screen for and monitor chronic conditions shows promise as two such means [9,10]. Telehealth integration may potentiate CHW-delivered community-based HTN care.