Feasibility study of a novel mHealth clinical decision support application to enable Community Health Workers to manage hypertension in rural Guatemala.

BACKGROUND

Hypertension is a leading global cause of morbidity and mortality, especially in low- and middle-income countries (LMICs), where low health service access limits diagnosis and treatment. Community health workers (CHWs) supported by mobile health (mHealth) clinical decision support (CDS) tools may help. This study evaluated the feasibility of CHW-led hypertension management using an mHealth CDS application in rural Guatemala.

METHODS

We conducted a six-month, single-group feasibility study in rural San Lucas Tolimán, Guatemala. Trained CHWs used a CommCare-based CDS application wherein algorithms based on WHO HEARTS guided medication titration, lifestyle counseling, and physician consultation. Adults (≥18 years) with diagnosed hypertension were followed monthly for six months. The primary feasibility outcome was prescribing agreement between CHWs and supervising physicians with application antihypertensive recommendations (minimum acceptable agreement = 90%). Primary clinical outcomes were changes in systolic (SBP) and diastolic (DBP) blood pressure. Secondary outcomes included retention, visit completion, patient satisfaction, and safety.

RESULTS

Thirty-two participants were enrolled (84% female); 30 (93.8%) completed six-month follow-up, with 96.4% of possible visits completed. Overall CHW-physician agreement with application recommendations was 96.7%, increasing to 98.9% over the final three months. Median SBP decreased 7.5 mmHg (95% CI 1.0-12.0) and mean DBP 3.1 mmHg (95% CI 0.1-6.1). The proportion of patients with controlled SBP (<140 mmHg) increased from 66.7% to 76.7% (p = 0.505). Eleven application errors (5% of 217 visits) occurred early and were corrected. There were no adverse events requiring hospitalization. Patient satisfaction remained high.

CONCLUSIONS

In this pilot, CHWs supported by an mHealth CDS application safely and effectively managed hypertension with high physician agreement, patient retention, and blood pressure improvement. These findings demonstrate the feasibility of CHW task-sharing hypertension management in low-resource settings and support evaluation of this approach in larger trials.