JMIR Publications

ABSTRACT

Background:

Hypertension is a major modifiable risk factor for the world’s leading cause of death cardiovascular disease. The prevalence of hypertension is disproportionately high in South Asian countries than other regions of the world. Inadequate screening for hypertension in primary care settings remains a challenge in many South Asian countries included Nepal. Nepal is mainly located in the Himalayas mountain region, posing significant geographical challenges for its rural citizens in access to primary healthcare and service delivery. This barrier increases costs and inconvenience for rural Nepalis to hypertension screening and treatment. As a result, the prevalence of hypertension in Nepal tripled in the last 25 years to 22.4% - 38.6%. Nepal’s Ministry of Health and Population relies on FCHVs to link health centers and communities to provide basic health services. Over 50,000 FCHVs in Nepal have received basic healthcare training and are assigned to take care of maternal and child health. Due to limited healthcare resources, adopting new methods to control hypertension is an urgent need in Nepal. Several recent studies in Nepal have recommended extending the roles of female community health volunteers (FCHVs) to include hypertension management through blood pressure monitoring and home-based education.

Objective:

To assess if a mobile health-based FCHV approach of combining the traditional FCHV program with digital technologies will be feasible and acceptable in rural Nepal.

Methods:

In this study, we recruited 17 FCHVs and extended their role from maternal and child health to hypertension management through screening blood pressures.

Results:

All 17 FCHVs successfully measured 1,113 rural Nepalis’ blood pressures, identified 169 hypertensive patients, and collected health behaviors data of the 169 hypertensive patients. Among the 169 patients, 73% of them had a mobile phone, and 93% were interested in receiving health-related information via a mobile phone. Among those who were interested in receiving information via a mobile phone, 91% preferred voice call, and 8% and 1% preferred short messaging service and apps, respectively.

Conclusions:

Results from this study indicate that a digital health intervention that leverages feature-phones combined with FCHVs may be an acceptable and pragmatic way to implement an evidence-based program to reduce hypertension in rural Nepal.