Abstract:
To evaluate the impact of clinician-targeted mHealth-generated care
suggestions on compliance with hypertension care guidelines in a resource-limited
setting. This study was conducted in 10 rural health clinics in Western Kenya that
offered hypertension care through nurses and clinical officers. Sites were grouped
into intervention and control groups. Intervention group clinicians had patientspecific
care suggestions triggered and displayed on a mobile application, mUzima,
for their action. Care suggestions were also triggered in the mHealth application for
control arm clinicians but were not displayed. Differences in compliance with
hypertension care guidelines were evaluated. The study involved 378 patients with
hypertension who had care suggestions generated during visits (217 in intervention
group and 161 in control group). There was a higher proportion of adherence to
hypertension care guidelines in the intervention group compared to the control group
(91.1% vs. 85.7%, p=0.014). The random effects model showed significant
variability in compliance rates among study clinicians (variance of 0.44, 95% CI:
0.12 -1.62). When displayed care suggestions were rejected by intervention
providers, the most common reason given was ‘Previously ordered’ (58.8%).
Clinicians felt that care suggestions improved awareness of hypertension care
guidelines. The successful scaled implementation of mUzima with patient specific
care suggestions led to higher adherence to hypertension care guidelines and
improved quality of hypertension care. Tailormade m-Health applications in
resource constrained settings for hypertension care and other chronic noncommunicable
diseases has the potential to lead to better adherence to care
guidelines and quality of care.
