Abstract 12657: Perceptions of the Role of Community Health Workers in Hypertension Management: A Qualitative Analysis of the LARK Hypertension Study

Abstract

Background: Hypertension, a major risk factor for cardiovascular disease, is the leading risk factor for global mortality. Increasing access to hypertension care is critically important to reducing the burden of global cardiovascular disease. The use of community health workers (CHWs) to increase access to care represents a potential strategy to improve hypertension treatment and control; however, it is not known how rural communities in low- and middle-income countries perceive the use of CHWs for this purpose. Our study therefore aims to examine community perceptions of CHWs in hypertension management. Methods: Traditional community gatherings and focus group discussions (20 sessions, 411 participants) were organized in rural western Kenya. Discussion topics included chronic diseases, factors related to linkage to care, and the role of CHWs in hypertension management. We performed inductive content analysis of transcripts from these sessions using NVivo 10 software. Coded items were grouped together into distinct themes, and relationships among these themes were formulated. Results: Six themes emerged from our analysis, each with implications regarding CHWs’ role in linkage and retention to hypertension care (Table). These themes included (1) CHWs’ intimate knowledge of the community; (2) CHWs’ role in providing health education; (3) CHWs’ role in facilitating logistical support to enable community members to access care; (4) the importance of psychosocial support that CHWs can provide; (5) the need for ‘professionalization’ of the CHW workforce; and (6) negative perceptions towards CHWs. Conclusions: Our themes are consistent with findings in the literature regarding the work that CHWs traditionally perform for communicable diseases and maternal/child health. Use of CHWs for hypertension management, leveraging the prior experience of other CHW programs, may be an effective strategy to reduce the burden of hypertension in low-resource settings.