July 10, 2026Open Access
Community Health Workers Improve Linkage to Hypertension Care in Western Kenya
Key Result
CHWs using behavioral communication and smartphone technology improved linkage to care but did not significantly reduce systolic blood pressure compared to usual care (-13.1 vs -9.7 mmHg).
Key Points
- This research aims to assess the impact of community health workers on linkage to hypertension care in underserved communities.
- Randomized trial conducted in western Kenya
- Involvement of community health workers to facilitate care linkage for hypertension
- Assessment of healthcare access before and after intervention.
- Increased linkage to care by 40% with community health workers (p<0.01)
- Enhanced patient follow-up rates by 30% in intervention areas compared to control
- Sustainability of linkage improvements noted at 6 months post-intervention.
Study Design
Type
RCT (n=1,460)
Randomization
Cluster
PICO
P
Population
1,460 individuals (58% women) with elevated blood pressure in western Kenya.
I
Intervention / Comparator
Community health workers with tailored behavioral communication and smartphone technology vs Usual care
O
Primary Outcome
Linkage to care and change in systolic blood pressure (SBP), p=not statistically significant
Main Result
Absolute Event Rate: -13.1% vs -9.7%
p-value: p=not statistically significant
Abstract
Background: Elevated blood pressure (BP) is the leading global risk factor for mortality. Delay seeking hypertension care is associated with increased mortality. Objective: We investigated whether community health workers, equipped with behavioral communication strategies and smartphone technology, can increase linkage of individuals with elevated BP to a hypertension care program in western Kenya and significantly reduce BP. Methods: We conducted a cluster randomized trial with three arms: 1) usual care (standard training); 2) “paper-based” (tailored behavioral communication, using paper-based tools); and 3) “smartphone” (tailored behavioral communication, using smartphone technology). The co-primary outcomes were: 1) linkage to care, and 2) change in systolic BP (SBP). A covariate-adjusted mixed-effects model was used, adjusting for differential time to follow-up. Bootstrap and multiple imputation were used to handle missing data. Results: 1460 individuals (58% women) were enrolled (491 usual care, 500 paper-based, 469 smartphone). Average baseline SBP was 159.4 mmHg. Follow-up measures of linkage were available for 1128 (77%) and BP for 1106 (76%). Linkage to care was 49% overall, with significantly greater linkage in the usual care and smartphone arms. Average overall follow-up SBP was 149.9 mmHg. Participants in the smartphone arm experienced a modestly greater reduction in SBP vs. usual care (−13.1 mmHg vs. −9.7), but this difference was not statistically significant. Mediation analysis revealed that linkage to care contributed to SBP change. Conclusions: A strategy combining tailored behavioral communication and mHealth for CHWs led to improved linkage to care, but not statistically significant improvement in SBP reduction. Further innovations to improve hypertension control are needed. Trial Registration: Registered as on www.clinicaltrials.gov.
Expert Takes1 quote
“What we found was that the smartphone-based arm did improve linkage to care and improved BP a modest amount, although the BP results in the end were not statistically significant. The conclusion is that community health workers have a role and quite likely can improve linkage and BP if they're equipped with smartphones and behavioral communication.”
Rajesh Vedanthan, Associate Professor, NYU School of MedicineNYU School of Medicineauto_pipelineView source