Feasibility of the CoPILOT digital application for linking community hypertension screening to primary care in rural Nepal

Background Hypertension (HTN) affects approximately 25% of adults in Nepal, where geographic barriers and financial constraints limit access to diagnosis and treatment. Mobile Health (mHealth) applications show promise for HTN control, yet their integration and support from Female Community Health Volunteers (FCHVs) and Front-Line Health Workers (FLHWs) remain underdeveloped. This study co-designed CoPILOT, an mHealth application, and aimed to evaluate the implementation outcomes, with an emphasis on how well it integrates into Nepal’s healthcare system. Methods We employed a pre-post-intervention mixed-methods design with 21 FLHWs and 30 FCHVs using Android phones at ten health posts (HPs) of Kavrepalanchowk, Nepal. Participants unable to use Android phones were excluded. We evaluated the program using the Reach, Effectiveness, Adoption, Implementation, and Maintenance framework. Quantitative data were summarized descriptively using backend data, while qualitative interviews were analyzed thematically to explore feasibility, facilitators, and barriers. Results Around 90% of FCHVs actively used CoPILOT, screening 294 participants (≥40 years of age), identifying 54 suspected and 129 previously diagnosed individuals with HTN within four weeks of CoPILOT use, and referring 60% to nearby HPs. FLHWs confirmed 50 new HTN cases and initiated medication for 5 out of 10 previously diagnosed but untreated hypertensive individuals. Barriers included medication adherence, network issues, and medication shortages at HPs. Conclusions CoPILOT is a user-friendly and feasible tool for identifying, referring, and diagnosing HTN in rural Nepal, as demonstrated by feasibility outcomes in this pilot study. Findings suggest a large-scale study is warranted to explore its potential in broader HTN management.