Background

Cardiovascular diseases are the leading cause of deaths and disability in many low-and middle-income countries, including Nepal. Prevention of cardiovascular diseases demands innovative solutions through multidisciplinary and multifaceted approaches.

Nepal’s female community health volunteer program has been in place for three decades. Duke researchers have conducted a trial to successfully extend the roles of these volunteers from primarily maternal and child health interventions to include hypertension, a major risk factor for cardiovascular diseases.

With a nearly 100% mobile phone ownership rate in the country, Nepal’s Ministry of Health has prioritized mobile health (mHealth) interventions. Medic Mobile has received support to scale up its feature-phone-based (non-smartphone) program to thousands of female community health volunteers to address prenatal care and maternal health. This Bass Connections project will collaborate with these partners to develop design insights and feature-phone-based programs, which will create a foundation for interventions with the potential to make a significant impact on hypertension prevention and control.

Project Description

The goal of this project is to establish a dynamic collaboration among students of different levels in two Duke campuses and faculty from diverse disciplines for developing a low-cost, user-centered digital solution to reduce blood pressure among hypertensive patients in rural Nepal.

The project team will conduct interviews with female community health volunteers, patients and policy actors to understand workflows, needs and challenges around hypertension care coordination in Nepal, including access and adherence barriers.

Team members will prepare a detailed feasibility, design and technical specification report (including final mHealth workflow sketches) and beta feature-phone-based programs. Medic Mobile will provide guidance and feedback to the team. Development of the beta version will be led by start-up company Laohan.

Finally, the team will organize a roundtable discussion in Kathmandu, Nepal, to take place during the winter break of 2018-19. All team members will be invited to attend as well as key stakeholders in Nepal, including Medic Mobile technicians, female community health volunteers, community physicians, medical specialists, Ministry of Health officials, District Health Bureau officials and the World Health Organization office in Nepal.

Anticipated Outcomes

Peer-reviewed publication describing feasibility, design and technical specification for designing community-based mHealth technology for reducing blood pressure in rural Nepal; beta version of program to be pilot-tested by female community health volunteers in rural Nepal (in the future); roundtable summary report on challenges, opportunities and solutions in adopting and scaling up mHealth technology in rural Nepal and other low-income settings

Timing

Summer 2018 – Spring 2019  

• Summer 2018: Field activities in Nepal (attend human-centered design workshop conducted by Medic Mobile; work in pairs to interview female community health volunteers, hypertensive patients and family members in selected rural communities; analyze transcription of interviews and field notes to refine feature-phone-based program design)
• Fall 2018: Beta version development; report/paper writing; roundtable discussion over winter break
• Spring 2019: Report/paper writing

Team Outcomes to Date

Developing A Feature-Phone Based Female Community Health Volunteer Program for Hypertension Control in Rural Nepal: Assessment Phase (poster by Zhao Ni, Sweta Kafle, Jingru Tan, Rinchen Doma, Rishika Gundi, Namratha Atluri, Olivia Neely, Yunfan Ge, Helena Merk, Kinza Khan, Wanbing Gu, Ryan Shaw, Lijing Yan), Global Health Research Showcase, Durham, NC, November 5, 2018