Developing a Mobile Phone-based Community Health Program for Hypertension Control in Nepal (2018-2019)

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

Student Opportunities

Students will get first-hand experiences implementing a global health project in a low-income country. They will work closely with each other under the mentorship of the faculty on research and hands-on activities such as formulating the right content for the program, developing and testing interview guidelines and conducting interviews, designing the beta version and analyzing qualitative data. They will contribute to prepare reports and academic papers. They will get an opportunity to travel to Nepal and work with partners.

Team leaders seek to recruit 2 undergraduate students from Duke University, 2 master’s students in Global Health from Duke Kunshan University who have committed to work in Nepal in summer 2018, and 2-4 master’s, medical or doctoral students from Duke University. Students who have a passion to work in digital technology innovation, primary healthcare and noncommunicable diseases are encouraged to apply. Relevant majors include but are not limited to engineering, computer science, global health, medicine and nursing.

The Durham-based and Kunshan-based teams will meet weekly in person and have biweekly teleconferences across the two campuses. The meetings will be in mornings in the U.S. (evening in China 12-13 hours ahead) or evening in the U.S. (morning in China). Meetings during the summer (June-August) will be more frequent, and some will be on site in Nepal.

Students will be graded based on their performance on their assigned tasks according to the responsibility matrix and their contributions to team work.

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

Crediting

Independent study credit available for fall and spring semesters; summer funding