Optimizing a Community Health Program for Hypertension Control in Nepal (2022-2023)

Important note: This team is a joint project between Duke and Duke Kunshan University. This team seeks student participants from both campuses. Prospective applicants should be prepared to collaborate across countries, which may necessitate virtual meetings in the early morning or late evening to accommodate time zone differences.

Background

Hypertension is the leading cause of death globally. In rural Nepal, where the health system is fragile and health literacy is low, the condition is steadily escalating. One-third of Nepalis have hypertension, and most are undiagnosed and uncontrolled. Patients face serious challenges, such as geographical barriers, inadequate screening, limited access to care and low medication adherence. The COVID-19 pandemic has brought other threats, since hypertension patients are more vulnerable to infection and serious illness. Contact avoidance, stigma and fear worsen health outcomes for many rural residents. 

The condition is preventable and treatable, but its management requires participation from multiple stakeholders. Community-based strategy combined with mobile health is a credible solution in Nepal, where female community health volunteers (FCHVs) play a vital role.

Project Description

Building on the work of a previous team, this project team will upgrade and optimize a feature-phone-based (non-smartphone) program to include frontline health workers, in order to improve management of hypertension in rural Nepal. The team aims to: 

  1. Identify the facilitators and barriers to hypertension care and access for the synergy of FCHVs and frontline health workers under the challenge of COVID-19
  2. Refine the feature-phone-based hypertension management program 
  3. Assess the feasibility and acceptability of the newly-developed program.

Team members will work in pairs to interview at least 50 key stakeholders. They will also organize a roundtable discussion in Kathmandu, with topics on project implementation, challenges and solutions as well as app development. The team will then organize a workshop with selected participants from the discussion to discuss how to sustain and scale up the hypertension management program.

The team will upgrade the FCHVs-centered program to synergize with frontline health workers, collaborating with Medic Mobile Nepal for technical support. First, frontline health workers will train FCHVs to perform blood pressure measurements and deliver the results to frontline health workers in real time through their feature phones. Later, well-trained FCHVs will assume the role of measuring and monitoring blood pressures among community participants, educating them on the importance of maintaining normal blood pressures, and referring participants with high blood pressure to frontline health workers. Next, frontline health workers will give participants preventative and treatment regimens. 

Team members will assist with the implementation of the new program in two rural communities in Dhulikhel, Nepal. Afterward, they will conduct four interviews among frontline health workers, FCHVs and community participants to assess the feasibility and acceptability of this program.

Anticipated Outputs

Mobile application; new hypertension management program; poster for an international conference; peer-reviewed scientific papers; summary report; data for grant proposal

Student Opportunities

Ideally, the team will be comprised of 3 graduate students and 6 undergraduate students from 3 campuses, with at least 3 students from Duke or Duke Kunshan University. Students who have a passion to work in digital technology innovation and mobile health, primary health care and noncommunicable diseases are encouraged to apply. Relevant majors include, but are not limited to, engineering, computer science, global health, medicine, nursing and biology.

This project will provide students with opportunities to learn the complexity of hypertension-related health issues in rural Nepal. Students will learn how to prepare educational materials and interview guidelines, and conduct interviews and analayze qualitative data. Team members will be encouraged to prepare meeting reports and write scientific manuscripts. 

Selected students who will travel to Nepal will receive first-hand knowledge on developing eHealth projects to tackle health issues in rural community settings. This fieldwork will take place in two rural communities in Dhulikhel, Nepal, and will be launched in May 2022 and last for about 16 weeks, 8 hours onsite work per each workday. For students who prefer to work remotely in the summer, a total of 20 hours per week are required to process data and attend virtual team meetings.

Students from each campus will be divided into 3 subgroups overseen by one faculty leader. Weekly in-person meetings will be held in each subgroup for lecturing and reporting progress. 

Yuxuan Wang will serve as the team’s project manager.

Timing

Summer 2022 – Summer 2023

  • Summer 2022 (optional): Receive ethical approval from Duke and local IRB; selected students travel to Nepal; conduct interviews
  • Fall 2022: Complete fieldwork; return to campus; start data analysis 
  • Spring 2023: Write two manuscripts; create conference poster; write report 
  • Summer 2023 (optional): Present poster; submit mansucripts

Crediting

Academic credit available for fall and spring semesters; summer funding available

See earlier related team, Developing a Mobile Phone-based Community Health Program for Hypertension Control in Nepal (2018-2019).

 

Image: Jharana Kumari Tharu - female community health volunteer in Binauna village, by USAID U.S. Agency for International Development, licensed under CC BY-NC 2.0

Community health worker in Nepal.

Team Leaders

  • Truls Ostbye, School of Medicine-Family Medicine and Community Health
  • YuXuan Wang, Duke Kunshan University–MSc Student
  • Lijing Yan, Duke Kunshan University

/yfaculty/staff Team Members

  • Tazeen Jafar, Duke-NUS Medical School

/zcommunity Team Members

  • Nepal Ministry of Health
  • Medic Mobile Nepal