Team profile by Iris Parshley, Yuxuan Wang, Jenny Kuo and McKenna Paulik

Optimizing a Community Health Program for Hypertension Control in Nepal (the OCEAN project) was a large, multi-armed research project. We worked in partnership with doctors and researchers at Kathmandu University, Nepal. We performed literature reviews, meta-analysis, quantitative and qualitative research and phone software development to build an optimized intervention for improving hypertension (HTN) control in rural Nepal.

Our team was broken into three major groups: Qualitative, Quantitative, and App teams. Each team had weekly meetings and was led by a student leader and faculty supervisors. Below are the summaries of responsibilities and outputs from each team.

Qualitative Team

The Qualitative Team mainly focused on a feasibility study of a phone app, which was designed to help health providers with management of hypertension in rural Nepal. The results of the test will provide insights for the optimization of the app and prepare it for further study such as a c-RCT. This year, we performed literature reviews to learn the roles of female community health volunteers (FCHVs) and frontline health workers (FLHWs) in hypertension management in low resource settings. As part of the feasibility study, we designed multifaceted interviews of FCHVs, FLHWs, and hypertensive patients. The results of the interviews will help us determine the merits and viability of the app. Our findings so far were summarized as a case study for WHO that demonstrates the barriers and facilitators of the use of mHealth for female health community volunteers in non-communicable disease management in Nepal. We also prepared to perform a knowledge, attitude and practice (KAP) survey with physicians who work in health posts in rural Nepal to understand how we can improve the efficiency and capacity of hypertension management. 

Quantitative Team

The Quantitative Team completed three studies during the 2022-2023 year. The first study was a meta-analysis, the second was a qualitative study, and the third was a quantitative study. The first study was called “Leveraging Digital Health Interventions to Prevent and Manage Hypertension in Low- and Middle-Income Countries: A Meta Analysis and Systematic Review.” This study highlighted the potential of mHealth interventions as a cost-effective and accessible solution to improve hypertension control in LMICs. It also underscored the importance of effective communication between institutions and individuals to maximize the benefits of mHealth interventions. The second study was called “The Barriers and Facilitators of Implementing Mobile Health Interventions in Nepal.” This study highlighted the importance of considering local cultural and technical factors in designing and implementing mHealth interventions. The third study was called “The Gap Between Rural and Urban Awareness, Treatment, and Control of Hypertension and Access to Communication Tool for Hypertension Control in Nepal: Rural-Urban Gap.” The study found that more than 90% of hypertensive patients in both urban and rural areas had access to a mobile phone, indicating the potential use of mobile phones to improve hypertension control in the future. These findings could help inform the development of effective strategies and interventions to improve hypertension management and prevent associated complications in Nepal.

App Team 

In order to improve a feature-phone-based hypertension management program, the App Team collaborated with Medic Mobile and Dhulikhel hospital coders. Their objective was to develop an interface that would enable FCHVs to screen patients residing in remote and difficult-to-access regions. The screening results could then be communicated to medical professionals that can provide referrals, arrange followup appointments and make other relevant recommendations. Moreover, the team is currently conducting in-field interviews with FCHVs to better understand the challenges they encounter in their work and to determine how the app can provide them with additional support.

Conclusion

As you can see, our complex project employed many research methods and began an intervention in Nepal during the past year. Working with an international team from Nepal, China, and the U.S., we developed critical communication, research, teamwork, writing and presentational skills. At times, it was difficult to collect every team member for the meetings across time zones, but ultimately, using file-sharing platforms we were able to complete each project with input and participation from each team member. We are hopeful that our research and intervention will help improve communication between patients, FCHV, FLHW and physicians and improve access to HTN care for patients with diabetes in rural Nepal. 

Leveraging Digital Health Interventions to Prevent and Manage Hypertension in Low- and Middle-Income Countries: A Meta-Analysis and Systematic Review

Poster by Chin Kuo, Pooja Singh, Trailokaya Bajgain, Yuxuan Wang, McKenna Paulik, Mingma Sherpa, Semin Kim, Zhenkun Fang, Iris Parsley, Lijing Yan, Truls Ostbye and Zhao Ni

Treatment and control of hypertension in low- and middle-income countries (LMICs) has been inadequate due to insufficient medical knowledge and resources. This study evaluated the efficacy of mobile health (mHealth) interventions in reducing blood pressure in adult patients in low- and middle-income countries (LMICs) through a systematic review and meta-analysis of 20 studies with 39,082 participants. Results showed that compared to the control group, the mobile healthcare intervention group showed a significant decrease in both SBP and DBP, with reductions of 3.73 mmHg (P<0.001; 95% CI: 2.39 to 5.08) and 2.84 mmHg (P<0.001; 95%CI: 1.75 to 3.94), respectively. Subgroup analysis indicated that mHealth communication between institutions and individuals was more effective in reducing blood pressure. These findings suggest that integrating mHealth into healthcare systems could improve hypertension control in underserved populations.

The Barriers and Facilitators of Implementing Mobile Health Interventions in Nepal: A Qualitative Analysis

Poster by Chin Kuo, Pooja Singh, Trailokaya Bajgain, Yuxuan Wang, McKenna Paulik, Mingma Sherpa, Semin Kim, Zhenkun Fang, Iris Parsley, Lijing Yan, Truls Ostbye and Zhao Ni

While previous research on mobile health (mHealth) in Nepal has focused on user perspectives and the effectiveness of mHealth interventions, the perspectives of engineers regarding the implementation of such interventions have been largely overlooked. This study aimed to address this gap by obtaining insights from software engineers on the barriers and facilitators of developing and implementing mHealth interventions in Nepal. Using a qualitative approach, we conducted 16 semi-structured interviews with professional software engineers who had developed mHealth interventions to promote health and had been residing in Nepal for over a year. The interviews were thematically coded, and three main themes emerged. First, the Nepali calendar needs to be integrated into mHealth apps to prevent confusion among Nepali patients who are accustomed to using it. Second, mHealth interventions need to be available in Nepali and English, and should support at least seven languages to reach 90% of Nepalese people. Finally, technical design features should consider the challenges posed by Nepal's unique geography and include open-source frameworks and short message service. The findings of this study highlight the importance of integrating essential elements, such as the Nepali calendar, language and technical features, to ensure successful implementation of mHealth interventions in Nepal.