Abstract 16831: Identifying Barriers to Hypertension Care: Development and Validation of a Behavioral Assessment Tool for Optimizing Linkage and Retention to Hypertension Care in Kenya (LARK Hypertension Study)
Introduction: Hypertension is the leading risk factor for global mortality. Hypertension treatment rates are low, partly due to inadequate linkage and retention to care. The LARK Study evaluates the use of community health workers (CHWs), equipped with a behavioral assessment and a tailored behavioral change strategy, to improve linkage and retention to hypertension care in Kenya. Here we describe the development and validation of the assessment tool used by CHWs to identify patients’ barriers to care, facilitating behavioral change communication.
Methods: We derived behavioral assessment items from prior research on barriers to hypertension care in Kenya. Patients, CHWs, and clinicians scored each item for clarity and representativeness, and provided qualitative feedback during focus groups. A content validity index (CVI), representing inter-rater agreement of scores, was calculated for each item. Multivariable linear mixed-effects models were used to compare CVIs and level of modification (none, minor, major, or deleted) by participant category.
Results: We tested 70 items in 9 focus groups. Mean CVIs were greater than 0.9 in all study groups (Table). Multivariable adjustment revealed that patients and CHWs had significantly higher CVIs than clinicians. Despite this, qualitative feedback from patients and CHWsled to higher item modification rates. 37 items were retained in the linkage assessment and 57 items in the retention assessment.
Conclusions: The mean CVI was greater than 0.9 in all study populations, indicating excellent inter-rater agreement of the overall clarity and representativeness of assessment items. However, CVI alone could not account for modifications suggested during qualitative discussions. A combination of quantitative and qualitative methods yielded the most informative evaluation of assessment items. These findings may be relevant to the validation of similar assessment tools in other low-resource settings.
Author Disclosures: A. Douglas: None. J. Rotich: None. P. Kiptoo: None. K.K. Lagat: None. K. Mutai: None. E. Tarus: None. C. Kofler: None. V. Naanyu: None. D. Menya: None. J.H. Kamano: None. T.S. Inui: None. A. DeLong: None. C.R. Horowitz: None. V. Fuster: None. R. Vedanthan: None.
- © 2015 by American Heart Association, Inc.