Community-based blood pressure measurement by non-health workers using electronic devices: a validation study

Abstract

IntroductionPopulation monitoring and screening of blood pressure is an important part of any population health strategy. Qualified health workers are expensive and often unavailable for screening. Non-health workers with electronic blood pressure monitors are increasingly used in community-based research. This approach is unvalidated. In a poor, urban community we compared blood pressure measurements taken by non-health workers using electronic devices against qualified health workers using mercury sphygmomanometers.MethodFifty-six adult volunteers participated in the research. Data were collected by five qualified health workers, and six non-health workers. Participants were randomly allocated to have their blood pressure measured on four consecutive occasions by alternating a qualified health worker with a non-health worker. Descriptive statistics and graphs, and mixed effects linear models to account for the repeated measurement were used in the analysis.ResultsBlood pressure readings by non-health workers were more reliable than those taken by qualified health workers. There was no significant difference between the readings taken by qualified health workers and those taken by non-health workers for systolic blood pressure. Non-health workers were, on average, 5–7 mmHg lower in their measures of blood pressure than the qualified health workers (95%HPD: −2.9 to −10.0) for diastolic blood pressure.ConclusionThe results provide empirical evidence that supports the practice of non-health workers using electronic devices for BP measurement in community-based research and screening. Non-health workers recorded blood pressures that differed from qualified health workers by no more than 10 mmHg. The approach is promising, but more research is needed to establish the generalisability of the results.

What do community health workers have to say about their work, and how can this inform improved programme design? A case study with CHWs within Kenya

“…The study reported here supports contemporary policy commitments to the value of CHWs, demonstrating the work they do in integrating health and welfare initiatives in low-income, CTC settings, confirming the conclusions drawn in previous, initiative-specific studies [e.g. ( 1 , 2 )]. However, there was no evidence here of Lehmann & Sanders’ differentiation ( 5 ) between generalists and specialists; all CHWs involved here could be seen as generalists, who acted as specialists in response to specific funded programmes, but whose role extended beyond this, providing continuity for the community whilst funding comes and goes.…”

“…Community engagement in health systems has been seen as both a practical response to the challenging conditions of health provision in low-income settings [e.g. ( 1 , 2 )] and a key principle for strengthening health systems more generally ( 3 ). However, a substantive account of CHW's own view of their own practice has been lacking up until now, hindering the integration or alignment of CHWs to the formal health care system at the community level.…”

Literacy and motivation for the prevention and control of hypertension among female community health volunteers: a qualitative study from Nepal

“…Adams et al ( 17 ) demonstrated health volunteers without a professional health worker background could be trained to make accurate blood pressure and anthropometric measurements. Reidpath et al found that blood pressure readings made by non-health workers were not statistically different from those made by health workers ( 18 ). A study showed that in India, CHWs could be trained to calibrate blood pressure apparatus in the local setting, and that CHWs made similar BP measurements as their educated supervisors ( 19 ).…”

Poor glycaemic control and its metabolic and demographic risk factors in a Malaysian community-based study

“…Blood pressure was measured at rest with an interval of 2 min between readings (Omron model HEM-7203) based on a validated strategy for community-based measurement (Reidpath et al 2012). The three blood pressure measures were averaged and used to categorise diastolic and systolic blood pressure (mmHg) according to the following cutoffs: normotensive (systolic \ 120 and diastolic \ 80; reference category), pre-hypertensive (120 C systolic \ 140; 80 C diastolic \ 90), hypertensive (140 C systolic; 90 C diastolic).…”