142nd APHA Annual Meeting and Exposition

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Development and Validation of a Behavioral Assessment Tool for Optimizing Linkage to Hypertension Care in Kenya: The LARK Study

142nd APHA Annual Meeting and Exposition (November 15 - November 19, 2014): http://www.apha.org/events-and-meetings/annual
Tuesday, November 18, 2014

Alexandra Douglas, MD-MPH Student (MS2) , Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York, NY
Jackson Rotich , Optimizing Linkage and Retention to Hypertension Care in Rural Kenya, MTRH-USAID AMPATH, Academic Model Providing Access to Healthcare, Eldoret, Kenya
Peninah Kiptoo , Optimizing Linkage and Retention to Hypertension Care in Rural Kenya, MTRH-USAID AMPATH, Academic Model Providing Access to Healthcare, Eldoret, Kenya
Kennedy Lagat , Optimizing Linkage and Retention to Hypertension Care in Rural Kenya, MTRH-USAID AMPATH, Academic Model Providing Access to Healthcare, Eldoret, Kenya
Jemima Kamano, MD , Department of Medicine at Moi Teaching and Referral Hospital, Academic Model Providing Access to Healthcare, Eldoret, Kenya
Claire Hutchinson , Mount Sinai School of Medicine, New York, NY
Kennedy Mutai , Optimizing Linkage and Retention to Hypertension Care in Rural Kenya, MTRH-USAID AMPATH, Academic Model Providing Access to Healthcare, Eldoret, Kenya
Emmanuel Tarus , Optimizing Linkage and Retention to Hypertension Care in Rural Kenya, MTRH-USAID AMPATH, Academic Model Providing Access to Healthcare, Eldoret, Kenya
Violet Naanyu, MA, PhD , School of Medicine, Department of Behavioral Sciences, Moi University, Eldoret, Kenya
Diana Menya , Department of Epidemiology and Nutrition, School of Public Health, Academic Model Providing Access to Healthcare/Moi University, Eldoret, Kenya
Thomas Inui, MD , Indiana University School of Medicine, Indianapolis, IN
Carol R. Horowitz, MD, MPH , Department of Health Evidence and Policy, Mount Sinai School of Medicine, New York, NY
Valentin Fuster, MD, PhD , Icahn School of Medicine at Mount Sinai, New York, NY
Rajesh Vedanthan, MD, MPH , Icahn School of Medicine at Mount Sinai, New York, NY
Introduction

Hypertension is the leading risk factor for mortality worldwide. Many environmental and behavioral barriers inhibit linkage of hypertensive individuals to healthcare, adversely impacting hypertension control. The LARK Study evaluates the use of community health workers (CHWs), equipped with a behavioral assessment and a tailored behavioral communication strategy, to improve linkage to hypertension care in western Kenya. Here we describe the development and validation of the assessment tool, to be used by CHWs to identify patients’ barriers to hypertension care, facilitating behavioral change communication.

Methods

We derived assessment questions from previous research on environmental, emotional, and cognitive barriers to hypertension care in Kenya. Patients, CHWs, and clinicians scored each question for clarity and representativeness, and provided qualitative feedback during focus groups. A content validity index, representing inter-rater agreement of scores, was calculated for each question.  We compared the quantitative and qualitative feedback for each question to determine its content validity and outcome in the final assessment.

Results

We tested 71 questions using nine focus groups (25 patients, 29 CHWs, 20 clinicians). While content validity indices demonstrated excellent inter-rater agreement (patients, 99%; CHWs, 97%; clinicians, 93%), qualitative feedback led to major revision or rejection of 50 questions. Thirty-seven questions were retained in the final assessment.

 

Conclusions

Qualitative feedback yielded meaningful changes to the assessment tool independent of items’ high content validity indices, which may reflect participant bias or limitations of the quantitative method. These findings may be relevant to the development and validation of similar assessment tools in other low-resource settings.

Learning Areas:

Chronic disease management and prevention
Communication and informatics
Planning of health education strategies, interventions, and programs
Social and behavioral sciences

Learning Objectives:
Describe a procedure for developing a behavioral assessment tool that is validated by and acceptable to both experts and participant stakeholders. Evaluate content validity indices and their utility in determining an assessment tool's validity.

Keyword(s): Hypertension, Communication

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I was the primary architect of the research protocol used to develop and validate the behavioral assessment tool described in this abstract. I am a MD-MPH student at the Icahn School of Medicine and have two years of prior experience working in East Africa with community health workers. My project was under the direct supervision of many experienced global health, global cardiology, and community-based research practitioners, including Rajesh Vedanthan and Carol Horowitz.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.

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