title: Evaluating the use of mobile phone technology to enhance cardiovascular disease screening by community health workers.
abstract: BACKGROUND
  Primary prevention of cardiovascular disease (CVD),by identifying individuals at risk is a well-established, but costly strategy when based on measurements that depend on laboratory analyses. A non-laboratory, paper-based CVD risk assessment chart tool has previously been developed to make screening more affordable in developing countries. Task shifting to community health workers (CHWs) is being investigated to further scale CVD risk screening. This study aimed to develop a mobile phone CVD risk assessment application and to evaluate its impact on CHW training and the duration of screening for CVD in the community by CHWs.
  
  
  METHODS
  A feature phone application was developed using the open source online platform, CommCare(©). CHWs (n=24) were trained to use both paper-based and mobile phone CVD risk assessment tools. They were randomly allocated to using one of the risk tools to screen 10-20 community members and then crossed over to screen the same number, using the alternate risk tool. The impact on CHW training time, screening time and margin of error in calculating risk scores was recorded. A focus group discussion evaluated experiences of CHWs using the two tools.
  
  
  RESULTS
  The training time was 12.3h for the paper-based chart tool and 3h for the mobile phone application. 537 people were screened. The mean screening time was 36 min (SD=12.6) using the paper-base chart tool and 21 min (SD=8.71) using the mobile phone application, p=<0.0001. Incorrect calculations (4.3% of average systolic BP measurements, 10.4% of BMI and 3.8% of CVD risk score) were found when using the paper-based chart tool while all the mobile phone calculations were correct. Qualitative findings from the focus group discussion corresponded with the findings of the pilot study.
  
  
  CONCLUSIONS
  The reduction in CHW training time, CVD risk screening time, lack of errors in calculation of a CVD risk score and end user satisfaction when using a mobile phone application, has implications in terms of adoption and sustainability of this primary prevention strategy to identify people with high CVD risk who can be referred for appropriate diagnoses and treatment.
authors.affiliation: Chronic Disease Initiative for Africa, University of Cape Town, South Africa. Electronic address: samsurka@gmail.com.
authors.forename: Sam
authors.initials: S
authors.lastname: Surka
authors.affiliation: Centre for Online Health, University of Queensland, Brisbane, Australia.
authors.forename: Sisira
authors.initials: S
authors.lastname: Edirippulige
authors.affiliation: Chronic Disease Initiative for Africa, University of Cape Town, South Africa.
authors.forename: Krisela
authors.initials: K
authors.lastname: Steyn
authors.affiliation: Division of Cardiovascular Medicine, Brigham & Women's Hospital, Boston, USA.
authors.forename: Thomas
authors.initials: T
authors.lastname: Gaziano
authors.affiliation: School of Public Health, University of Western Cape, Cape Town, South Africa.
authors.forename: Thandi
authors.initials: T
authors.lastname: Puoane
authors.affiliation: Chronic Disease Initiative for Africa, Division of Diabetes and Endocrinology, Department of Medicine, University of Cape Town, South Africa.
authors.forename: Naomi
authors.initials: N
authors.lastname: Levitt
mesh_terms: D000328:Adult; D000368:Aged; D002318:Cardiovascular Diseases / Q000175:diagnosis* / Q000517:prevention & control; D040421:Cell Phone; D003150:Community Health Workers; D005260:Female; D017144:Focus Groups; D006293:Health Promotion / Q000379:methods*; D006801:Humans; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D063731:Mobile Applications; D010865:Pilot Projects; D055815:Young Adult
keywords: Cardiovascular disease risk assessment; Community health workers; Mobile phones; Task-shifting; mHealth