Addressing post-stroke care in rural areas with Peru as a case study. Placing emphasis on evidence-based pragmatism.
Stroke is a major cause of death and disability, with most of its burden now affecting low- and middle-income countries (LMIC). People in rural areas of LMIC who have a stroke receive very little acute stroke care and local healthcare workers and family caregivers in these regions lack the necessary knowledge to assist them. Intriguingly, a recent rapid growth in cell-phone use and digital technology in rural areas has not yet been appropriately exploited for health care training and delivery purposes. What should be done in rural areas, at the community setting-level, where access to healthcare is limited remains a challenge. We review the evidence on improving post-stroke outcomes including lowering the risks of functional disability, stroke recurrence, and mortality, and propose some approaches, to target post-stroke care and rehabilitation, noting key challenges in designing suitable interventions and emphasizing the advantages mHealth and communication technologies can offer. In the article, we present the prevailing stroke care situation and technological opportunities in rural Peru as a case study. As such, by addressing major limitations in rural healthcare systems, we investigate the potential of task-shifting complemented with technology to utilize and strengthen both community-based informal caregivers and community healthcare workers.
CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru; School of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru. Electronic address: jaime.miranda@upch.pe.
J Jaime
JJ
Miranda
CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru. Electronic address: miguel.moscoso.p@upch.pe.
Miguel G
MG
Moscoso
Global Health Research Center, Duke Kunshan University, Kunshan, Jiangsu, China; Duke Global Health Institute, Duke University, Durham, NC, USA. Electronic address: lijing.yan@duke.edu.
Lijing L
LL
Yan
CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru. Electronic address: fdiezcanseco@upch.pe.
Francisco
F
Diez-Canseco
CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru; Unidad de Conocimiento y Evidencia (CONEVID), Universidad Peruana Cayetano Heredia, Lima, Peru. Electronic address: german.malaga@upch.pe.
Germán
G
Málaga
Center for Global Health, Universidad Peruana Cayetano Heredia, Lima, Peru; Cysticercosis Unit, National Institute of Neurological Sciences, Lima, Peru. Electronic address: hgarcia1@jhu.edu.
Hector H
HH
Garcia
Medical University of South Carolina, Charleston, SC, USA. Electronic address: ovibes@musc.edu.
Bruce
B
Ovbiagele
D006233:Persons with Disabilities; D055317:Evidence-Based Practice; D006801:Humans; D010568:Peru / Q000453:epidemiology; D012424:Rural Population / Q000706:statistics & numerical data*; D020521:Stroke / Q000453:epidemiology* / Q000628:therapy*; D000071939:Stroke Rehabilitation / Q000706:statistics & numerical data; D017216:Telemedicine
Implementation science; Stroke; Task-shifting; mHealth