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