Reliability, usability and identified need for home-based cardiometabolic health self-assessment during the COVID-19 pandemic in Soweto, South Africa

Abstract

A major obstacle to tackling the growing burden of chronic disease in South Africa is lack of testing, particularly where individuals face multiple barriers to accessing health services. We conducted a pilot study to evaluate a cardiometabolic self-measurement kit, including assessment of blood pressure, obesity and urine analysis, amongst adults in Soweto, South Africa. Participants (N = 94) were recruited by researchers during community health screening and were provided with a home test kit including a tablet with self-measurement instructions. The participants entered their results on the tablet and, on completion, the researcher immediately repeated the measurements. We interviewed 10% of participants to understand their experience and views of the kits. Concordance correlation coefficients ranged from 0.78 for waist circumference to 0.93 for height, while the overall percentage agreement ranged from 80.5% for both urine protein and urine glucose testing to 91.4% for the identification of central obesity (ratio of waist circumference to height of ≥ 0.5). Participants saw the need for self-testing and found the process for the most part simple, though urine testing and height self-assessment presented some challenges. This pilot study suggests that self-assessment at home has the potential to facilitate the identification of individuals at risk for cardiometabolic disease in low-income settings, adding to a growing body of evidence on the use of self-testing in disease prevention and detection. However, we would not recommend self-testing for urine glucose and protein without further study.

Acceptability and feasibility of home-based hypertension and physical activity screening by community health workers in an under-resourced community in South Africa

“…We also found high levels of acceptance towards the home visits, responsiveness to the advice provided, and a willingness to learn about their cardiovascular health. This is both a milestone for NCD implementation research and an important finding in a community where typically only one in every five individuals has sufficient health literacy (Calvert et al 2022 ).…”

Telemedicine for blood pressure control in low- and middle-income countries: the journey ahead

“…If this is not the case, the risk is that such systems will widen economic and digital divides between and within countries and contribute further to healthcare inequity, affecting those that cannot afford the best healthcare services. Even in upper-middle-income countries with high mobile phone ownership, such as South Africa, the digital divide (i.e., the inequity in access to and use of information communication technologies) persists and was brought into sharp focus recently when schools closed and moved to online education during the COVID-19 pandemic [6,7] . However, the pandemic also demanded a reconsideration of care for people living with hypertension at a time when clinics were overrun and patients avoided healthcare facilities.…”