Co-developing a community health worker-led hypertension control intervention in Peru through a human-centered design approach

<title>ABSTRACT</title> <sec> <title>Objective.</title> To define the essential content and design elements for hypertension support delivered by community health workers (CHWs) in Puno, Peru, aligned with the HEARTS Initiative. </sec> <sec> <title>Methods.</title> We applied a human-centered design approach to co-create strategies for a CHW-led hypertension intervention through five interactive workshops with 24 CHWs, 32 healthcare workers (doctors, nurses, and administrators), and 18 community members with hypertension. </sec> <sec> <title>Results.</title> We identified five key recommendations on the objectives and needs of a CHW-led hypertension support program. First, improve patient-level health behaviors. CHWs can encourage heart-healthy diets, exercise, medication adherence in tandem with traditional remedies, and regular care-seeking through home-based behavioral education tailored to the local context. Second, improve facility-level hypertension care. CHWs can fill care gaps due to physician shortages, complicated healthcare systems, complex scheduling procedures, and language differences, while fostering more respectful healthcare. Third, link CHWs to the formal health system. Joint training, monthly meetings, and improved communication with formal healthcare providers can enhance CHW integration in the healthcare system and reduce concerns about CHWs overstepping their role in patient care. Fourth, train and equip CHWs. CHWs require training on hypertension and their roles in healthcare delivery, as well as compensation, appropriate and sufficient materials, and transportation assistance. Fifth, design educational materials on hypertension. Culturally relevant, pictorial materials with accessible language and regular content updates help engage patients. </sec> <sec> <title>Conclusions.</title> The human-centered design process enabled co-development of a culturally responsive, CHW-led hypertension support intervention that operationalizes HEARTS principles. </sec>