Augmented Reality for Community Health Agents

Problem - In Sao Paulo's public health system there is low engagement of population with health promotion services offered by Primary Care Clinics (PCCs). Several factors contribute to low adherence to medication and healthy habits in hypertension treatment. The potential of Community Health Agents (CHAs) during home visits is underappreciated due to lack of specific training around orientation of families about chronic diseases. 

Solution - Engage CHAs of PCCs in health promotion, hypertension prevention and control strategies through an augmented reality app with common everyday objects interaction.

Scale - The app can run on IOS and Android devices. The content on hypertension and potentially other chronic diseases will be interactive and simple. Training will be scaled by video format. The solution will be of open access to serve populations and community agents around the globe. Its implementation will take place in a started project with a final phase dedicated to scale. 

In Brazil, cardiovascular diseases are the top one cause of death as in the world and there are approximately 36 million people with hypertension. National data estimate that the prevalence of referred hypertension is 22.7% among Brazilian adults and the prevalence in São Paulo happens mostly in women over 60, with a low level of schooling. 

In underserved and poor communities, families face multiple barriers to active health engagement. Primary care teams struggle to deal with the dual burden of disease from NTDs and NCDs in addition to mother, child care and epidemic demands. Despite of the multitude of responsibility, there is a lack in consistent training and empowerment of those front line workers and there are no regular trainings on specific chronic diseases.

The demand for Primary Care Clinics for prevention is low, and in the case of hypertensive population, there is often also late search for treatment. Among diagnosed hypertensive users, a significant portion effectively adheres to treatment, however, many face challenges in adhering to medication and adopting healthy habits which is the key to keeping the pressure under control.

Itaquera is a heterogeneous neighbourhood with high income areas next to low income urban occupations and communities, population around 550,000, a HDI of 0,803 and progressive presence of immigrants. 

The project has listened more than 200 people among clinic managers, doctors, nurses, pharmacists, nursing technicians, community health agents, community and others. In Itaquera territory, there are over 432,000 active users of the public health system, representing 78% of the region's inhabitants, and over 99,000 hypertensive users according to ISA Capital, City Hall Health Survey. However, there is a low population engagement with the Primary Care Clinics, essential for prevention and health promotion. 

Part of the Primary Health Care service runs on the Family Health Strategy (FHS) model, with Community Health Agents who carry out home visits and territory strategies. In Itaquera there are almost 500 agents working on FHS model who will be trained and empowered through augmented reality, with contents and tools to support daily work, aiming at health promotion and hypertension care.

Community Health Agents are a key element in the Public Primary Care services in Brazil, as they establish bonds with communities through regular home visits.

The Better Hearts Better Cities Augmented Reality app empowers Community Health Agents (CHA) and the community by expanding information, prevention, strategies and care plans on hypertension through an augmented reality app applied to everyday and simple objects. The App will have three types of use: capacity building of community health agents, activities in groups of PCCs, and self-care supported by the community.

The app will first be used to train the agents, so that later it is used in the home visits that agents perform and in groups of activities offered by the PCCs. They will be able to track, engage, and educate local population on disease prevention, hypertension control, and wellness promotion strategies.

The BHBC CHA's App has the main contents divided between CHA's exclusive training ("train the trainer" model) and CHA's community interaction content. They are subdivided in the following blocks:

1. Hypertension Information and risk factors, including global data about prevalence and morbidity in Brazil and the world: use of augmented reality directly on the human body showing how the disease affects the organismand how their risk factors contribute to its development;

2. Physical Activities Demonstration: use of augmented reality to illustrate physical activities with the use of everyday objects for exercises, such as the use of stairs and the available house infrastructure.

3. Drug Information: use of augmented reality to increase adherence to medication and blood pressure self-control,

4. Healthy Eating Demonstration: use of augmented reality to clarify food information, translating food labels and warning about risky ingredients, such as sodium in highly processed food. Through images and signs, point out food in the cabinet, dish or refrigerator for hypertension prevention and treatment.

The app includes gamified challenges for healthy habits adoption, reinforcing user engagement with community agents.