Acceptability of Patient-centered Hypertension Education Delivered by Community Health Workers among People Living with HIV/AIDS in Rural Uganda

Abstract

Background The prevalence of hypertension is increasing among people living with HIV/AIDS (PLWHA) in low- and middle-income countries (LMICs). However, knowledge of the complications and management of hypertension among PLWHA in Uganda remains low. We explored the acceptability of implementing hypertension (HTN) specific health education by community health workers (CHWs) among PLWHA in rural Uganda. Methods We conducted a qualitative study consisting of 22 in-depth interviews (14 PLWHA/HTN and 8 CHWs), 3 focus group discussions (FGDs), 2 with PLWHA/HTN and 1 with CHWs from Nakaseke district, Uganda. Participants were interviewed after a single session interaction with the CHW. Data were transcribed from luganda (local language) into English and analyzed using thematic analysis. We used Sekhon’s model of acceptability of health Interventions to explore participants’ perceptions. Results Participants believed CHWs utilized easy-to-understand, colloquial, non-technical language during education delivery, had a pre-existing rapport with the CHWs that aided faster communication, and had more time to explain illness than medical doctors had. Participants found the educational material ( PocketDoktor Ô ) to be simple and easy to understand, and perceived that the education would lead to improved health outcomes. Participants stated their health was a priority and sought further disease-specific information. We also found that CHWs were highly motivated to carry out the patient-centered education. While delivering the education, CHWs experienced difficulties in keeping up with the technical details regarding hypertension in the PocketDoktor Ô , financial stress and patient questions beyond their self-perceived skill level and experience. PLWHA/HTN had challenges accessing the health facility where the intervention was delivered and preferred a household setting.Conclusions Hypertension patient-centered education delivered by CHWs using the PocketDoktorÔ was acceptable to PLWHA and hypertension in Nakaseke area in rural, Uganda. There is need for further studies to determine the cost implications of delivering this intervention among PLWHA across LMIC settings.

Virtual management of hypertension: lessons from the COVID-19 pandemic–International Society of Hypertension position paper endorsed by the World Hypertension League and European Society of Hypertension

“…Patient education is more effective when tailored to a patient's individual needs, including two-way feedback between patient and care provider and using a variety of delivery approaches including printed materials [57], telephone based brief interactive sessions, group online education sessions, interactive digital tools and creating opportunities for peer-support [58][59][60][61]. These interventions can be effectively delivered by physicians, nurses, pharmacists or community health workers and in multidisciplinary teams [62,63]. For patients with low health literacy levels, strategies that use visual aids such as video or infographics; deliver self-management curriculum in small, more achievable instructional units; repeat intervention training; confirm learning or mastery; and provide corrective or tailored instruction until mastery is attained, improve achievement of CVD self-management behaviors [64].…”

A community health worker delivered intervention to address hypertension among adults engaged in HIV care in northern Tanzania: Outcomes from a pilot feasibility study

“…Prior studies in Tanzania have shown that HIV care delivery by CHWs is favorably received 34,35 . Furthermore, a few studies have also revealed that interventions offering NCD care delivered by CHWs are feasible, highly acceptable, and effective 36,37 . The utilization of CHWs to provide care may be an attractive strategy in a health care system that is overtaxed by high patient volumes and few prescribing providers 38,39 …”