Adopting Task-Shifting Strategies for Hypertension Control in Ghana: Insights From a Realist Synthesis of Stakeholder Perceptions

Abstract

Background: The adoption, intention, initial decision or action to implement evidence-based strategies for hypertension control in real-world settings is a challenge in low-and middle-income countries. Although stakeholders are essential for the adoption of evidence-based interventions, data on how to engage them to improve uptake of these strategies is lacking. Using a realist synthesis of stakeholder perspectives, the authors describe a process for engaging stakeholders to identify facilitators and barriers to the adoption of an evidencebased task-strengthening strategy for hypertension control in Ghana. Objectives: To identify stakeholder perceptions of the factors influencing the adoption of evidence-based taskshifting strategies for hypertension control in Ghana. Methods: A realist evaluation of interviews, focus groups, and brainstorming activities was conducted to evaluate stakeholder perceptions of an evidence-based strategy designed to identify, counsel, and refer patients with hypertension for care in community health centers. Stakeholders included community health officers, administrators, and policymakers from the Ghana Health Service, researchers, and community health officers in community-based health planning services in the Kintampo region of Ghana. The study used a realist synthesis approach to thematically analyze the qualitative data generated. Results: Sixty-two stakeholders participated in the study. They identified inner contextual characteristics such as the provision of resources, training, supervision, and monitoring as well as community outreach as important for the adoption of an evidence-based strategy in Ghana. The findings highlight how stakeholders are faced with multiple and often competing system strains when contemplating uptake of evidencebased strategies for hypertension control. Conclusions: Through the application of a realist synthesis of stakeholder perceptions, the study identified factors likely to enhance the adoption of an evidence-based strategy for hypertension control in Ghana. The lessons learned will help shape the translation of evidence in real-world settings, and could be valuable in future planning to enhance the adoption of evidence-based strategies for hypertension control in LMICs. Ghana, similar to other countries in sub-Saharan Africa, is experiencing an epidemic of cardiovascular diseases propelled by rapidly increasing rates of hypertension [1,2]. More than 1 in 5 Ghanaians has hypertension, which is the second leading cause of outpatient morbidity in adults older than 45 years in Ghana [1e3]. The adoption or action to utilize evidence-based strategies [4e7] for hypertension control is a challenge in low-and middleincome countries (LMICs) like Ghana [8]. Although evidence-based interventions (EBIs) exist for cardiovascular disease risk reduction, the ability of health systems in LMICs to ensure their effective and equitable uptake is lacking [9,10]. The adoption of EBIs for hypertension control has the potential to improve blood pressure control by enhan...

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