An implementation science study to enhance cardiovascular disease prevention in Mukono and Buikwe districts in Uganda: a stepped-wedge design

Abstract

Background Uganda is experiencing a shift in major causes of death with cases of stroke, heart attack, and heart failure reportedly on the rise. In a study in Mukono and Buikwe in Uganda, more than one in four adults were reportedly hypertensive. Moreover, very few (36.5%) reported to have ever had a blood pressure measurement. The rising burden of CVD is compounded by a lack of integrated primary health care for early detection and treatment of people with increased risk. Many people have less access to effective and equitable health care services which respond to their needs. Capacity gaps in human resources, equipment, and drug supply, and laboratory capabilities are evident. Prevention of risk factors for CVD and provision of effective and affordable treatment to those who require it prevent disability and death and improve quality of life. The aim of this study is to improve health profiles for people with intermediate and high risk factors for CVD at the community and health facility levels. The implementation process and effectiveness of interventions will be evaluated. Methods The overall study is a type 2-hybrid stepped-wedge (SW) design. The design employs mixed methods evaluations with incremental execution and adaptation. Sequential crossover take place from control to intervention until all are exposed. The study will take place in Mukono and Buikwe districts in Uganda, home to more than 1,000,000 people at the community and primary healthcare facility levels. The study evaluation will be guided by; 1) RE-AIM an evaluation framework and 2) the CFIR a determinant framework. The primary outcomes are implementation – acceptability, adoption, appropriateness, feasibility, fidelity, implementation cost, coverage, and sustainability. Discussion The study is envisioned to provide important insight into barriers and facilitators of scaling up CVD prevention in a low income context. This project is registered at the ISRCTN Registry with number ISRCTN15848572. The trial was first registered on 03/01/2019.

Acceptability of a community cardiovascular disease prevention programme in Mukono and Buikwe districts in Uganda: a qualitative study

“…These factors could also offer an explanation for the high demand for biomedical interventions from CHWs. Cognizant of these gaps, the design of the overall project intervention incorporated a health facility intervention to build the capacity of health workers at the primary health care and higher levels to better prevent and manage NCDs [23]. The health worker training focuses on equipping them with better communication skills and improving the patient -provider and provider -CHW relationships.…”

“…The community CVD programme includes working with CHWs, existing networks and community structures to promote knowledge, improved lifestyles, risk assessment and cardiovascular health as previously described [23]. The programme involves training of CHWs to conduct health education, promote lifestyle change through motivational interviewing and goal setting techniques, screen for risk factors at the community using non laboratory tools, and conduct house-to-house visits within their communities.…”

“…Data were collected through focus group discussions (FGDs) among CHWs and community members in four selected parishes of Kyabakadde and Nabalanga in Mukono district, and Busabaga and Lugala in Buikwe district. These parishes were selected because they were scheduled to benefit from a CVD prevention programme implemented under the SPICES -Scaling up Packages of Interventions for Cardiovascular disease prevention in selected sites in Europe and sub-Saharan Africaproject [23]. In each of the parishes, four villages that had been randomly selected to receive the community intervention had their CHWs invited to participate in the FGDs.…”

Cardiovascular risk factor mapping and distribution among adults in Mukono and Buikwe districts in Uganda: small area analysis

“…The data utilised for this risk factor mapping and analysis is drawn from the baseline survey conducted in December 2018 and January 2019 to benchmark key indicators for a type 2-hybrid stepped-wedge (SW) trial reported elsewhere [6]. The baseline was conducted in 20 parishes (Fig.…”

A protocol paper: community engagement interventions for cardiovascular disease prevention in socially disadvantaged populations in the UK: an implementation research study

“…The SPICES Project is a Horizon 2020 project financed by the European Commission that aims to address the CVD burden [22]. The overall objective is to implement and evaluate a comprehensive cardiovascular disease (CVD) prevention and care program at the community level in five countries (Belgium, France, South Africa, Uganda, and UK), to identify and compare barriers and facilitators for implementation across study contexts and to develop a learning community.…”