Application of the Consolidated Framework for Implementation Research to examine nurses’ perception of the task shifting strategy for hypertension control trial in Ghana

Abstract

Background: The burden of hypertension in many low-and middle-income countries is alarming and requires effective evidence-based preventative strategies that is carefully appraised and accepted by key stakeholders to ensure successful implementation and sustainability. We assessed nurses' perceptions of a recently completed Task Shifting Strategy for Hypertension control (TASSH) trial in Ghana, and facilitators and challenges to TASSH implementation. Methods: Focus group sessions and in-depth interviews were conducted with 27 community health nurses from participating health centers and district hospitals involved in the TASSH trial implemented in the Ashanti Region, Ghana, West Africa from 2012 to 2017. TASSH evaluated the comparative effectiveness of the WHO-PEN program versus provision of health insurance for blood pressure reduction in hypertensive adults. Qualitative data were analyzed using open and axial coding techniques with emerging themes mapped onto the Consolidated Framework for Implementation Research (CFIR). Results: Three themes emerged following deductive analysis using CFIR, including: (1) Patient health goal settingrelative priority and positive feedback from nurses, which motivated patients to make healthy behavior changes as a result of their health being a priority; (2) Leadership engagement (i.e., medical directors) which influenced the extent to which nurses were able to successfully implement TASSH in their various facilities, with most directors being very supportive; and (3) Availability of resources making it possible to implement the TASSH protocol, with limited space and personnel time to carry out TASSH duties, limited blood pressure (BP) monitoring equipment, and transportation, listed as barriers to effective implementation.

Process evaluation of complex interventions in non-communicable and neglected tropical diseases in low- and middle-income countries: a scoping review

“…When exploring how the theories or frameworks were used, 53 of 81 (66%) studies applied the given theory or framework; 15 (19%) studies were informed by the theory or framework; 11 of 81 (14%) studies tested the theory or framework; and 2 studies used more than one, for example, applied and tested the theory. Some examples of the use of theories and frameworks are Morrison et al 41 who used the MRC framework to describe the implementation and fidelity of a Participatory Learning Action in an RCT in diabetes in Bangladesh; Gyamfi et al 42 who developed their interview guide using the CFIR focusing on resources needed to implement a task-shifting intervention in Ghana; and Hashimoto et al 43 who analysed the process and effects of implementing a vector surveillance system for Chagas diseases in the health centres from Honduras using the PRECEDE-PROCEED model ( online supplemental material 5 ).…”

Constructing a Nurse-led Cardiovascular Disease Intervention in Rural Ghana: A Qualitative Analysis

“…However, these interventions require training, materiel, and especially human resources, and their scope of CVD care and efficacy in achieving it depend on how these resources are applied. For example, studies in Cameroon and Nigeria demonstrate that nonphysicians can intervene to lower blood pressure, and a nurse-led hypertension intervention in the Ashanti region of Ghana was positively received by nonphysician providers [39][40][41]. But the first of these interventions struggled with frequent reassignment of scant nurse providers [39].…”

“…Conversely, the second benefited from pharmacists adjusting hypertension medications in lieu of overworked physicians [40]. And prior work in Ghana demonstrated that CHPS nurses can identify and refer patients with hypertension to nearby clinics [13], but personnel time, equipment, and transportation remain as scale-up threats [41].…”

Using implementation science theories and frameworks in global health

“…The CFIR was for example adapted to study acceptability of a health intervention in Zambia 73 or to investigate sustainability in Ghana. 74 The CFIR may be mobilised to support data collection according to a deductive approach and/or at the data analysis stage to sort out data collected according to an inductive approach. 72 Besides descriptive frameworks, researchers may also use conceptual or theoretical frameworks, which are analytical.…”