Capacity and Readiness for Implementing Evidence-Based Task-Strengthening Strategies for Hypertension Control in Ghana: A Cross-Sectional Study

Abstract

Background: Assessing the practice capacity for hypertension management and control within communitybased health planning and services system is an important step toward implementing evidence-based interventions to reduce uncontrolled hypertension at the community level.Objectives: To assess the capacity and readiness of community health workers to implement a taskstrengthening strategy for hypertension control (TASSH) at the community level.Methods: This was a cross-sectional study guided by the Consolidated Framework for Implementation Research conducted among community health workers in 6 contiguous districts within the Brong-Ahafo Region of Ghana. Study variables were described using frequency tables.Results: A total of 179 community health officers (CHOs) were interviewed. The majority of respondents knew lifestyle-related messages to be provided to their clients such as heart-healthy diets (91.6%, n ¼ 164), physical activity (90.5%, n ¼ 162), and low sodium intake (88.3%, n ¼ 158), but not about other lifestyle-modifying messages such as caffeine reduction (46.4%, n ¼ 83). The majority (79%) of the respondents did not know the names of the first-line hypertension medications. Fifty-one percent of respondents did not know about the blood pressure threshold for initiation of blood pressure management. About 90% of respondents had not been trained on hypertension management. More than 80% are however motivated to implement the TASSH intervention. Conclusions:The majority of CHOs in this study were aware of lifestyle modifications such as diet modifications and increase in physical activity. However, their knowledge was limited in the blood pressure threshold for initiating treatment and in the knowledge of first-line hypertension medication, irrespective of the number of years practiced. Training on hypertension is also low. However, CHOs are motivated to control hypertension at the community level. Community-level interventions such as TASSH can leverage on their motivation to demonstrate an impact on hypertension control.

Uptake of Task-Strengthening Strategy for Hypertension (TASSH) control within Community-Based Health Planning Services in Ghana: study protocol for a cluster randomized controlled trial

“…Assessment of adoption ratings on TASSH will be made at 12 months post-randomization, and sustainability will be assessed at 24 months post-randomization. Group B will receive usual care practices (screen, counsel, and refer patients without practice facilitation) at CHPS zones [ 27 ]. Adoption ratings of TASSH will be assessed for group B at 12 months post-randomization, and sustainability assessment will occur at 24 months post-randomization.…”

“…The study is currently ongoing in 70 of the 97 CHPS zones in three contiguous districts within the Bono East Region (Kintampo North, Kintampo South District, and Nkoranza North District) of Ghana. The study area is predominantly rural and mostly farming communities [26,27]. About 40% of the adult population have no education.…”

Stakeholder Engagement in Late-Stage Translation Research and Implementation Science: Perspectives From the National Heart, Lung, and Blood Institute

“…The program recognized that success will require patients, health care providers, health system, and leadership to recognize the immediate and long-term benefits of the new intervention. In Ghana, stakeholders are identifying facilitators and barriers to the adoption of evidence-based taskshifting strategies for hypertension management [20,21]. Stakeholders include community health officers, administrators, policymakers from the Ghana Health Services, researchers, and community health officers in communitybased regional health planning services [20,21].…”

“…In Ghana, stakeholders are identifying facilitators and barriers to the adoption of evidence-based taskshifting strategies for hypertension management [20,21]. Stakeholders include community health officers, administrators, policymakers from the Ghana Health Services, researchers, and community health officers in communitybased regional health planning services [20,21]. In Guatemala, patients, family members, community members, health care providers, and Ministry of Health officials from 5 districts in Guatemala City are being engaged to help define details of the planned evidence-based interventions to be studied [16].…”

Organizational readiness to implement task-strengthening strategy for hypertension management among people living with HIV in Nigeria

“…Identifying potential obstacles may enable the tailoring of the intervention based on available resources [ 15 ]. While evidence-based approaches, such as task-strengthening (whereby specific duties are transferred to health workers with shorter training or fewer qualifications), thereby increasing their effectiveness, are well known for HTN management and care [ 16 , 17 ], implementation of such approaches has been sub-optimal. To our knowledge, organizational readiness has not been considered to integrate evidence-based HTN interventions within HIV care in Nigeria using evidence-based task-strengthening approaches.…”