PT452 Barriers and Facilitators to Nurse Management of Hypertension in Rural Western Kenya: A Qualitative Analysis

Vedanthan, Rajesh; Tuikong, Nelly; Hutchinson, Claire; Blank, Evan; Kamano, Jemima; Kimaiyo, Sylvester; Inui, Thomas S.; Horowitz, Carol R.; Fuster, Valentı́n

doi:10.1016/j.gheart.2014.03.2157

Cited by 4 publications

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“…Stigma has commonly been associated with infectious diseases such as HIV, and HIV-related stigma and discrimination have been well established as barriers to accessing HIV prevention, treatment, and support services (18). Our group has previously reported that co-locating hypertension management in the same facility as HIV care can present challenges due to HIV-related stigma (19). However, in the current study, participants described NCD-speci c stigma that could act as a barrier to care.…”

Section: Discussionmentioning

confidence: 63%

Chronic Disease Stigma, Skepticism of the Health System, and Socio-economic Fragility: Qualitative Assessment of Factors Impacting Receptiveness to Group Medical Visits and Microfinance for Non-Communicable Disease Care in Rural Kenya

Dong

Leung

Naert

et al. 2020

Preprint

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Background: Non-communicable diseases (NCDs) are the leading cause of mortality in the world, and innovative approaches to NCD care delivery are being actively developed and evaluated. Combining the group-based experience of microfinance and group medical visits is a novel approach to NCD care delivery that has demonstrated beneficial impact in previous pilot studies. However, the contextual factors, facilitators, and barriers impacting wide-scale implementation of these approaches within a low- and middle-income country setting are not well known.Methods: Two types of qualitative group discussion were conducted: 1) mabaraza (singular, baraza), a traditional East African community gathering used to discuss and exchange information in large group settings; and 2) focus group discussions (FGDs) among rural clinicians, community health workers, microfinance group members, and patients with NCDs. Trained research staff members led the discussions using structured question guides. Content analysis was performed with NVivo using deductive and inductive codes that were then grouped into themes.Results: We conducted 5 mabaraza and 16 FGDs. A total of 205 individuals (113 men and 92 women) participated in the mabaraza, while 162 individuals (57 men and 105 women) participated in the FGDs. Participants expressed interest in participating in microfinance and group medical visits, but cited several key challenges: 1) stigma of chronic disease, 2) earned skepticism of the health system, and 3) socio-economic fragility.Conclusions: Our qualitative study revealed and illuminated actionable factors that could impact the success of implementation of group medical visits and microfinance initiatives for NCD care. While several challenges were highlighted, participants also felt that planned interventions could address and mitigate the impact of these dynamic factors. We anticipate that our approach and analysis provides new insights and methodological techniques that will be relevant to other low-resource settings worldwide.Trial Registration: Clinicaltrials.gov, NCT02501746, registration date: July 17, 2015

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Section: Discussionmentioning

confidence: 63%

Chronic Disease Stigma, Skepticism of the Health System, and Socio-economic Fragility: Qualitative Assessment of Factors Impacting Receptiveness to Group Medical Visits and Microfinance for Non-Communicable Disease Care in Rural Kenya

Dong

Leung

Naert

et al. 2020

Preprint

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“…First, the search strategy excluded studies that did not provide population-representative estimates of hypertension management service coverage. Qualitative studies that examined the extent of provider knowledge relevant to hypertension treatment were therefore excluded [ 54 , 55 ]. Several representative facility-based studies examined aspects of quality hypertension care, but without linking to a population-level survey, the percent of the population receiving these services, and thus the effective coverage, was unknown [ 56 , 57 ].…”

Section: Discussionmentioning

confidence: 99%

Evidence for an expanded hypertension care cascade in low- and middle-income countries: a scoping review

Peters

Noonan

Rao

et al. 2022

BMC Health Serv Res

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Background With nearly 90% of annual hypertension-related deaths occurring in low- and middle-income countries (LMICs), there is an urgent need to measure the coverage of health services that effectively manage hypertension. However, there is little agreement on how to define effective coverage and the existing hypertension care cascade (hypertension prevalence, percent aware, percent treated, and percent controlled) does not account for the quality of care received by patients. This study reviews definitions of effective coverage and service quality for hypertension management services and proposes an expanded hypertension care cascade to improve measurement of health systems performance. Methods A systematic scoping review of literature published in six electronic databases between January 2000 and October 2020 identified studies that defined effective coverage of hypertension management services or integrated dimensions of service quality into population-based estimates of hypertension management in LMICs. Findings informed an expanded hypertension care cascade from which quality-adjusted service coverage can be calculated to approximate effective coverage. Results The review identified 18 relevant studies, including 6 that defined effective coverage for hypertension management services and 12 that reported a measure of service quality in a population-based study. Based on commonly reported barriers to hypertension management, new steps on the proposed expanded care cascade include (i) population screened, (ii) population linked to quality care, and (iii) population adhering to prescribed treatment. Conclusion There is little consensus on the definition of effective coverage of hypertension management services, and most studies do not describe the quality of hypertension management services provided to populations. Incorporating aspects of service quality to the hypertension care cascade allows for the calculation of quality-adjusted coverage of relevant services, enabling an appropriate measurement of health systems performance through effective coverage.

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“…First, the search strategy excluded studies that did not provide population-representative estimates of hypertension management service coverage. Qualitative studies that examined the extent of provider knowledge relevant to hypertension treatment were therefore excluded (50,51). Several representative facility-based studies examined aspects of quality hypertension care, but without linking to a populationlevel survey, the percent of the population receiving these services, and thus the effective coverage, was unknown (52,53).…”

Section: Discussionmentioning

confidence: 99%

Evidence for an Expanded Hypertension Care Cascade in Low- and Middle-Income Countries: A Scoping Review

Peters

Noonan

Rao

et al. 2022

Preprint

View full text Add to dashboard Cite

Background With nearly 90% of annual hypertension-related deaths occurring in low- and middle-income countries (LMICs), there is an urgent need to measure the coverage of health services that effectively manage hypertension. However, there is little agreement on how to define effective coverage and the existing hypertension care cascade (hypertension prevalence, percent aware, percent treated, and percent controlled) does not account for the quality of care received by patients. This study reviews definitions of effective coverage and service quality for hypertension management services and proposes an expanded hypertension care cascade to improve measurement of health systems performance. Methods A systematic scoping review of literature published in six electronic databases between January 2000 and October 2020 identified studies that defined effective coverage of hypertension management services or integrated dimensions of service quality into population-based estimates of hypertension management. Findings informed an expanded hypertension care cascade from which quality-adjusted service coverage can be calculated to approximate effective coverage. Results The review identified 20 relevant studies, including 8 that defined effective coverage for hypertension management services and 12 that reported a measure of service quality in a population-based study. Based on commonly reported barriers to hypertension management, new steps on the proposed expanded care cascade include (i) population screened, (ii) population linked to quality care, and (iii) population adhering to prescribed treatment. Conclusion There is little consensus on the definition of effective coverage of hypertension management services, and most studies do not describe the quality of hypertension management services provided to populations. Incorporating aspects of service quality to the hypertension care cascade allows for the calculation of quality-adjusted coverage of relevant services, enabling an appropriate measurement of health systems performance through effective coverage.

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PT452 Barriers and Facilitators to Nurse Management of Hypertension in Rural Western Kenya: A Qualitative Analysis

Cited by 4 publications

References 0 publications

Chronic Disease Stigma, Skepticism of the Health System, and Socio-economic Fragility: Qualitative Assessment of Factors Impacting Receptiveness to Group Medical Visits and Microfinance for Non-Communicable Disease Care in Rural Kenya

Chronic Disease Stigma, Skepticism of the Health System, and Socio-economic Fragility: Qualitative Assessment of Factors Impacting Receptiveness to Group Medical Visits and Microfinance for Non-Communicable Disease Care in Rural Kenya

Evidence for an expanded hypertension care cascade in low- and middle-income countries: a scoping review

Evidence for an Expanded Hypertension Care Cascade in Low- and Middle-Income Countries: A Scoping Review

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