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

Abstract

Background: Cardiovascular diseases (CVDs) are on the rise in many low-and middle-income countries where 80% of related deaths are registered. Community CVD prevention programmes utilizing self-care approaches have shown promise in contributing to population level reduction of risk factors. However, the acceptability of these programmes, which affects their uptake and effectiveness, is unknown including in the sub-Saharan Africa context. This study used the Theoretical Framework of Acceptability to explore the prospective acceptability of a community CVD prevention programme in Mukono and Buikwe districts in Uganda. Methods: This qualitative descriptive study was conducted in March 2019 among community health workers (CHWs), who would implement the intervention and community members, the intervention recipients, using eight focus group discussions. All discussions were audio-recorded, transcribed verbatim and analysed thematically guided by the theoretical framework. Results: CHWs and community members reported high eagerness to participate in the programme. Whereas CHWs had implemented similar community programmes and cited health promotion as their role, community members looked forward to health services being brought nearer to them. Although the intervention was preventive in nature, CHWs and community members expressed high interest in treatments for risk factors and were skeptical about the health system capacity to deliver them. CHWs anticipated barriers in mobilising communities who they said sometimes may not be cooperative while community members were concerned about failing to access treatment and support services after screening for risk factors. The major cost to CHWs and community members for engaging in the intervention was time that they would have dedicated to income generating activities and social events though CHWs also had the extra burden of being exemplary. CHWs were confident in their ability to deliver the intervention as prescribed if well trained, supported and supervised, and community members felt that if provided sufficient information and supported by CHWs, they could change their behaviours. Conclusions: The community CVD prevention programme was highly acceptable among CHWs and community members in Mukono and Buikwe districts of Uganda amidst a few burdens and opportunity costs. Suggestions made by study participants to improve programme effectiveness informed programme design and implementation for impact.

Access to and use of sexual and reproductive health services among street children in Uganda: Does Migration matter?

“…As such, street children must dully navigate the challenges of migration while adapting to the new street culture, new language and socio-emotional culture (49)(50). Studies elsewhere have yielded similar results with limited access to health and reproductive care services reported among the urban rural youth, migrant sex workers and out-of-school adolescents (38) (51).…”

“…show that 61.99% (n=318) of the street children had received at least one component of the SRH services in the last twelve months while 11.50% (n=29) had received all the three SRH services (STI screening, HIV testing & FP use). Across all the SRH service components, use of services was generally lower among migrant compared to the non-migrant street children, with51.76% migrants having ever tested for HIV in the past 12 months compared to 67.25% of the lifelong native street children; use of any modern family planning method was low with 14.14% of migrant street children compared to 22.71% of non-migrant street children. Similarly, prevalence of STI screening was lower for migrant street children compared to lifelong native street children.…”

Cardiovascular disease prevention knowledge and associated factors among adults in Mukono and Buikwe districts in Uganda

“…Over 80% of our respondent households had a mobile phone whose ownership was associated with being knowledgeable thus increasing the potential for mobile health interventions, which have shown promise for CVD prevention in low- and middle- income countries [ 26 , 27 ]. Also, although community health workers were a less reported avenue for advice, our previous research has shown that they are acceptable [ 28 ] and thus could be a key resource to target to improve community awareness on CVD especially in low income settings through their routine health promotion activities. Indeed, systematic reviews have demonstrated that community health workers could be effective in tackling the burden of CVD in both low- and- middle income countries [ 29 ].…”

Barriers and facilitators of implementation of a community cardiovascular disease prevention programme in Mukono and Buikwe districts in Uganda using the Consolidated Framework for Implementation Research

“…Moreover, community approaches have been successful in supporting infectious disease control efforts and improvement of health outcomes in SSA [16,17]. However, there is limited evidence of replication of similar efforts for NCDs even with increasing evidence of the acceptability of such programmes [18].…”