Adapting a nurse-led primary care initiative to cardiovascular disease control in Ghana: A qualitative study

Abstract

Background CVD is the leading cause of morbidity and mortality worldwide, and its prevalence is rising in Ghana. The Community-Based Health Planning and Services (CHPS) initiative has used community-level clinics, home visits by nurses, and outreach services to decrease maternal and child mortality across Ghana. However, CHPS currently lacks capacity to screen for or treat CVD and its risk factors. Methods We conducted in-depth interviews (IDIs) with 21 nurse community health officers (CHOs) and 10 supervising sub-district leaders (SDLs) to identify factors that constrain or facilitate CHPS screening and treatment for CVD through the World Health Organization’s HEARTS protocol in the rural communities of the Kassena-Nankana East and West districts of Ghana. We transcribed audio recordings of the interviews, coded their content, and analyzed codes for key themes. Results Respondents spoke to CVD care barriers across three themes: community demand for CVD care; community access to CVD care; and provider capacity to render CVD care. CHOs and SDLs noted that community members were often unaware of CVD, despite high reported local prevalence of risk factors such as alcohol use and stress. Moreover, community members were unable to travel to or pay for treatment once diagnosed. CHOs lacked training on CVD and its risk factors, as well as medications and supplies to treat conditions such as high blood pressure. However, CHOs and SDLs recognized the importance of CVD care, expressed interest in acquiring further training, and emphasized the need to improve logistical support for primary care as a precondition for CVD care. Conclusion Nurses and supervisors associated with the CHPS program voiced multiple obstacles to CVD care, but also listed several feasible steps to address them. Initiatives such as CVD-focused training; provision of essential CVD equipment and pharmaceuticals; community education campaigns; and transportation to aid patients and providers could address these barriers. Future work will explore the feasibility and acceptability of these interventions among staff and community members, in preparation for a locally adapted pilot initiative drawing from the HEARTS initiative designed to control CVD risk factors such as hypertension, depression, and alcohol abuse.