Barriers and facilitators to the implementation of a community-based hypertension improvement project in Ghana: a qualitative study of ComHIP

Abstract

Background: Globally, hypertension is a leading cause of cardiovascular disease and mortality, with the majority of deaths occurring in low-and middle-income countries. Because the burden of hypertension is increasing in low resource settings with restricted infrastructure, it is imperative that new models for hypertension care are realised. One such model is the Community-based Hypertension Improvement Project (ComHIP) which employs a community-based method of task-shifting for managing hypertension. This study is a qualitative analysis of the barriers and facilitators of the main components of ComHIP.Methods: We purposively selected 55 informants for semi-structured interviews or focus group discussions, which were carried out bythree trained local researchers in Krobo, Twi or English. Informants included patients enrolled in ComHIP, health care providers and Licensed Chemical Sellers trained by ComHIP, and Ghana Health Service employees. Data were analysed using a multi-step thematic analysis. Results: While results of the effectiveness of the intervention are pending, overall, patients and nurses reported positive experiences within ComHIP, and found that it helped enable them to manage their hypertension. Healthcare providers appreciated the additional training, but had some gaps in their knowledge. Ghana Health Service employees were cautiously optimistic about the programme, but expressed some worries about the sustainability of the programme. Many informants expressed concerns over the inability of community nurses and workers to dispense anti-hypertensives, due to legal restrictions. Conclusions: The WHO recommends task-sharing as a technique for managing chronic conditions such as hypertension in resource constrained settings. ComHIP presents an example of a task-sharing programme with a high level of acceptability to all participants. Going forward, we recommend greater levels of communication and dialogue to allow community-based health workers to be allowed to dispense anti-hypertensives.

Scoping review of community health participatory research projects in Ghana

“…Table 4 summarises the number of studies relevant to each of the seven levels of community participation across the four phases of project development. The highest levels of participation (level 5 to level 7) were found in the diagnosis phase for two studies (13.3%) [ 30 , 31 ], in the development phase for four studies (26.7%) [ 8 , 29 , 30 , 32 ] in the implementation phase for five studies (33.3%) [ 8 , 29 , 30 , 32 , 33 ] and in the evaluation phase for three studies (17.6%) [ 31–33 ]. Overall, levels of participation were highest in one of the studies on healthcare quality, although evaluation was scored as ‘unknown’ [ 30 ].…”

“…The participation of the community was described with insufficient detail to be assessed (unknown category) for one study in the Development phase (5.8%) [ 33 ] and one (5.8%) in the Evaluation phase [ 30 ]. Overall, levels of community participation across all studies were assessed as low.…”

“…Participants who enrolled earlier were much more likely to stay in the programme than those who enrolled later. Adler et al (2020) [ 33 ] Qualitative; individual interviews and focus group discussions Analysed the barriers and facilitators of the main components of ComHIP The effectiveness of the intervention was yet to be determined but overall, patients and nurses reported positive experiences within ComHIP and that it helped them manage their hypertension. Adongo et al (2014) [ 29 ] Experimental (quasi-experiment design) Evaluated whether the design and implementation of CHPS are transferable to an urban setting.…”

Evaluation of hypertension screening guidelines implementation at the public health centers in Tabanan District, Bali, Indonesia

“…22 Similarly, community-based hypertension screening and treatment activities in Ghana also encountered problems, one of which was the availability of facilities and infrastructure. 23 The basic examinations expected to be performed at the PHCs included blood pressure, height, weight, waist circumference, and hip circumference measurements. These measurements required simple tools.…”

“…A study in Ghana found that health workers thought the activities conducted outside of working hours should be balanced with appropriate compensation. 23 Other recommendation is to provide service at two times schemes, morning for elderly or non-working target and evening for younger groups.…”