Barriers Influencing Linkage to Hypertension Care in Kenya: Qualitative Analysis from the LARK Hypertension Study

Naanyu, Violet; Vedanthan, Rajesh; Kamano, Jemima H.; Rotich, Jackson; Lagat, Kennedy K; Kiptoo, Peninah; Kofler, Claire; Mutai, Kennedy; Bloomfield, Gerald S.; Menya, Diana; Fuster, Valentín; Horowitz, Carol R.; Inui, Thomas S.

doi:10.1007/s11606-015-3566-1

Cited by 52 publications

(51 citation statements)

References 36 publications

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“…poverty), and health system factors (e.g. popularity of alternative therapies) [19]. In a study from Uganda, where they implemented an intervention that included a transport voucher to a health facility to enhance healthcare seeking, a very high proportion of individuals attended a healthcare provider for hypertension (83%) within six months after a community-based screening [12].…”

Section: Discussionmentioning

confidence: 99%

Low uptake of hypertension care after community hypertension screening events in Lagos, Nigeria

Nelissen

Okwor

Khalidson³

et al. 2018

Global Health Action

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Background: In Lagos, Nigeria, approximately 33% of the population suffers from hypertension, yet antihypertensive treatment coverage is low. To improve access to care, a decentralized pharmacy-based hypertension care model was piloted. This study reports on the recruitment strategies used and is part of a larger study to evaluate the feasibility of the care model. Objective: To describe our experience executing three different strategies to recruit hypertensive patients in the program: community hypertension screenings, hospital and pharmacy referral. Methods: Individuals with elevated blood pressure and no history of cardiovascular disease were referred to the program’s recruitment days to see a medical doctor for hypertension diagnosis and enrollment. Individuals were referred from community screenings, tertiary hospital outpatient clinics, and pharmacies participating in the program. For the community screenings, we report the number needed to screen (NNS) to find one individual with elevated blood pressure, the NNS to enroll one individual in the program, and factors associated with enrollment in the program among participants referred. Results: We recruited 226 individuals (69%) in the program via the pharmacies, 97 (30%) via the community screenings, and 2 (<1%) via hospital referral. At the community screenings 3,204 individuals participated, 729 (23%) had elevated blood pressure and 618 (85%) were eligible for referral of whom 142 (23%) visited the recruitment days, and 97 (16%) enrolled. The NNS to find one individual with elevated blood pressure was 5, and the NNS to enroll one individual was 34. Enrollment in the program was associated with advancing age, blood pressure ≥160/100 and currently using antihypertensive medication. Conclusions: Despite the potential attractiveness of community screenings to identify and refer individuals with hypertension, enrollment in the program was low. For future programs we recommend pharmacy referral as individuals seem more inclined to access care through healthcare providers they are familiar with.

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Section: Discussionmentioning

confidence: 99%

Low uptake of hypertension care after community hypertension screening events in Lagos, Nigeria

Nelissen

Okwor

Khalidson³

et al. 2018

Global Health Action

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“…35,36 It is possible that the HIV stigma reported in this community was related to the history of AMPATH providing primarily HIV care in the local health facilities. HIV stigma can be countered by appealing to other emotional factors such as mortality concerns, as expressed by participants.…”

Section: Nurse Management Of Hypertension In Kenyamentioning

confidence: 99%

Barriers and Facilitators to Nurse Management of Hypertension: A Qualitative Analysis from Western Kenya

et al. 2016

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Background: Hypertension is the leading global risk for mortality. Poor treatment and control of hypertension in low- and middle-income countries is due to several reasons, including insufficient human resources. Nurse management of hypertension is a novel approach to address the human resource challenge. However, specific barriers and facilitators to this strategy are not known. Objective: To evaluate barriers and facilitators to nurse management of hypertensive patients in rural western Kenya, using a qualitative research approach. Methods: Six key informant interviews (five men, one woman) and seven focus group discussions (24 men, 33 women) were conducted among physicians, clinical officers, nurses, support staff, patients, and community leaders. Content analysis was performed using Atlas.ti 7.0, using deductive and inductive codes that were then grouped into themes representing barriers and facilitators. Ranking of barriers and facilitators was performed using triangulation of density of participant responses from the focus group discussions and key informant interviews, as well as investigator assessments using a two-round Delphi exercise. Results: We identified a total of 23 barriers and nine facilitators to nurse management of hypertension, spanning the following categories of factors: health systems, environmental, nurse-specific, patient-specific, emotional, and community. The Delphi resultswere generally consistent with the findings from the content analysis. Conclusion: Nurse management of hypertension is a potentially feasible strategy to address the human resource challenge of hypertension control in low-resource settings. However, successful implementation will be contingent upon addressing barriers such as access to medications, quality of care, training of nurses, health education, and stigma. Ethn Dis. 2016;26(3):315-322; doi:10.18865/ed.26.3.315.

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“…Recent studies demonstrate that programs for control of HIV can be leveraged for the control of chronic diseases such as HTN [18,19], though quantitative data on care linkage, blood pressure control, and other operational outcomes are scarce [20,21,22]. Pilot projects to date have been small and local in scope, with mixed results in linking HTN patients to care and achieving blood pressure control [2,3,4,23,24,25,26]. These inconsistent findings may be due to incomplete program fidelity: projects designed to screen and treat patients for HTN and CVD are not consistently implemented as intended, precluding accurate assessment of their impact.…”

Section: Introductionmentioning

confidence: 99%

Hypertension testing and treatment in Uganda and Kenya through the SEARCH study: An implementation fidelity and outcome evaluation

Heller¹,

Balzer

Kazi

et al. 2020

PLoS ONE

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Background Hypertension (HTN) is the single leading risk factor for human mortality worldwide, and more prevalent in sub-Saharan Africa than any other region [1]-although resources for HTN screening, treatment, and control are few. Most regional pilot studies to leverage HIV programs for HTN control have achieved blood pressure control in half of participants or fewer [2,3,4]. But this control gap may be due to inconsistent delivery of services, rather than ineffective underlying interventions. Methods We sought to evaluate the consistency of HTN program delivery within the SEARCH study (NCT01864603) among 95,000 adults in 32 rural communities in Uganda and Kenya from 2013-2016. To achieve this objective, we designed and performed a fidelity evaluation of the step-by-step process (cascade) of HTN care within SEARCH, calculating rates of HTN screening, linkage to care, and follow-up care. We evaluated SEARCH's assessment of each participant's HTN status against measured blood pressure and HTN history. Findings SEARCH completed blood pressure screens on 91% of participants. SEARCH HTN screening was 91% sensitive and over 99% specific for HTN relative to measured blood pressure and patient history. 92% of participants screened HTN+ received clinic appointments, and

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Barriers Influencing Linkage to Hypertension Care in Kenya: Qualitative Analysis from the LARK Hypertension Study

Cited by 52 publications

References 36 publications

Low uptake of hypertension care after community hypertension screening events in Lagos, Nigeria

Low uptake of hypertension care after community hypertension screening events in Lagos, Nigeria

Barriers and Facilitators to Nurse Management of Hypertension: A Qualitative Analysis from Western Kenya

Hypertension testing and treatment in Uganda and Kenya through the SEARCH study: An implementation fidelity and outcome evaluation

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