Monitoring Study Participants and Implementation with Phone Calls to Support Hypertension Control During the COVID-19 Pandemic: The Case of a Multicomponent Intervention Trial in Guatemala

Hernández-Galdamez, Diego; Mansilla, Kristyne; Peralta, Ana Lucía Jiménez; Rodríguez-Szaszdi, Javier; Ramírez, Juan Camilo; Roche, Dina; Gulayin, Pablo; Ramírez‐Zea, Manuel; He, Jiang; Irazola, Vilma; Fort, Meredith P.

doi:10.5334/gh.954

Cited by 9 publications

(8 citation statements)

References 9 publications

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“…Simultaneously, providers of GBV prevention and response services have been tasked with providing quality care in the face of significant resource challenges, slowed coordination, and minimal protections for their own physical and mental health. Similarly to other studies that have documented challenges in GBV service provision during the COVID-19 pandemic [ 18 , 32 , 40 , 45 , 46 , 47 , 48 , 49 ], findings from this study highlight the inordinate challenges faced by providers (lack of funding, PPE shortages, limited technological infrastructure, and poor cross-sectoral communication and collaboration) and the exacerbation of poverty and adversity faced by survivors. Efforts to strengthen the GBV prevention and response system should include, among other strategies, strengthening partnerships and critical infrastructure for GBV prevention/response, public transportation, and telecommunications, particularly among rural areas and Indigenous populations.…”

Section: Discussionsupporting

confidence: 74%

“…Further, mechanisms of GBV service delivery were forced to shift abruptly in Guatemala, particularly with the public transportation suspensions that went into effect from March to August 2020 [ 47 ]. These limitations on public transportation made it difficult for survivors to report violence or utilize services they would ordinarily have had in-person access to.…”

Section: Discussionmentioning

confidence: 99%

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“At the Root of COVID Grew a More Complicated Situation”: A Qualitative Analysis of the Guatemalan Gender-Based Violence Prevention and Response System during the COVID-19 Pandemic

Vahedi

Seff

Rodriguez

et al. 2022

IJERPH

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A growing body of literature has documented an increased risk of gender-based violence (GBV) within the context of COVID-19 and service providers’ reduced capacity to address this vulnerability. Less examined are the system-level impacts of the pandemic on the GBV sector in low- and middle-income countries. Drawing on the perspectives of 18 service providers working across various GBV-related sectors in Guatemala, we explored how the Guatemalan GBV prevention and response system operated during the COVID-19 pandemic. Findings highlight that the pandemic reinforced survivors’ existing adversities (inadequate transportation access, food insecurity, digital divides), which subsequently reduced access to reporting, justice, and support. Consequently, the GBV prevention and response system had to absorb the responsibility of securing survivors’ essential social determinants of health, further limiting already inflexible budgets. The pandemic also imposed new challenges, such as service gridlocks, that negatively affected survivors’ system navigation and impaired service providers’ abilities to efficiently receive reports and mobilize harm reduction and prevention programming. The findings underscore the systemic challenges faced by GBV service providers and the need to incorporate gender mainstreaming across public service sectors—namely, transportation and information/communication—to improve lifesaving GBV service delivery for Guatemalan survivors, particularly survivors in rural/remote regions.

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Section: Discussionsupporting

confidence: 74%

Section: Discussionmentioning

confidence: 99%

“At the Root of COVID Grew a More Complicated Situation”: A Qualitative Analysis of the Guatemalan Gender-Based Violence Prevention and Response System during the COVID-19 Pandemic

Vahedi

Seff

Rodriguez

et al. 2022

IJERPH

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“…78 Additionally, WhatsApp messages, audio, and video calls improved patients’ access in remote communities. 68 A cross-sectional analysis of an ongoing randomized trial in Guatemala 80 reported on the success of telephone calls for verifying delivery of anti-hypertensive medication (e.g., 73% in the intervention group vs. 51% in the control group). Remote healthcare strategies were also used for patient education.…”

Section: Resultsmentioning

confidence: 99%

“…103 A study from Guatemala used an integrated intervention approach, including patient health coaching and home blood pressure monitoring in rural communities, and reported fewer problems with antihypertensive medication availability. 80…”

Section: Resultsmentioning

confidence: 99%

Disruption to diabetes and hypertension care during the COVID-19 pandemic in Latin America and the Caribbean and mitigation approaches: A Scoping Review

Ogungbe,

Jabakhanji,

Mehta

et al. 2024

Preprint

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Summary Background The COVID-19 pandemic disrupted care for non-communicable diseases globally. This study synthesizes evidence on disruptions to primary care, focusing on hypertension and diabetes care and mitigation approaches taken during the pandemic in Latin America and the Caribbean (LAC). Methods We conducted a scoping review, searching nine electronic databases for studies from January 2020 to December 2022 on COVID-19-related primary care disruptions and interventions, including studies on hospital-based interventions given their relevance to the pandemic response in LAC. We adapted the Primary Health Care Performance Initiative framework to develop our search strategy and synthesize data. For studies reporting interventions, we included studies conducted outside of LAC. Findings Of 33,510 references screened, 388 studies were included (259 reported disruptions in LAC, 61 interventions in LAC, 63 interventions outside LAC, and five interventions from countries within and outside LAC), with three-quarters presenting data from Brazil, Argentina, Mexico, and Peru; few studies focused on rural areas. Additionally, the few studies that adequately quantified care disruptions reported a reduction in hypertension and diabetes control during the pandemic (e.g., hypertension control rate decreased from 68% to 55% in Mexico). Frequently reported causes of disruption included burnout and mental health challenges among healthcare workers (with disproportionate effects by type of worker), reduced medication supplies, and reduced frequency of clinic visits by patients (e.g., due to financial constraints). The most reported interventions included remote care strategies (e.g., smartphone applications, virtual meeting platforms) and mental health programs for healthcare workers. Remote care strategies were deemed feasible for care delivery, triaging, and clinical support for non-physicians. Patients were generally satisfied with telemedicine, whereas providers had mixed perceptions. Robust evidence on the effectiveness of remote care strategies for diabetes and hypertension care was unavailable in LAC. Interpretation Hypertension and diabetes control appeared to worsen in LAC during the pandemic. Major reported causes of care disruptions were workforce issues, reduced medication supply, and changes in patient perceptions of seeking and receiving primary healthcare. Remote care strategies were feasible for various purposes and were well received by patients. However, the lack of data on intervention effectiveness underscores the importance of strengthening research capacity to generate robust evidence during future pandemics. Developing resilient healthcare systems able to provide care for hypertension and diabetes during future pandemics will depend on investment in the healthcare workforce, medical supply chain, health data and research infrastructure, and technology readiness.

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“…Additionally, this particular assessment did not include perspectives from program recipients (i.e. patients), although our study team has captured patient perspectives in a different analysis (25).…”

Section: Discussionmentioning

confidence: 99%

Assessing the implementation of a multi-component hypertension program in a Guatemalan under-resourced dynamic context: An application of the RE-AIM/PRISM extension for sustainability and health equity

Paniagua-Ávila

Shelton

Guzman

et al. 2023

Preprint

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Background: The COVID-19 pandemic necessitated rapid changes in the delivery of care across public primary care settings in rural Guatemala in 2020. In response, a hypertension program implemented within the public primary care system required multiple adaptations, providing an illustrative example of dynamic implementation amidst changing context in an under-resourced setting. This study describes the evolvability of an evidence-based intervention (EBI; protocol-based hypertension treatment) and one of its main implementation strategies (team-based collaborative care) during the COVID-19 pandemic and discusses implications for health equity and sustainability. Methods: This convergent mixed methods analysis assessed implementation across five Ministry of Health districts during the initial phase of the pandemic. Qualitative and quantitative data were collected, analyzed, and integrated, informed by the RE-AIM (Reach, Effectiveness, Adoption, Implementation Maintenance) Framework’s extension for sustainability, and its contextual enhancement, PRISM (Pragmatic, Robust, Implementation and Sustainability Model). For RE-AIM, we focused on the “Implementation” domain, operationalizing it qualitatively as continued delivery and adaptations to the EBI and implementation strategy, and quantitatively as the extent of delivery over time. We conducted 18 in-depth interviews with health providers / administrators (n=8) and study staff (n=10) and performed a matrix-based thematic-analysis. Qualitative results informed the selection of quantitative implementation summarized as behavior over time graphs. Quantitative implementation data and illustrative quotes are presented as joint displays. Results: In relation to implementation, several organic adaptations hindered delivery, threatened sustainability, and may have exacerbated health inequities. Planned adaptations enhanced program delivery and may have supported improved equity and sustainability. Salient PRISM factors that influenced implementation included “Organizational perspective of the EBI”, “Fit” and “Implementation and sustainability infrastructure”. Facilitators to continued delivery included the perception that the EBI is beneficial, program champions, and healthcare team organization. Barriers included the perception that the EBI is complicated, competition with other primary care activities, and temporary suspension of services due to COVID-19. Conclusions: Multi-level contextual changes led to numerous adaptations of the EBI and implementation strategy. Systems thinking approaches may shed light on how a program’s sustainability and its equitable delivery are influenced by adaptations over time in response to dynamic, multi-level contextual factors. Trial registration: NCT03504124

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Monitoring Study Participants and Implementation with Phone Calls to Support Hypertension Control During the COVID-19 Pandemic: The Case of a Multicomponent Intervention Trial in Guatemala

Cited by 9 publications

References 9 publications

“At the Root of COVID Grew a More Complicated Situation”: A Qualitative Analysis of the Guatemalan Gender-Based Violence Prevention and Response System during the COVID-19 Pandemic

“At the Root of COVID Grew a More Complicated Situation”: A Qualitative Analysis of the Guatemalan Gender-Based Violence Prevention and Response System during the COVID-19 Pandemic

Disruption to diabetes and hypertension care during the COVID-19 pandemic in Latin America and the Caribbean and mitigation approaches: A Scoping Review

Assessing the implementation of a multi-component hypertension program in a Guatemalan under-resourced dynamic context: An application of the RE-AIM/PRISM extension for sustainability and health equity

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