Short-term pilot feasibility study of a nurse-led intervention to improve blood pressure control after stroke in Nigeria

Wahab, Kolawole; Owolabi, Mayowa; Akinyemi, Rufus; Jenkins, Carolyn; Arulogun, Oyedunni; Akpa, Onoja Matthew; Gebregziabher, Mulugeta; Uvere, Ezinne; Saulson, Raelle; Ovbiagele, Bruce

doi:10.1016/j.jns.2017.04.005

Cited by 15 publications

(22 citation statements)

References 23 publications

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“…Of the 63 studies included in the review, there were 32 randomised controlled trials (from 33 publications),24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38, 39, 40, 41, 42, 43, 44, 45, 46, 47, 48, 49, 50, 51, 52, 53, 54, 55, 56 11 cluster randomised trials,57, 58, 59, 60, 61, 62, 63, 64, 65, 66, 67 and 20 before-and-after studies68, 69, 70, 71, 72, 73, 74, 75, 76, 77, 78, 79, 80, 81, 82, 83, 84, 85, 86, 87 (appendix pp 3–38). 50 studies were done in Asia and Africa.…”

Section: Resultsmentioning

confidence: 99%

“…Seven studies46, 48, 54, 62, 63, 64, 65, 66 tested a referral system for participants with high or uncontrolled blood pressure. In two studies,62, 64 community health workers referred patients to health-care facilities for anti-hypertensive drugs.…”

Section: Resultsmentioning

confidence: 99%

“…Four studies70, 72, 80, 84 had follow-up interventions for management of blood pressure. Two studies each employed nurses72, 84 and community health workers54, 64 for follow up. Navichraren and colleagues 84 telephoned participants following life-style education classes but reported no difference in blood pressure.…”

Section: Resultsmentioning

confidence: 99%

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Task sharing with non-physician health-care workers for management of blood pressure in low-income and middle-income countries: a systematic review and meta-analysis

Anand

Joseph

Geetha

et al. 2019

The Lancet Global Health

153

145

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Background Task sharing for the management of hypertension could be useful for understaffed and resource-poor health systems. We assessed the effectiveness of task-sharing interventions in improving blood pressure control among adults in low-income and middle-income countries. Methods We searched the Cochrane Library, PubMed, Embase, and CINAHL for studies published up to December 2018. We included intervention studies involving a task-sharing strategy for management of blood pressure and other cardiovascular risk factors. We extracted data on population, interventions, blood pressure, and task sharing groups. We did a meta-analysis of randomised controlled trials. Findings We found 3012 references, of which 54 met the inclusion criteria initially. Another nine studies were included following an updated search. There were 43 trials and 20 before-and-after studies. We included 31 studies in our meta-analysis. Systolic blood pressure was decreased through task sharing in different groups of health-care workers: the mean difference was-5•34 mm Hg (95% CI-9•00 to-1•67, I²=84%) for task sharing with nurses,-8•12 mm Hg (-10•23 to-6•01, I²=57%) for pharmacists,-4•67 mm Hg (-7•09 to-2•24, I²=0%) for dietitians,-3•67 mm Hg (-4•58 to-2•77, I²=24%) for community health workers, and-4•85 mm Hg (-6•12 to-3•57, I²=76%) overall. We found a similar reduction in diastolic blood pressure (overall mean difference-2•92 mm Hg,-3•75 to-2•09, I²=80%). The overall quality of evidence based on GRADE criteria was moderate for systolic blood pressure, but low for diastolic blood pressure. Interpretation Task-sharing interventions are effective in reducing blood pressure. Long-term studies are needed to understand their potential impact on cardiovascular outcomes and mortality. Funding Wellcome Trust/DBT India Alliance.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Task sharing with non-physician health-care workers for management of blood pressure in low-income and middle-income countries: a systematic review and meta-analysis

Anand

Joseph

Geetha

et al. 2019

The Lancet Global Health

153

145

View full text Add to dashboard Cite

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“…The WHO, for example, recommends task sharing where access to health services is constrained by a lack of health workers [34]. Other programmes in sub-Saharan Africa have found at least limited success when nurses were trained to manage hypertension (for example in DRC [35], in Nigeria [36], in Kenya [37], and Ghana [38]. In ComHIP, whilst results on the overall programme impact and cost effectiveness are still forthcoming, the data from this and earlier qualitative analysis (Adler et al forthcoming ) suggest that various components of ComHIP including its task-sharing experiment was acceptable to patients and nurses involved in the programme.…”

Section: Discussionmentioning

confidence: 99%

Health system challenges to hypertension and related non-communicable diseases prevention and treatment: perspectives from Ghanaian stakeholders

Laar

Adler

Kotoh

et al. 2019

BMC Health Serv Res

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Background Hypertension, itself a cardiovascular condition, is a significant risk factor for other cardiovascular diseases. Hypertension is recognized as a major public health challenge in Ghana. Beginning in 2014, a collaborative team launched the community-based hypertension improvement program (ComHIP) in one health district in Ghana. The ComHIP project, a public-private partnership, tests a community-based model that engages the private sector and utilizes information and communication technology (ICT) to control hypertension. This paper, focuses on the various challenges associated with managing hypertension in Ghana, as reported by ComHIP stakeholders. Methods A total of 55 informants – comprising patients, health care professionals, licensed chemical sellers (LCS), national and sub-national policymakers – were purposively selected for interview and focus group discussions (FGDs). Interviews were audio-recorded and transcribed verbatim. Where applicable, transcriptions were translated directly from local language to English. The data were then analysed using two-step thematic analysis. The protocol was approved by the two ethics review committees based in Ghana and the third, based in the United Kingdom. All participants were interviewed after giving informed consent. Results Our data have implications for the on-going implementation of ComHIP, especially the importance of policy maker buy-in, and the benefits, as well as drawbacks, of the program to different stakeholders. While our data show that the ComHIP initiative is acceptable to patients and healthcare providers – increasing providers’ knowledge on hypertension and patients’ awareness of same- there were implementation challenges identified by both patients and providers. Policy level challenges relate to task-sharing bottlenecks, which precluded nurses from prescribing or dispensing antihypertensives, and LCS from stocking same. Medication adherence and the phenomenon of medical pluralism in Ghana were identified challenges. The perspectives from the national level stakeholders enable elucidation of whole of health system challenges to ComHIP and similarly designed programmes. Conclusions This paper sheds important light on the patient/individual, and system level challenges to hypertension and related non-communicable disease prevention and treatment in Ghana. The data show that although the ComHIP initiative is acceptable to patients and healthcare providers, policy level task-sharing bottlenecks preclude optimal implementation of ComHIP.

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“…Other programmes in sub-Saharan Africa have found at least limited success in the implementation of training nurses in the management of hypertension (for example in DRC [20]; in Nigeria [21]; in Kenya [22]; and Ghana [23]). Quantitative results show that while ComHIP succeeded in managing hypertension in patients who remained in the programme, there was a high loss to follow up [24].…”

Section: Task Sharingmentioning

confidence: 99%

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

Adler

Laar

Kotoh

et al. 2020

BMC Health Serv Res

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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.

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Short-term pilot feasibility study of a nurse-led intervention to improve blood pressure control after stroke in Nigeria

Cited by 15 publications

References 23 publications

Task sharing with non-physician health-care workers for management of blood pressure in low-income and middle-income countries: a systematic review and meta-analysis

Task sharing with non-physician health-care workers for management of blood pressure in low-income and middle-income countries: a systematic review and meta-analysis

Health system challenges to hypertension and related non-communicable diseases prevention and treatment: perspectives from Ghanaian stakeholders

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

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