Abstract
BackgroundCardiovascular diseases (CVDs) are on the rise in many low-and middle-income countries where 80% of related deaths are registered. Community CVD prevention programmes utilizing self-care approaches have shown promise in contributing to population level reduction of risk factors. However, the acceptability of these programmes, which affects their uptake and effectiveness, is unknown including in the sub-Saharan Africa context. This study used the Theoretical Framework of Acceptability to explore the prospective acceptability of a community CVD prevention programme in Mukono and Buikwe districts in Uganda.MethodsThis qualitative descriptive study was conducted in March 2019 among community health workers (CHWs), who would implement the intervention and community members, the intervention recipients, using eight focus group discussions. All discussions were audio-recorded, transcribed verbatim and analysed thematically guided by the theoretical framework.ResultsCHWs and community members reported high eagerness to participate in the programme. Whereas CHWs had implemented similar community programmes and cited health promotion as their role, community members looked forward to health services being brought nearer to them. Although the intervention was preventive in nature, CHWs and community members expressed high interest in treatments for risk factors and were skeptical about the health system capacity to deliver them. CHWs anticipated barriers in mobilising communities who they said sometimes may not be cooperative while community members were concerned about failing to access treatment and support services after screening for risk factors. The major cost to CHWs and community members for engaging in the intervention was time that they would have dedicated to income generating activities and social events though CHWs also had the extra burden of being exemplary. CHWs were confident in their ability to deliver the intervention as prescribed if well trained, supported and supervised, and community members felt that if provided sufficient information and supported by CHWs, they could change their behaviours.ConclusionsThe community CVD prevention programme was highly acceptable among CHWs and community members in Mukono and Buikwe districts of Uganda amidst a few burdens and opportunity costs. Suggestions made by study participants to improve programme effectiveness informed programme design and implementation for impact.
Highlights
Cardiovascular diseases (CVDs) are on the rise in many low-and middle-income countries where 80% of related deaths are registered
A total of 41 community health workers (CHWs) participated in the four Focus Group Discussion (FGD), 28 of whom were female
The study findings are organised under the seven themes of the Theoretical Framework of Acceptability: ethicality, affective attitude, burden, opportunity costs, perceived effectiveness, selfefficacy and intervention coherence
Summary
Cardiovascular diseases (CVDs) are on the rise in many low-and middle-income countries where 80% of related deaths are registered. Cardiovascular diseases (CVDs) are on the rise in many low-and middle-income countries (LMICs) where 80% of related deaths are registered [1, 2]. In these countries, the disease is experienced at younger ages compared to high income countries [3] and risk factors including hypertension and diabetes are increasing. In sub-Saharan Africa, recent systematic reviews have estimated the pooled prevalence of hypertension to range from 24% to over 50% among persons aged 18 years and above [4, 5]. The high CVD burden and risk factors in LMICs are negatively impacting health systems placing a high strain on the scarce health resources and contributing to significant social and economic consequences including loss of economic productivity and high treatment costs negatively affecting household incomes [3, 8]
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