Abstract
BackgroundThe burden of hypertension in many low-and middle-income countries is alarming and requires effective evidence-based preventative strategies that is carefully appraised and accepted by key stakeholders to ensure successful implementation and sustainability. We assessed nurses’ perceptions of a recently completed Task Shifting Strategy for Hypertension control (TASSH) trial in Ghana, and facilitators and challenges to TASSH implementation.MethodsFocus group sessions and in-depth interviews were conducted with 27 community health nurses from participating health centers and district hospitals involved in the TASSH trial implemented in the Ashanti Region, Ghana, West Africa from 2012 to 2017. TASSH evaluated the comparative effectiveness of the WHO-PEN program versus provision of health insurance for blood pressure reduction in hypertensive adults. Qualitative data were analyzed using open and axial coding techniques with emerging themes mapped onto the Consolidated Framework for Implementation Research (CFIR).ResultsThree themes emerged following deductive analysis using CFIR, including: (1) Patient health goal setting- relative priority and positive feedback from nurses, which motivated patients to make healthy behavior changes as a result of their health being a priority; (2) Leadership engagement (i.e., medical directors) which influenced the extent to which nurses were able to successfully implement TASSH in their various facilities, with most directors being very supportive; and (3) Availability of resources making it possible to implement the TASSH protocol, with limited space and personnel time to carry out TASSH duties, limited blood pressure (BP) monitoring equipment, and transportation, listed as barriers to effective implementation.ConclusionAssessing stakeholders’ perception of the TASSH implementation process guided by CFIR is crucial as it provides a platform for the nurses to thoroughly evaluate the task shifting program, while considering the local context in which the program is implemented. The feedback from the nurses informed barriers and facilitators to implementation of TASSH within the current healthcare system, and suggested system level changes needed prior to scale-up of TASSH to other regions in Ghana with potential for long-term sustainment of the task shifting intervention.Trial registrationTrial registration for parent TASSH study: NCT01802372. Registered February 27, 2013.
Highlights
The burden of hypertension in many low-and middle-income countries is alarming and requires effective evidence-based preventative strategies that is carefully appraised and accepted by key stakeholders to ensure successful implementation and sustainability
Assessing stakeholders’ perception of the Task Shifting Strategy for Hypertension control (TASSH) implementation process guided by Consolidated Framework for Implementation Research (CFIR) is crucial as it provides a platform for the nurses to thoroughly evaluate the task shifting program, while considering the local context in which the program is implemented
Site and participant characteristics A total of 27 Community Health Nurses (CHNs) were interviewed from various sites representative of urban and rural facilities from the Ashanti region included in the parent TASSH study (Table 1)
Summary
The burden of hypertension in many low-and middle-income countries is alarming and requires effective evidence-based preventative strategies that is carefully appraised and accepted by key stakeholders to ensure successful implementation and sustainability. We assessed nurses’ perceptions of a recently completed Task Shifting Strategy for Hypertension control (TASSH) trial in Ghana, and facilitators and challenges to TASSH implementation. Implementing effective evidence-based health interventions for hypertension control in Sub-Saharan African (SSA) countries like Ghana is urgent considering the alarming increase in hypertension related morbidity and mortality. Recent systematic reviews estimate the overall prevalence of hypertension in low- and middle- income countries (LMICs) at 32.3% [3] and 25–41% for SSA [4]. It is imperative that health interventions are carefully appraised and accepted by key stakeholders, including site directors, patients, and nurses in order to ensure successful implementation and sustainability. Thereby avoiding the pitfall of ‘one shot deal’ programs occurring with interventions which fail to assess the implementation process [9] in LMICs
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