Abstract
BackgroundIn Sub Saharan Africa, the incidence of hypertension and other modifiable cardiovascular risk factors is growing rapidly. Poor adherence to prescribed prevention and treatment regimens by patients can compromise treatment outcomes. Patient-centered cardiovascular health education is likely to improve shortcomings in adherence. This paper describes a study that aims to develop a cardiovascular health education program for patients participating in a subsidized insurance plan in Nigeria and to evaluate the applicability and effectiveness in patients at increased risk for cardiovascular disease.Methods/DesignDesign: The study has two parts. Part 1 will develop a cardiovascular health education program, using qualitative interviews with stakeholders. Part 2 will evaluate the effectiveness of the program in patients, using a prospective (pre-post) observational design.Setting: A rural primary health center in Kwara State, Nigeria.Population: For part 1: 40 patients, 10 healthcare professionals, and 5 insurance managers. For part 2: 150 patients with uncontrolled hypertension or other cardiovascular risk factors after one year of treatment.Intervention: Part 2: patient-centered cardiovascular health education program.Measurements: Part 1: Semi-structured interviews to identify stakeholder perspectives. Part 2: Pre- and post-intervention assessments including patients' demographic and socioeconomic data, blood pressure, body mass index and self-reporting measures on medication adherence and perception of care. Feasibility of the intervention will be measured using process data.Outcomes: For program development (part 1): overview of healthcare professionals' perceptions on barriers and facilitators to care, protocol for patient education, and protocol implementation plan.For program evaluation (part 2): changes in patients' scores on adherence to medication and life style changes, blood pressure, and other physiological and self-reporting measures at six months past baseline.Analysis: Part 1: content analytic technique utilizing MAXQDA software. Part 2: univariate and multilevel analysis to assess outcomes of intervention.DiscussionDiligent implementation of patient-centered education should enhance adherence to cardiovascular disease prevention and management programs in low income countries.Trial RegistrationISRCTN47894401
Highlights
In Sub Saharan Africa, the incidence of hypertension and other modifiable cardiovascular risk factors is growing rapidly
Study Population The study population for Part 1 will consist of four groups: Group 1 - A purposeful sample of 20 patients with ‘controlled hypertension’ distributed by gender (50% male and female), and age (18-35 yrs, 3655 yrs, 56 yrs and over) who were included in the Quality improvement cardiovascular care Kwara (QUICK) - I study; Group 2 - A purposeful sample of 20 patients with ‘uncontrolled hypertension’ distributed by gender (50% male and female), and age (18-35 yrs, 36-55 yrs, 56 yrs and over) who were included in QUICK - I study; Group 3 - Eight to ten healthcare professionals treating patients with hypertension (HTN), diabetes mellitus (DM) or cardiovascular diseases (CVD) at Ogo Oluwa Hospital (OOH); and Group 4 Five to ten managers and doctors of the Health Maintenance Organization (HMO) Hygeia
Recent prevalence data from National Surveys indicate that many risk factors for CVD are highly prevalent in Nigeria: alcohol abuser/dependant - 4.4% (M - 8.1%, F 0%); overweight/obesity (BMI ≥ 30 kg/m2) - 13.9% (M 5.5%, F - 21.1%); physical inactivity - 6.8%; tobacco use 9.9% (M - 19.3%, F - 1.8%); raised cholesterol - (M 10.4%, F - 21.6%); raised blood pressure - 12.4% (M - 12.1%, F - 12.7%); and diabetes - 2.8% (M - 2.7%, F - 3%)
Summary
In Sub Saharan Africa, the incidence of hypertension and other modifiable cardiovascular risk factors is growing rapidly. Sub Saharan African (SSA) countries are currently experiencing a rapid increase in the incidence of cardiovascular diseases (CVD) [1,2]. Poor adherence to prescribed medication regimens or lifestyle advices can severely compromise the effectiveness of CVD prevention and treatment [3]. Evidence to date indicates that patient education is one of the most successful interventions to improve adherence and patient self-management of chronic diseases, especially if the education addresses patients’ beliefs and concerns about the condition and treatment, identifies social cultural and individual barriers to adherence and enhances patients’ confidence in their ability to overcome those barriers [7]
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