Abstract
BackgroundThe purpose of this study was to explore stakeholders' perception of an on-going evidence-based task-shifting strategy for hypertension (TASSH) in 32 community health centers and district hospitals in Ghana.MethodsUsing focus group discussions and in-depth interviews, qualitative data were obtained from 81 key stakeholders including patients, nurses, and site directors of participating community health centers involved in the TASSH trial. Qualitative data were analyzed using open and axial coding techniques.ResultsAnalysis of the qualitative data revealed three themes that illustrate stakeholders' perceptions of the ongoing task-shifting strategy for blood pressure control in Ghana and they include: 1) awareness and understanding of the TASSH program; 2) reasons for participation and non-participation in TASSH; and 3) the benefit and drawbacks to the TASSH program.ConclusionThe findings support evidence that successful implementation of any task-shifting strategy must focus not only on individual patient characteristics, but also consider the role contextual factors such as organizational and leadership factors play. The findings also demonstrate the importance of understanding stakeholder's perceptions of evidence-based task-shifting interventions for hypertension control as it may ultimately influence the sustainable uptake of these interventions into "real world" settings.
Highlights
The purpose of this study was to explore stakeholders' perception of an on-going evidence-based task-shifting strategy for hypertension (TASSH) in 32 community health centers and district hospitals in Ghana
This study evaluates among hypertensive patients who receive care in community health centers (CHCs), the comparative effectiveness of the implementation of the World Health Organization Package of Essential NonCommunicable Disease Intervention for Primary Care (WHO PEN) program targeted at cardiovascular risk assessment and hypertension control, versus provision of health insurance coverage, on blood pressure (BP) reduction at 12-months and sustainability at 24-months [16]
While it was evident that the TASSH strategy increased patients awareness of their hypertension, with the nurses going above and beyond their call of duty to implement the program, and the site directors expressing satisfaction with the reduction of their patient workload, there were challenges identified by the patients, including the perceived lack of selfefficacy to adopt the recommended lifestyle changes long-term
Summary
The purpose of this study was to explore stakeholders' perception of an on-going evidence-based task-shifting strategy for hypertension (TASSH) in 32 community health centers and district hospitals in Ghana. There is a need to support these decisions with the best evidence available, evidence that takes the perceptions of stakeholders into consideration [4, 5] It can take many years for a new intervention to be broadly implemented [6], and implementation and scale-up may involve multiple stakeholders operating in a nexus of differing agendas, priorities, leadership styles, and negotiation strategies [7]. In these circumstances, the perceptions of key stakeholders are needed to clearly articulate who answers to whom, what communication methods are to be utilized, and how to best facilitate a sense of inclusion and support for \ implementation from the beginning [7]. As stakeholders have the ultimate say as to what evidence is adopted and used, understanding their perceptions may guide efforts to scale-up known evidence-based task-shifting interventions suitable for low resource setting in Sub-Saharan Africa (SSA) [6]
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