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Stakeholder perspectives to inform adaptation of a hypertension treatment program in primary healthcare centers in the Federal Capital Territory, Nigeria: a qualitative study

BACKGROUND: Implementing an evidence-based hypertension program in primary healthcare centers (PHCs) in the Federal Capital Territory, Nigeria is an opportunity to improve hypertension diagnosis, treatment, and control and reduce deaths from cardiovascular diseases. This qualitative research study w...

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Autores principales: Okoli, Rosemary C. B., Shedul, Gabriel, Hirschhorn, Lisa R., Orji, Ikechukwu A., Ojo, Tunde M., Egenti, Nonye, Omitiran, Kasarachi, Akor, Blessing, Baldridge, Abigail S., Huffman, Mark D., Ojji, Dike, Kandula, Namratha R.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8404273/
https://www.ncbi.nlm.nih.gov/pubmed/34462016
http://dx.doi.org/10.1186/s43058-021-00197-8
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author Okoli, Rosemary C. B.
Shedul, Gabriel
Hirschhorn, Lisa R.
Orji, Ikechukwu A.
Ojo, Tunde M.
Egenti, Nonye
Omitiran, Kasarachi
Akor, Blessing
Baldridge, Abigail S.
Huffman, Mark D.
Ojji, Dike
Kandula, Namratha R.
author_facet Okoli, Rosemary C. B.
Shedul, Gabriel
Hirschhorn, Lisa R.
Orji, Ikechukwu A.
Ojo, Tunde M.
Egenti, Nonye
Omitiran, Kasarachi
Akor, Blessing
Baldridge, Abigail S.
Huffman, Mark D.
Ojji, Dike
Kandula, Namratha R.
author_sort Okoli, Rosemary C. B.
collection PubMed
description BACKGROUND: Implementing an evidence-based hypertension program in primary healthcare centers (PHCs) in the Federal Capital Territory, Nigeria is an opportunity to improve hypertension diagnosis, treatment, and control and reduce deaths from cardiovascular diseases. This qualitative research study was conducted in Nigerian PHCs with patients, non-physician health workers, administrators and primary care physicians to inform contextual adaptations of Kaiser Permanente Northern California's hypertension model and the World Health Organization’s HEARTS technical package for the system-level, Hypertension Treatment in Nigeria (HTN) Program. METHODS: Purposive sampling in 8 PHCs identified patients (n = 8), non-physician health workers (n = 12), administrators (n = 3), and primary care physicians (n = 6) for focus group discussions and interviews. The Primary Health Care Performance Initiative (PHCPI) conceptual framework and Consolidated Framework for Implementation Research (CFIR) domains were used to develop semi-structured interviews (Appendix 1, Supplemental Materials) and coding guides. Content analysis identified multilevel factors that would influence program implementation. RESULTS: Participants perceived the need to strengthen four major health system inputs across CFIR domains for successful adaptation of the HTN Program components: (1) reliable drug supply and blood pressure measurement equipment, (2) enable and empower community healthcare workers to participate in team-based care through training and education, (3) information systems to track patients and medication supply chain, and (4) a primary healthcare system that could offer a broader package of health services to meet patient needs. Specific features of the PHCPI framework considered important included: accessible and person-centered care, provider availability and competence, coordination of care, and proactive community outreach. Participants also identified patient-level factors, such as knowledge and beliefs about hypertension, and financial and transportation barriers that could be addressed with better communication, home visits, and drug financing. Participants recommended using existing community structures, such as village health committees and popular opinion leaders, to improve knowledge and demand for the HTN Program. CONCLUSIONS: These results provide information on specific primary care and community contextual factors that can support or hinder implementation and sustainability of an evidence-based, system-level hypertension program in the Federal Capital Territory, Nigeria, with the ultimate aim of scaling it to other parts of the country. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s43058-021-00197-8.
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spelling pubmed-84042732021-08-31 Stakeholder perspectives to inform adaptation of a hypertension treatment program in primary healthcare centers in the Federal Capital Territory, Nigeria: a qualitative study Okoli, Rosemary C. B. Shedul, Gabriel Hirschhorn, Lisa R. Orji, Ikechukwu A. Ojo, Tunde M. Egenti, Nonye Omitiran, Kasarachi Akor, Blessing Baldridge, Abigail S. Huffman, Mark D. Ojji, Dike Kandula, Namratha R. Implement Sci Commun Research BACKGROUND: Implementing an evidence-based hypertension program in primary healthcare centers (PHCs) in the Federal Capital Territory, Nigeria is an opportunity to improve hypertension diagnosis, treatment, and control and reduce deaths from cardiovascular diseases. This qualitative research study was conducted in Nigerian PHCs with patients, non-physician health workers, administrators and primary care physicians to inform contextual adaptations of Kaiser Permanente Northern California's hypertension model and the World Health Organization’s HEARTS technical package for the system-level, Hypertension Treatment in Nigeria (HTN) Program. METHODS: Purposive sampling in 8 PHCs identified patients (n = 8), non-physician health workers (n = 12), administrators (n = 3), and primary care physicians (n = 6) for focus group discussions and interviews. The Primary Health Care Performance Initiative (PHCPI) conceptual framework and Consolidated Framework for Implementation Research (CFIR) domains were used to develop semi-structured interviews (Appendix 1, Supplemental Materials) and coding guides. Content analysis identified multilevel factors that would influence program implementation. RESULTS: Participants perceived the need to strengthen four major health system inputs across CFIR domains for successful adaptation of the HTN Program components: (1) reliable drug supply and blood pressure measurement equipment, (2) enable and empower community healthcare workers to participate in team-based care through training and education, (3) information systems to track patients and medication supply chain, and (4) a primary healthcare system that could offer a broader package of health services to meet patient needs. Specific features of the PHCPI framework considered important included: accessible and person-centered care, provider availability and competence, coordination of care, and proactive community outreach. Participants also identified patient-level factors, such as knowledge and beliefs about hypertension, and financial and transportation barriers that could be addressed with better communication, home visits, and drug financing. Participants recommended using existing community structures, such as village health committees and popular opinion leaders, to improve knowledge and demand for the HTN Program. CONCLUSIONS: These results provide information on specific primary care and community contextual factors that can support or hinder implementation and sustainability of an evidence-based, system-level hypertension program in the Federal Capital Territory, Nigeria, with the ultimate aim of scaling it to other parts of the country. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s43058-021-00197-8. BioMed Central 2021-08-30 /pmc/articles/PMC8404273/ /pubmed/34462016 http://dx.doi.org/10.1186/s43058-021-00197-8 Text en © The Author(s) 2021 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/ (https://creativecommons.org/publicdomain/zero/1.0/) ) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
spellingShingle Research
Okoli, Rosemary C. B.
Shedul, Gabriel
Hirschhorn, Lisa R.
Orji, Ikechukwu A.
Ojo, Tunde M.
Egenti, Nonye
Omitiran, Kasarachi
Akor, Blessing
Baldridge, Abigail S.
Huffman, Mark D.
Ojji, Dike
Kandula, Namratha R.
Stakeholder perspectives to inform adaptation of a hypertension treatment program in primary healthcare centers in the Federal Capital Territory, Nigeria: a qualitative study
title Stakeholder perspectives to inform adaptation of a hypertension treatment program in primary healthcare centers in the Federal Capital Territory, Nigeria: a qualitative study
title_full Stakeholder perspectives to inform adaptation of a hypertension treatment program in primary healthcare centers in the Federal Capital Territory, Nigeria: a qualitative study
title_fullStr Stakeholder perspectives to inform adaptation of a hypertension treatment program in primary healthcare centers in the Federal Capital Territory, Nigeria: a qualitative study
title_full_unstemmed Stakeholder perspectives to inform adaptation of a hypertension treatment program in primary healthcare centers in the Federal Capital Territory, Nigeria: a qualitative study
title_short Stakeholder perspectives to inform adaptation of a hypertension treatment program in primary healthcare centers in the Federal Capital Territory, Nigeria: a qualitative study
title_sort stakeholder perspectives to inform adaptation of a hypertension treatment program in primary healthcare centers in the federal capital territory, nigeria: a qualitative study
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8404273/
https://www.ncbi.nlm.nih.gov/pubmed/34462016
http://dx.doi.org/10.1186/s43058-021-00197-8
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