Browsing by Author "Masana, L."
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Item Factors hindering hypertension control: perspectives of front-line health professionals in rural Ghana(Public Health, 2020-01-07) Aikins, A.D.; Nyaaba, G.N.; Masana, L.; Beune, E.; Agyemang, C.Objective: Hypertension (HTN) control remains a major public health challenge in sub-Saharan Africa (SSA). Health professionals influence patient adherence and self-management practices for HTN particularly in rural and lower socio-economic communities in SSA. Contextual evidence on the reasons for the suboptimal control of HTN in clinical settings is crucial to improving health delivery practices for HTN and preventing HTN related-complications. Study design: A cross-sectional qualitative study. Methods: Semistructured interviews were conducted among 40 purposively sampled front-line health professionals in seven health facilities in northern Ghana. Data were analysed using a thematic approach through pre-identified and evolving themes. Results: We identified three key themes underlying the poor HTN control. First, health professionals’ barriers included communication difficulties, poor collaboration and referrals among health professionals and limited training on HTN and other non-communicable diseases (NCDs). Secondly, health systemerelated barriers included limited health personnel, drug shortages, inadequate facilities and equipment and challenges with National Health Insurance (NHIS). The third theme was patient-related barriers including non-adherence, use of traditional treatments, sociocultural factors and lack of appreciation. Conclusion: A holistic public health approach, which builds upon health professionals’ capacities, harnesses and integrates into existing health policy and systems structures and empowers and collaborates with communities could contribute to improving HTN control in rural settings. Health policymakers need to consider the sociocultural, economic and geographical characteristics in such settings, which influence health service delivery practices in designing and implementing HTN interventions. There is also a need for health policy to integrate NCD training and management of multiple and comorbid conditions into the training curriculum of health training institutions to build health professionals capacity to facilitate the uptake of evidence-based NCD interventions and manage the double burden of diseases.Item Illness representations and coping practices for self-managing hypertension among sub-Saharan Africans: A comparative study among Ghanaian migrants and non-migrant Ghanaians(Patient Education and Counseling, 2019-04) Nyaaba, G.N.; Agyemang, C.; Masana, L.; de-Graft Aikins, A.; Beune, E.; Larrea-Killinger, C.; Stronks, K.Objective Hypertension (HTN) control is a major obstacle among sub-Saharan African populations partly due to poor self-management. We explored and compared how persons’ social and physical context shapes their illness representations regarding HTN and the coping strategies they develop and adapt to mitigate challenges in self-managing HTN. Methods A cross sectional multisite qualitative study using semi-structured interviews among 55 Ghanaians with HTN living in The Netherlands and urban and rural Ghana. A thematic approach was used in data analysis. Results Family HTN history, personal experiences with HTN and outcomes of using biomedical and traditional treatments shaped participants’ illness representations and coping strategies. Migrants and urban non-migrants modified medication schedules and integrated taking medication into daily routine activities to cope with experienced side effects of taking antihypertensive medication while rural non-migrants used traditional remedies and medicines to mitigate experienced medication side effects and/or in search for a cure for HTN. Conclusion Contextual factors within participants’ social and physical environments shape their illness representations and coping strategies for HTN though interactive phrases. Practice implications Health professionals should harness the relationships within peoples’ social and physical environments, encourage implementation of family-wide behavioural changes and involve family and communities in HTN treatment to enhance patients’ self-management of HTN.Item Lay community perceptions and treatment options for hypertension in rural northern Ghana: a qualitative analysis(BMJ Open, 2018-11) Nyaaba, G.N.; Masana, L.; Aikins, A.D.G.; Stronks, K.; Agyemang, C.Objective Adherence to hypertension treatment is a major public health challenge for low and middle-income countries particularly in sub-Saharan Africa. One potential reason could be the discordance between lay and medical explanatory models of hypertension and its treatment. Understanding community perceptions and practices may contribute to improving hypertension control as they present insights into psychosocial and cultural factors that shape individual behaviour. We explore community perceptions regarding hypertension and its treatment in rural northern Ghana and how they differ from medical understanding. Design This was a qualitative study using semi-structured interviews and focus group discussions to collect data, which were analysed using a thematic approach. Setting A multisite study conducted in four rural communities in two regions of northern Ghana. Participants We conducted 16 semi-structured interviews and eight focus group discussions with community leaders and members, respectively. Results Three major themes were identified: community perceptions, treatment options and community support for people with hypertension. Community perceptions about hypertension include hypertension perceived as excess blood in the body and associated with spiritual or witchcraft attacks. Traditional medicine is perceived to cure hypertension completely with concurrent use of biomedical and traditional medicines encouraged in rural communities. Community members did not consider themselves at risk of developing hypertension and reported having inadequate information on how to provide social support for hypertensive community members, which they attributed to low literacy and poverty. Conclusion There is a substantial mismatch between communities’ perceptions and medical understanding of hypertension and its treatment. These perceptions partly result from structural factors and social norms shaped by collective processes and traditions that shape lay beliefs and influence individual health behaviour. Socioeconomic factors also thwart access to information and contribute to inadequate social support for persons with hypertension. These findings highlight the need for a public health approach to hypertension control targeting families and communities.