Barriers and facilitators to the implementation of a community-based hypertension improvement project in Ghana: a qualitative study of ComHIP
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Date
2020-01-30
Journal Title
Journal ISSN
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Publisher
BMC Health Services Research
Abstract
Background: Globally, hypertension is a leading cause of cardiovascular disease and mortality, with the majority of
deaths occurring in low- and middle-income countries. Because the burden of hypertension is increasing in low
resource settings with restricted infrastructure, it is imperative that new models for hypertension care are realised.
One such model is the Community-based Hypertension Improvement Project (ComHIP) which employs a
community-based method of task-shifting for managing hypertension. This study is a qualitative analysis of the
barriers and facilitators of the main components of ComHIP.
Methods: We purposively selected 55 informants for semi-structured interviews or focus group discussions, which
were carried out bythree trained local researchers in Krobo, Twi or English. Informants included patients enrolled in
ComHIP, health care providers and Licensed Chemical Sellers trained by ComHIP, and Ghana Health Service
employees. Data were analysed using a multi-step thematic analysis.
Results: While results of the effectiveness of the intervention are pending, overall, patients and nurses reported
positive experiences within ComHIP, and found that it helped enable them to manage their hypertension.
Healthcare providers appreciated the additional training, but had some gaps in their knowledge. Ghana Health
Service employees were cautiously optimistic about the programme, but expressed some worries about the
sustainability of the programme. Many informants expressed concerns over the inability of community nurses and
workers to dispense anti-hypertensives, due to legal restrictions.
Conclusions: The WHO recommends task-sharing as a technique for managing chronic conditions such as
hypertension in resource constrained settings. ComHIP presents an example of a task-sharing programme with a
high level of acceptability to all participants. Going forward, we recommend greater levels of communication and
dialogue to allow community-based health workers to be allowed to dispense anti-hypertensives.
Description
Research Article
Keywords
Hypertension, Implementation research, Facilitators, Ghana, Community-based, Qualitative research