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
University of Nigeria, Nsukka, Nigeria.
University of Abuja Teaching Hospital Gwagwalada, Abuja, Nigeria.
Implement Sci Commun. 2021 Aug 30;2(1):97. doi: 10.1186/s43058-021-00197-8.
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.
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.
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.
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.
在尼日利亚联邦首都地区的基层医疗中心实施基于证据的高血压项目，是改善高血压诊断、治疗和控制并减少心血管疾病死亡的契机。这项定性研究在尼日利亚的基层医疗中心开展，研究对象包括患者、非医师卫生工作者、管理人员和初级保健医生，目的是为北加利福尼亚凯撒医疗集团的高血压模型以及世界卫生组织的HEARTS技术包在尼日利亚系统层面的高血压治疗（HTN）项目进行因地制宜的调整提供依据。
在8个基层医疗中心进行目的抽样，确定了8名患者、12名非医师卫生工作者、3名管理人员和6名初级保健医生参与焦点小组讨论和访谈。采用初级卫生保健绩效倡议（PHCPI）概念框架和实施研究综合框架（CFIR）领域来制定半结构化访谈（附录1，补充材料）和编码指南。内容分析确定了会影响项目实施的多层次因素。
参与者认为，要成功调整HTN项目的组成部分，需要在CFIR各领域加强四大主要卫生系统投入：（1）可靠的药品供应和血压测量设备；（2）通过培训和教育，使社区卫生工作者能够并有权参与团队式护理；（3）用于跟踪患者和药品供应链的信息系统；（4）一个能够提供更广泛卫生服务套餐以满足患者需求的基层医疗系统。PHCPI框架中被认为重要的具体特征包括：可及且以人为本的护理、提供者的可及性和能力、护理协调以及积极的社区外展。参与者还确定了患者层面的因素，如对高血压的认识和信念，以及经济和交通障碍，可通过更好的沟通、家访和药品融资来解决。参与者建议利用现有的社区结构，如村卫生委员会和民意领袖，来提高对HTN项目的认识和需求。
这些结果提供了有关特定基层医疗和社区背景因素的信息，这些因素可能支持或阻碍在尼日利亚联邦首都地区实施基于证据的系统层面高血压项目及其可持续性，最终目标是将其推广到该国其他地区。
