Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, 21205, USA.
National Institute for Medical Research, Tukuyu Medical Research Centre, Moshi, Tanzania.
BMC Health Serv Res. 2022 May 31;22(1):721. doi: 10.1186/s12913-022-08064-5.
Inadequate adherence to hypertension (HT) clinical standards by healthcare providers is one of the major barriers for HT management. We examined the effectiveness of four short instructional training videos on HT management.
Eighteen primary health care facilities were randomly selected using systematic sampling from five districts in the Dar es Salaam region, Tanzania. Pre-post provider knowledge assessments were conducted six months after training and provider performance was measured using patient observations on 8-10 consecutive adult patients per facility. A Screening Quality Index (SQI), comprised of ten HT screening standards, was used to measure adherence.
Pre-post knowledge scores improved significantly, for, time between blood pressure (BP) readings (28.1% to 72.7%, p=0.01), BP threshold for patients with complications (21.2% to 97.0%, p<0.001), and lifestyle/dietary counseling (from 36.4% to 97.0%, p<0.001). SQI was significantly higher following the training for all provider groups; Nurses (3.0±3.5 to 8.4±1.0, p<0.001), Assistant Medical Officers and Medical Officers (3.5±4.1 to 7.6±2.4, p<0.001), and Assistant Clinical Officers and Clinical Officers (5.4±3.8 to 8.4±2.0, p<0.001). After training, significantly higher adherence was evident for key aspects of managing patients with HT: e.g., counseling on medication (62.1% to 92.7%, p=0.002), side effects (41.4% to 56.1%, p=0.009), reducing caloric intake (69.0 % to 95.1%, p=0.003), reducing cooking salt (65.5% to 97.6%, p<0.01), increasing physical activity (55.2% to 92.7% p<0.001), stopping/reducing cigarette smoking (24.1% to 63.4%, p=0.001), and reducing alcohol consumption (24.1% to 68.3%, p<0.001). SQI was significantly associated with number of years of provider experience (more than 2 years), type of primary healthcare facility (public facility), and exposure to the training intervention.
Training with short instructional videos can improve provider competency and clinical performance for HT management. The strategy has the potential to enhance effective implementation of HT control strategies in primary care clinics in Tanzania and elsewhere.
医疗保健提供者对高血压（HT）临床标准的遵守不足是 HT 管理的主要障碍之一。我们研究了四种关于 HT 管理的简短教学培训视频的效果。
从坦桑尼亚达累斯萨拉姆地区的五个区采用系统抽样法随机选择了 18 个基层医疗保健设施。培训六个月后进行了提供者知识前后评估，并通过对每个设施的 8-10 名连续成年患者进行观察来衡量提供者的表现。使用包含十个 HT 筛查标准的筛查质量指数（SQI）来衡量依从性。
提供者的知识得分在以下方面显著提高：两次血压（BP）读数之间的时间（28.1%至 72.7%，p=0.01）、有并发症患者的 BP 阈值（21.2%至 97.0%，p<0.001）和生活方式/饮食咨询（从 36.4%至 97.0%，p<0.001）。培训后，所有提供者群体的 SQI 均显著升高；护士（3.0±3.5 至 8.4±1.0，p<0.001）、助理医疗官和医疗官（3.5±4.1 至 7.6±2.4，p<0.001）和助理临床官和临床官（5.4±3.8 至 8.4±2.0，p<0.001）。培训后，管理 HT 患者的关键方面明显提高了依从性：例如，药物咨询（62.1%至 92.7%，p=0.002）、副作用（41.4%至 56.1%，p=0.009）、减少热量摄入（69.0%至 95.1%，p=0.003）、减少烹饪盐（65.5%至 97.6%，p<0.01）、增加身体活动（55.2%至 92.7%，p<0.001）、停止/减少吸烟（24.1%至 63.4%，p=0.001）和减少饮酒（24.1%至 68.3%，p<0.001）。SQI 与提供者经验（超过 2 年）、初级保健设施类型（公共设施）和培训干预接触显著相关。
使用简短的教学视频进行培训可以提高 HT 管理的提供者能力和临床表现。该策略有可能加强坦桑尼亚和其他地方初级保健诊所中 HT 控制策略的有效实施。
