Diallo Brahima A, Hassan Syreen, Kagwanja Nancy, Oyando Robinson, Badjie Jainaba, Mumba Noni, Prentice Andrew M, Perel Pablo, Etyang Anthony, Nolte Ellen, Tsofa Benjamin
Nutrition and Planetary Health, MRC Unit The Gambia at LSHTM, Banjul, Other / None, 273, The Gambia.
London School of Hygiene and Tropical Medicine, London, UK.
NIHR Open Res. 2024 Aug 19;4:5. doi: 10.3310/nihropenres.13523.3. eCollection 2024.
Hypertension is the single leading risk factor for premature death in Sub-Saharan Africa (SSA). Prevalence is high, but awareness, treatment, and control are low. Community-centred interventions show promise for effective hypertension management, but embedding such interventions sustainably requires a good understanding of the wider context within which they are being introduced. This study aims to conduct a systematic health system assessment exploring the micro (patients/carers), meso (health care workers and facilities), and macro (broader system) contexts in rural Gambia and Kenya.
This study will utilise various qualitative approaches. We will conduct (i) focus group discussions with people living with hypertensive to map a 'typical' patient journey through health systems, and (ii) in-depth interviews with patients and family carers, health care workers, decision-makers, and NCD partners to explore their experiences of managing hypertension and assess the capacity and readiness of the health systems to strengthen hypertension management. We will also review national guidelines and policy documents to map the organisation of services and guidance on hypertension management. We will use thematic analysis to analyse data, guided by the cumulative complexity model, and theories of organisational readiness and dissemination of innovations.
This study will describe the current context for the management of hypertension from the perspective of those involved in seeking (patients), delivering (health care workers) and overseeing (decision-makers) health services in rural Gambia and Kenya. It will juxtapose what should be happening according to health system guidance and what is happening in practice, drawing on the experiences of study participants. It will outline the various barriers to and facilitators of hypertension management, as perceived by patients, providers, and decision-makers, and the conditions that would need to be in place for effective and sustainable implementation of a community-centred intervention to improve the management of hypertension in rural settings.
高血压是撒哈拉以南非洲（SSA）过早死亡的首要单一风险因素。其患病率很高，但知晓率、治疗率和控制率却很低。以社区为中心的干预措施显示出有效管理高血压的前景，但要可持续地实施此类干预措施，需要充分了解引入这些措施的更广泛背景。本研究旨在对冈比亚和肯尼亚农村地区进行系统的卫生系统评估，探索微观（患者/护理人员）、中观（医护人员和医疗机构）和宏观（更广泛的系统）背景。
本研究将采用多种定性方法。我们将开展：（i）与高血压患者进行焦点小组讨论，以勾勒出患者在卫生系统中的“典型”就医过程；（ii）对患者及其家庭护理人员、医护人员、决策者和非传染性疾病合作伙伴进行深入访谈，以探讨他们管理高血压的经验，并评估卫生系统加强高血压管理的能力和准备情况。我们还将审查国家指南和政策文件，以梳理高血压管理的服务组织和指导方针。我们将使用主题分析法对数据进行分析，以累积复杂性模型、组织准备理论和创新传播理论为指导。
本研究将从冈比亚和肯尼亚农村地区参与寻求（患者）、提供（医护人员）和监督（决策者）卫生服务的人员的角度，描述当前高血压管理的背景。它将结合卫生系统指南中应发生的情况与实际发生的情况，借鉴研究参与者的经验。它将概述患者、提供者和决策者所认为的高血压管理的各种障碍和促进因素，以及有效和可持续实施以社区为中心的干预措施以改善农村地区高血压管理所需的条件。
