Mundagowa Paddington Tinashe, Musariri Malvin, Magande Pamela, Hlabangana Tendai, Mukwambo Linda Jane, Zambezi Pemberai, Muchemwa-Munasirei Priscillah, Mukora-Mutseyekwa Fadzai
Africa University, Mutare, Manicaland, Zimbabwe
University of South Carolina Arnold School of Public Health, Columbia, South Carolina, USA.
BMJ Open. 2024 Dec 20;14(12):e085211. doi: 10.1136/bmjopen-2024-085211.
Implementing evidence-based innovations often fails to translate into meaningful outcomes in practice due to dynamic real-world contextual factors. Identifying these influencing factors is pivotal to implementation success. This study aimed to determine the barriers and facilitators of implementing a community health worker (CHW)-delivered home management of hypertension (HoMHyper) intervention from a stakeholder's perspective using the Consolidated Framework for Implementation Research (CFIR).
Exploratory qualitative study.
Five primary healthcare facilities in Mutare City, Zimbabwe.
25 CHWs, 10 health facility nurses and 3 Mutare City health administrators.
Perceived barriers to implementation of the HoMHyper intervention were staff shortage, patient privacy and confidentiality, limited access to antihypertensive medication, CHW incentivisation and equipment shortage, as well as patient knowledge and beliefs about hypertension. The proposed intervention was superior to the current practice, easy to implement and adaptable in the local context. Perceived facilitating factors were commitment from health system leadership, CHW training and support, regular engagement between CHWs and health providers, community partnerships, and CHW self-efficacy and knowledge and skills.
Integrating CHWs into chronic disease management can potentially improve health service access in low-resource settings. Well-coordinated planning guided by implementation evidence frameworks such as the CFIR significantly enhances the identification of important barriers and facilitators to inform implementation.
由于动态的现实世界背景因素，实施基于证据的创新措施在实践中往往无法转化为有意义的成果。识别这些影响因素是实施成功的关键。本研究旨在从利益相关者的角度，使用实施研究综合框架（CFIR）来确定实施由社区卫生工作者（CHW）提供的高血压居家管理（HoMHyper）干预措施的障碍和促进因素。
探索性定性研究。
津巴布韦穆塔雷市的五家初级卫生保健机构。
25名社区卫生工作者、10名卫生机构护士和3名穆塔雷市卫生管理人员。
实施HoMHyper干预措施的感知障碍包括人员短缺、患者隐私和保密、抗高血压药物获取受限、社区卫生工作者激励措施和设备短缺，以及患者对高血压的认知和信念。拟议的干预措施优于现行做法，易于实施且能在当地环境中适应。感知到的促进因素包括卫生系统领导层的承诺、社区卫生工作者培训和支持、社区卫生工作者与卫生服务提供者之间的定期互动、社区伙伴关系，以及社区卫生工作者的自我效能感、知识和技能。
将社区卫生工作者纳入慢性病管理有可能改善资源匮乏地区的卫生服务可及性。由CFIR等实施证据框架指导的协调良好的规划可显著增强对重要障碍和促进因素的识别，为实施提供依据。
