Exploring contextual factors influencing the implementation of evidence-based care for hypertension in Rwanda: a cross-sectional study using the COACH questionnaire.
Exploring contextual factors influencing the implementation of evidence-based care for hypertension in Rwanda: a cross-sectional study using the COACH questionnaire.
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DOI：
10.1136/bmjopen-2020-048425
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发表时间：
2021-09-21
期刊：
影响因子：
2.9
通讯作者：
Davila-Roman VG
中科院分区：
文献类型：
--
作者：
Baumann AA;Hooley C;Goss CW;Mutabazi V;Brown AL;Schechtman KB;Twagirumukiza M;de Las Fuentes L;Reeds D;Williams M;Mutimura E;Bergström A;Nishimwe A;Ingabire C;Davila-Roman VG
高血压是造成全球疾病负担的最大因素。在卢旺达，与大多数低收入和中等收入国家一样，高血压发病率及其相关发病率和死亡率的上升正在对保健和经济造成重大影响。了解高血压护理的医疗系统背景是必要的。使用社区卫生环境评估（COACH）工具研究医疗保健提供者感知的高血压卫生保健环境。横断面队列回答了COACH问卷和关于高血压训练的调查。卢旺达的三所三级保健医院。医疗保健专业人员（n=223）。COACH工具包括49个项目和8个子量表：资源、社区参与、工作承诺、非正式支付、领导力、工作文化、行动监测服务（5分李克特量表）和知识来源（0-1分量表）。调查高血压培训的四个问题。应答者（n=223, 75%为女性；56%为20-35岁）包括护士（n=142, 64%）、助产士（n=42, 19%）、初级保健医生（n=28, 13%）和专科医生（n= 11,5%）。对工作的承诺、领导力、工作文化和非正式支付的分量表得分在4.7到4.1之间，社区参与、行动监测服务和组织资源得分在3.1到3.5之间。知识来源的平均得分为0.6±0.3。虽然73%的人报告在过去一年中参加过说教式高血压研讨会，但只有28%的人接受过长期培训，51%的人有少于3年的高血压护理工作经验。大多数人（99%）表示需要接受高血压护理方面的额外培训。卢旺达需要增加和持续的培训。医疗救援人员表示致力于工作，并报告了支持性领导，同时承认资源有限，没有监测系统。在实施可持续的高血压护理规划之前，COACH工具为制定培训战略提供了相关指导。
Hypertension is the largest contributor to the Global Burden of Disease. In Rwanda, as in most low-income and middle-income countries, an increasing prevalence of hypertension and its associated morbidity and mortality is causing major healthcare and economic impact. Understanding healthcare systems context in hypertension care is necessary. To study the hypertension healthcare context as perceived by healthcare providers using the Context Assessment for Community Health (COACH) tool. A cross-sectional cohort responded to the COACH questionnaire and a survey about hypertension training. Three tertiary care hospitals in Rwanda. Healthcare professionals (n=223). The COACH tool consists of 49 items with eight subscales: resources, community engagement, commitment to work, informal payment, leadership, work culture, monitoring services for action (5-point Likert Scale) and sources of knowledge (on a 0–1 scale). Four questions surveyed training on hypertension. Responders (n=223, 75% women; 56% aged 20–35 years) included nurses (n=142, 64%, midwives (n=42, 19%), primary care physicians (n=28, 13%) and physician specialists (n=11, 5%)). The subscales commitment to work, leadership, work culture and informal payment scored between 4.7 and 4.1 and the community engagement, monitoring services for action and organizational resources scored between 3.1 and 3.5. Sources of knowledge had a mean score of 0.6±0.3. While 73% reported having attended a didactic hypertension seminar in the past year, only 28% had received long-term training and 51% had <3-year experience working with hypertension care delivery. The majority (99%) indicated a need for additional training in hypertension care. There is a need for increased and continuous training in Rwanda. Healthcare responders stated a commitment to work and reported supportive leadership, while acknowledging limited resources and no monitoring systems. The COACH tool provides contextual guidance to develop training strategies prior to the implementation of a sustainable hypertension care programme.
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影响因子：
7.7
作者：
Lloyd-Sherlock P;Beard J;Minicuci N;Ebrahim S;Chatterji S
通讯作者：
Chatterji S
DOI：
10.1016/s0140-6736(18)32225-6
发表时间：
2018-11-10
期刊：
Lancet (London, England)
影响因子：
--
作者：
GBD 2017 Risk Factor Collaborators
通讯作者：
GBD 2017 Risk Factor Collaborators
影响因子：
4.9
作者：
Unger, Thomas;Borghi, Claudio;Schutte, Aletta E.
通讯作者：
Schutte, Aletta E.
DOI：
10.1007/s11414-015-9475-6
发表时间：
2017-04
期刊：
The journal of behavioral health services & research
影响因子：
--
作者：
Powell BJ;Beidas RS;Lewis CC;Aarons GA;McMillen JC;Proctor EK;Mandell DS
通讯作者：
Mandell DS
影响因子：
7.2
作者：
Bergstrom, Anna;Skeen, Sarah;Wallin, Lars
通讯作者：
Wallin, Lars