Constructing a Nurse-led Cardiovascular Disease Intervention in Rural Ghana: A Qualitative Analysis.
Constructing a Nurse-led Cardiovascular Disease Intervention in Rural Ghana: A Qualitative Analysis.
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DOI：
10.5334/aogh.3379
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发表时间：
2021
影响因子：
2.9
通讯作者：
Heller DJ
中科院分区：
文献类型：
--
作者：
Wood EP;Garvey KL;Aborigo R;Dambayi E;Awuni D;Squires AP;Jackson EF;Phillips JF;Oduro AR;Heller DJ
心血管疾病(CVD)是低收入和中等收入国家日益沉重的负担。加纳试图通过将心血管疾病诊断和管理的任务转移给护士来解决这一问题。社区卫生规划和服务倡议在加纳全境提供孕产妇和儿科保健，但在提供心血管疾病护理方面面临障碍。我们采用深入的访谈来确定解决心血管疾病护理中的制约因素的解决方案，以在加纳上东部地区的两个地区开展由护士领导的心血管疾病干预。这项研究试图确定非医生主导的心血管疾病筛查和治疗干预措施，以便纳入加纳目前的初级卫生保健结构。本研究采用定性描述性设计，对社区卫生官员(CHO)和社区卫生服务机构主管街道干事(SDO)进行了31次半结构式访谈。总结性内容分析揭示了参与者最常见的干预想法和背书。提供者认可了三种干预措施：增加社区心血管疾病知识和参与度，提高非内科医生的处方能力，以及确保提供者获得医疗和运输设备。提供者建议社区领导人和志愿者传播心血管疾病知识，整理既定的收集做法，以教育社区并制定行动计划。提供者要求讲课与体验式学习相结合，以提高他们开处方的信心。供应商建议修订报销和设备采购程序，以加快获得必要用品的速度。一线CHPS初级保健提供者相信心血管疾病护理是可行的。他们建议采取三管齐下的干预措施，将社区推广、提供者培训和后勤支持结合起来，从而将任务转移范围扩大到高血压以外的领域，包括其他心血管疾病危险因素。这种模式可以在其他地方复制。
Cardiovascular disease (CVD) is a growing burden in low- and middle-income countries. Ghana seeks to address this problem by task-shifting CVD diagnosis and management to nurses. The Community-Based Health Planning and Services (CHPS) initiative offers maternal and pediatric health care throughout Ghana but faces barriers to providing CVD care. We employed in-depth interviews to identify solutions to constraints in CVD care to develop a nurse-led CVD intervention in two districts of Ghana’s Upper East Region. This study sought to identify non–physician-led interventions for the screening and treatment of cardiovascular disease to incorporate into Ghana’s current primary health care structure. Using a qualitative descriptive design, we conducted 31 semistructured interviews of community health officers (CHOs) and supervising subdistrict officers (SDOs) at CHPS community facilities. Summative content analysis revealed the most common intervention ideas and endorsements by the participants. Providers endorsed three interventions: increasing community CVD knowledge and engagement, increasing nonphysician prescribing abilities, and ensuring provider access to medical and transportation equipment. Providers suggested community leaders and volunteers should convey CVD knowledge, marshaling established gathering practices to educate communities and formulate action plans. Providers requested lectures paired with experiential learning to improve their prescribing confidence. Providers recommended revising reimbursement and equipment procurement processes for expediting access to necessary supplies. Frontline CHPS primary care providers believe CVD care is feasible. They recommended a three-pronged intervention that combines community outreach, provider training, and logistical support, thereby expanding task-shifting beyond hypertension to include other CVD risk factors. This model could be replicable elsewhere.