Phone-based Interventions under Nurse Guidance after Stroke II (PINGS II)

项目总结 全球估计表明，撒哈拉以南非洲(SSA)现在是中风发病率和流行率最高的地区。 然而，系统资源有限，患者资源稀缺，医疗服务不协调，临床医生短缺， 极大地阻碍了南部非洲国家执行有效措施以控制关键的能力 血管危险因素，如高血压(HTN)，在常规临床实践中可防止中风复发。在……里面 特别是，SSA对HTN对卒中病因的影响大小估计是全球最高的。HTN经常 由于以下原因，该地区相当大比例的成年人口未得到承认、得不到充分治疗和控制 一系列因素，包括对高血压的文化信仰和误解，低自我效能，非 坚持治疗，没有卫生设施，卫生人员，无法获得抗高血压药物 药物、医生的治疗惰性和其他因素。随着预期的继续从 主要是慢性非传染性疾病的感染性疾病，中风在SSA中的负担很可能 在接下来的几十年里甚至会进一步增加。考虑到上述所有因素，这是一个紧迫的问题 SSA国家优先发展和测试自我管理干预措施，以控制高血压 那些不良后果风险最高的人。护士带队电话干预的总体目标 卒中后2期指导(PINGS-2)是采用混合研究设计，首先，在 一项以理论模型为基础、以mHealth技术为中心、以护士为主导的多水平随机对照试验 在500例近期卒中患者中显著改善长期血压控制的综合方法 在加纳的10家医院遭遇。其次，PINGS II寻求制定一项实施战略，以 在LMIC环境中采用mHealth进行卒中后血压控制的常规整合和政策采用。我们将利用 从NIH全球脑疾病资助的R21试点研究(NS094033)中获得的经验，以测试A 改进的、文化上量身定做的、潜在可实施的干预措施，旨在解决主要的可修改 中风的风险&资源不足的系统中的其他关键变量，承担着次优护理和结果的负担。这个 主要结果是在12个月时血压控制，以及一系列次要结果指标，如 服药依从性、自我效能、心血管急诊科就诊、生活质量和 调解人的结果。虽然建立以护士为主导、以移动健康为中心的自我保健的有效性是重要的 管理干预在LMICs中控制血压，同时开始制定一个 实施计划。因此，我们将努力确定具体情况下的实施促进者和障碍，以 了解实施环境，并为日常使用制定基于证据的实施策略 通过多个利益攸关方参与，在加纳采取ping干预的政策。

PROJECT SUMMARY Global estimates suggest that sub-Saharan Africa (SSA) now has the highest incidence and prevalence of stroke. However, limited system resources, meager patient resources, uncoordinated care, and shortage of clinicians, greatly hamper the capacity of countries in SSA to implement effective measures aimed at controlling key vascular risk factors such as hypertension (HTN) to thwart stroke recurrence in routine clinical practice. In particular, SSA has the highest estimated effect size of HTN for stroke causation worldwide. HTN is often unrecognized, undertreated and uncontrolled in a significant proportion of the adult population in this region due to a clustering of factors including cultural beliefs and misconceptions about hypertension, low self-efficacy, non- adherence to treatment, unavailability of health facilities, health personnel, lack of access to of antihypertensive medications, therapeutic inertia by physicians, and other factors. With the anticipated continued transition from primarily infectious conditions to chronic non-communicable diseases, the burden of stroke in SSA is likely to increase even further over the next several decades. Given all of the aforementioned factors, it is an urgent priority for countries in SSA to develop and test self-management interventions to control hypertension among those at highest risk of adverse outcomes. The overall objective of Phone-based Intervention under Nurse Guidance after Stroke II (PINGS-2) is to deploy a hybrid study design to firstly, demonstrate the efficacy in a randomized controlled trial of a theoretical-model-based, mHealth technology-centered, nurse-led, multi-level integrated approach to substantially improve longer term BP control among 500 recent stroke patients encountered at 10 hospitals in Ghana. Secondly, PINGS II seeks to develop an implementation strategy for routine integration and policy adoption of mhealth for post-stroke BP control in a LMIC setting. We will leverage experience gained from the NIH Global Brain Disorders funded R21 pilot study (NS094033) to test efficacy of a refined, culturally-tailored, and potentially implementable intervention aimed at addressing the premier modifiable risk for stroke & other key variables in an under-resourced system burdened by suboptimal care & outcomes. The primary outcome is blood pressure control at month 12 alongside a host of secondary outcome measures such as medication adherence, self-efficacy, cardiovascular emergency department encounters, quality of life, and mediator outcomes. While it is important to establish the efficacy of a nurse-led, m-health-centered self- management intervention for blood pressure control in LMICs, it equally crucial to simultaneously begin crafting an implementation plan. Hence we will seek to identify context-specific implementation facilitators and barriers, to understand the implementation context, and craft evidence-based implementation strategies for routine use & policy adoption of the PINGS intervention in Ghana through multiple stakeholder engagements.