Sustaining an Evidence-based Task-shifting Strategy for Blood Pressure Control in Ghana

 描述（由申请人提供）：加纳有2350万人口，其中350万成年人患有高血压。此外，全国医生与人口的比例为1：13，000。鉴于资源如此有限， 以缓解加纳等国高血压流行病的上升趋势。其中一种方法是任务转移，其定义是将初级保健职责从医生合理分配给非医生医疗保健提供者。目前正在加纳进行一项在社区卫生中心（CHC）、地区医院和社区卫生护士（CHN）进行的任务转移和血压控制的随机分组试验。虽然拟议的干预措施将告诉我们，任务转移策略的实施是否会导致血压降低和维持在个人层面上，目前，很少有人知道利益相关者对干预本身的看法，或因素和/或背景可能促进或限制战略的实施期后的维持。可以解决这个问题的一种方法是群体概念映射（GCM），这是一种结构化的混合方法，考虑不同利益相关者群体的观点，以确定可能影响真实的世界环境中EBP实施的潜在障碍和促进因素[6]。本研究的目的是使用群体概念映射来识别利益相关者（例如CHN，医生等）。对可能影响加纳任务转移战略维持的障碍和促进因素的看法。具体目标是：1）确定利益攸关方对在加纳维持世卫组织出口前网络模式的价值和可能促进或阻碍其维持的因素的看法; 2）评估这些因素在一段时间内维持的重要性和可能性; 3）制定在加纳维持世卫组织出口前网络模式的概念框架。这项研究将有助于我们的知识基础上的多个因素，影响维持一个基于证据的做法在低资源的设置传统上代表性不足的传播和实施研究。

 DESCRIPTION (provided by applicant): Ghana has a population of 23.5 million people, of which 3.5 million adults are hypertensive. Furthermore, the country's physician-to-population ratio is 1:13,000 nationally. Given such limited resources, cost-effective systems-level strategies are urgently needed to mitigate the rising epidemic of hypertension in countries like Ghana. One such approach is task- shifting, defined as the rational distribution of primary care duties from physicians to non-physician healthcare providers. A cluster-randomized trial of task-shifting and blood pressure control in community health centers (CHCs), district hospitals and with community health nurses (CHN) is currently on-going in Ghana. While the proposed intervention will tell us whether implementation of the task-shifting strategy results in blood pressure reduction and maintenance at the individual level, at present, very little is known about stakeholder perceptions of the intervention itself, or the factors and/or context likely to facilitte or limit sustainment of the strategy beyond the implementation period. One method than can address this is group concept-mapping (GCM), a structured mixed-methods approach that considers the perspectives of different stakeholder groups to identify potential barriers and facilitators likely to impact implementation of EBPs in real- world settings [6]. The goal of this study is to use group concept mapping to identify stakeholder (e.g. CHNs, physicians, etc.) perspectives on the barriers and facilitators likely to influence the sustainment of the task-shifting strategy in Ghana. The specific aims are: 1) To identify stakeholder perspectives on the value of and factors likely to facilitate or hinder the sustainment of the WHO PEN model in Ghana; 2) To assess the perceived importance and likelihood that these factors would be sustained over time; and 3) To develop a conceptual framework on sustaining the WHO PEN model in Ghana. This study will contribute to our knowledge base on the multiple factors that influence sustainment of an evidence based practice in a low-resource setting traditionally underrepresented in dissemination and implementation research.