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

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 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.