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

加纳维持基于证据的血压控制任务转移策略

• 批准号: 8952757
• 负责人: Juliet Iwelunmor
• 金额: $ 7.93万
• 依托单位: UNIVERSITY OF ILLINOIS AT URBANA-CHAMPAIGN
• 依托单位国家: 美国
• 财政年份: 2015
• 资助国家: 美国
• 起止时间: 2015-07-01 至 2017-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8952757
• 关键词: Acute; Address; Adoption; Adult; Africa South of the Sahara; Area; Australia; Canada; Caring; Cluster randomized trial; Communicable Diseases; Community Health Centers; Community Health Nurse Specialist; Community Health Nursing; Country; Data; Development; District Hospitals; Environment; Epidemic; Evidence based practice; Ghana; Goals; Health; Health Personnel; Health Professional; Health Services; Health system; Healthcare Systems; Hypertension; Individual; Intervention; Lead; Life; Maintenance; Maps; Methods; Modeling; Nurses; Outcome Study; Participant; Patients; Perception; Phase; Physicians; Population; Positioning Attribute; Preparation; Primary Health Care; Process; Research Design; Resources; Socioeconomic Factors; Structure; System; Testing; Time; Training; United Kingdom; United States; Work; World Health Organization; base; blood pressure reduction; blood pressure regulation; cost; cost effective; design; dissemination research; evidence base; hypertension prevention; implementation research; implementation science; implementation trial; innovation; public health relevance

 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.

 描述(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。鉴于这样有限的资源，具有成本效益的系统一级战略 以缓解加纳等国日益严重的高血压流行。一种这样的方法是任务转移，定义为合理分配初级保健职责，从医生到非医生的医疗保健提供者。加纳目前正在进行一项在社区卫生中心(CHCs)、地区医院和社区卫生护士(CHN)中进行的任务转移和血压控制的整群随机试验。虽然拟议的干预措施将告诉我们，实施任务转移战略是否会在个人层面上导致血压下降和维持，但目前，对于利益攸关方对干预措施本身的看法，或者可能促进或限制战略在实施期后持续的因素和/或背景，知之甚少。可以解决这一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，它考虑了不同利益攸关方群体的观点，以确定可能影响EBPS在现实世界环境中实施的潜在障碍和促进者[6]。本研究的目标是使用群体概念图来确定利益相关者(例如CHNS、医生等)对可能影响加纳任务转移战略持续的障碍和促进者的看法。具体目标是：1)确定利益攸关方对世卫组织国际笔会模式在加纳维持的价值和可能促进或阻碍的因素的看法；2)评估这些因素被认为的重要性和长期维持的可能性；3)制定关于在加纳维持世卫组织国际笔会模式的概念框架。这项研究将有助于我们关于影响循证做法在低资源环境下维持的多个因素的知识库，在传播和执行研究中传统上没有得到充分的重视。