An exploration of the risk factors, beliefs and management of hypertension in primary care in Nigeria - a mixed methods study

Objective: To explore ways to improve care of hypertension at the primary care level in Nigeria Background: Although the burden of communicable diseases is still present in Africa, the burden of non-communicable diseases is rapidly increasing. Chronic conditions like hypertension are common among both rural and urban populations in Nigeria. In many regions of Nigeria, the primary health care (PHC) facility is usually the only source of formal health care available. Many clients who use PHC facilities in Nigeria may have hypertension yet they often go undetected and untreated. Setting: Twenty (20) rural (N=10) and urban (N=10) primary health care centres in the Federal Capital Territory Nigeria Methods: A multi-level triangulation mixed method design was used. Participants: Forty-one (41) primary health care clients and forty-one (41) primary health care workers participated in the qualitative study while 650 clients participated in the quantitative study which investigated the prevalence of hypertension and cardiovascular risk factors. Results: Overall, the study revealed a substantial unmet need for hypertension in primary care in Nigeria. The sample population for this study is very young with about 90% of the population aged between 18-44 years old. Overall, among those 40years and older, 94.4% (95%CI: 88.9-97.7) had 10-year risk of cardiovascular event less than 10%. Most participants had 1-2 risk factors (58.4% [95%CI: 54.5-62.3]) while 32.3% [95%CI: 28.7-36.1]) had 3-5 risk factors for cardiovascular diseases. The overall hypertension service readiness and availability of the 20 primary care facilities was very low. The overall prevalence of hypertension was 27.9% (95%CI: 24.5- 31.6). The qualitative study identified important ethnic differences and similarities in beliefs about meaning, risk factors, symptoms and treatment of hypertension between PHC clients and workers. It also revealed that non-physician PHC workers were enthusiastic to take on additional roles in managing hypertension which is currently beyond their scope of duty. Conclusions: This study provides important information for improving care of hypertension in primary care in Nigeria by first highlighting the burden of hypertension and risk factors among primary care clients. Then it identifies differences and similarities in beliefs between PHC clients and PHC workers as well as current experiences of PHC workers with managing hypertension which could help inform appropriate hypertension management program in Nigeria

Protocol for a systematic review and qualitative synthesis of information quality frameworks in eHealth

Introduction Electronic health (eHealth) applications have become a very large repository of health information which informs critical decisions relating to the diagnosis, treatment and prognosis of patients. Poor information quality (IQ) within eHealth may compromise patient safety. Evaluation of IQ in eHealth is therefore necessary to promote patient safety. An IQ framework specifies what aspects of information to assess and how to conduct the assessment. This systematic review aims to identify dimensions within existing IQ frameworks in eHealth and develop a new IQ framework for the assessment of eHealth.Method and analysis We will search Embase, Medline, PubMed, Cumulative Index to Nursing and Allied Health Literature, Maternity and Infant Care, PsycINFO (American Psychological Association), Global Health, Scopus, ProQuest Dissertations and Theses Global, Health Management Information Consortium and reference lists of relevant publications for articles published in English until November 2018. Studies will be selected by two independent reviewers based on prespecified eligibility criteria. Two reviewers will independently extract data in each eligible study using a prepiloted Microsoft Excel data extraction form. Thematic synthesis will be employed to define IQ dimensions and develop a new IQ framework for eHealth.Ethics and dissemination Ethical approval is not required for this systematic review as primary data will not be collected. The result of the review will be disseminated through publication in an academic journal and scientific conferences.PROSPERO registration number CRD4201809714

Protocol for a systematic review and qualitative synthesis of information quality frameworks in eHealth

Introduction: Electronic health (eHealth) applications have become a very large repository of health information which informs critical decisions relating to the diagnosis, treatment and prognosis of patients. Poor information quality (IQ) within eHealth may compromise patient safety. Evaluation of IQ in eHealth is therefore necessary to promote patient safety. An IQ framework specifies what aspects of information to assess and how to conduct the assessment. This systematic review aims to identify dimensions within existing IQ frameworks in eHealth and develop a new IQ framework for assessment of eHealth. Method and Analysis: We will search EMBASE, Medline, PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Maternity and Infant Care, PsycINFO, Global Health, Scopus, ProQuest Dissertations and Theses Global, Health Management Information Consortium and reference lists of relevant publications for articles published in English until November 2018. Studies will be selected by two independent reviewers based on pre-specified eligibility criteria. Two reviewers will independently extract data in each eligible study using a pre-piloted Microsoft Excel data extraction form. Thematic synthesis will be employed to define IQ dimensions and develop a new IQ framework for eHealth. Ethics and Dissemination: Ethical approval is not required for this systematic review as primary data will not be collected. The result of the review will be disseminated through publication in an academic journal and scientific conferences. Keywords: Quality in healthcare, health informatics, telemedicine, systematic review, information quality Review Registration: PROSPERO CRD4201809714

Beliefs about hypertension among primary health care workers and clients in Nigeria: A qualitative study.

OBJECTIVE:The main objective of the study was to elicit beliefs about hypertension among Nigerian Primary Health Care clients and workers. BACKGROUND:In many regions of Nigeria, the primary health care facility is usually the only source of formal health care available. Since hypertension is a chronic condition that requires lifelong life style modification and drug treatment, it is important to understand the context and background to the condition through the beliefs and perceptions among both lay persons and health care providers who manage the condition. SETTING:Rural and urban primary health care facilities in the Federal Capital Territory Nigeria. PARTICIPANTS:A total of Eighty-one (81) primary health care clients and workers participated in the study. METHODS AND OUTCOME MEASURE:A qualitative research using interviews, focus group discussions and reflective work as sources of data collection. The outcome measures were emerging themes from thematic framework analysis. RESULTS:There were four themes that summarize beliefs of both PHC workers and clients namely: (1) Meaning of hypertension (2) causes of hypertension, (3) Consequences of hypertension (4) Perceptions of treatment, one additional distinct theme was elicited among PHC workers "contextual explanation". However, under each of the shared four themes, there were both similarities and differences in beliefs expressed between PHC workers and clients. CONCLUSIONS:This study highlights important similarities and differences in beliefs about hypertension among primary health care clients and primary health care workers that have significant implications for management of hypertension in primary care settings in Nigeria

Characteristics of PHC clients used in the in-depth interviews and focus group discussion.

Characteristics of PHC clients used in the in-depth interviews and focus group discussion.</p

Summary of similarities and differences in themes and subthemes.

Summary of similarities and differences in themes and subthemes.</p

Forest Plot showing prevalence of hypertension% & 95%CI across studies that used BP cut-off ≥ 160/90mmHg.

<p>Forest Plot showing prevalence of hypertension% & 95%CI across studies that used BP cut-off ≥ 160/90mmHg.</p

Characteristics of PHC workers used in the in-depth interviews and focus group discussion.

Characteristics of PHC workers used in the in-depth interviews and focus group discussion.</p

Proportion of Lay persons with respective beliefs under EM categories: “definition”, “cause”, “Course”, “symptoms” &” treatment” in quantitative studies.

<p>Proportion of Lay persons with respective beliefs under EM categories: “definition”, “cause”, “Course”, “symptoms” &” treatment” in quantitative studies.</p