Development and evaluation of a patient-centered cardiovascular health education program among insured primary care patients with hypertension in rural Nigeria: The QUICK-II study

Background: Cardiovascular diseases (CVD) are increasingly common in Nigeria and sub Saharan Africa (SSA). Poverty is rampant and quality of primary care substandard. Moreover adherence capacity for prescribed anti-hypertensive treatment is limited and blood pressure (BP) control consequently poor. To limit CVD affordable high-quality hypertension care and patient-centered cardiovascular health education program (CHEP) are important but lacking. This thesis investigates outcomes of providing low-income hypertensive patients from rural Nigeria with the suggested interventions. Objectives: Development, implementation and evaluation of CHEP among patients with access to high-quality hypertension care in a primary care hospital in rural Nigeria. Methods: CHEP was developed based on qualitative interview studies among: 40 hypertensive patients; 11 healthcare professionals; 4 insurance managers, (July-December 2010). CHEP was evaluated using quantitative (pre/post) study among 149 insured patients with uncontrolled hypertension and/or medication non-adherence, (February-September 2012). Data management was assisted with MAXQDA and STATA software. Results: CHEP development: Patient-identified facilitators/inhibitors of medication adherence: patient-related (e.g. trust in orthodox/western pills); healthcare-related (e.g. long waiting times); medication-related (e.g. medication side-effects); socio-cultural (e.g. negative cultural body images). Provider/insurer-identified enablers/barriers of high-quality hypertension care: availability/non-availability of necessary resources (e.g. health insurance); healthy stakeholders’ relationships. CHEP protocol. CHEP evaluation: more participants reported high adherence to medications, healthy behaviors; participants with controlled BP doubled; improved medication adherence was significantly associated with decreased medication concerns and improved medication self-efficacy. Conclusion: Implementing CHEP in context of insured high-quality hypertension care improved medication/behavioral adherence and BP control. Such interventions have potential to limit CVD among SSA’s growing hypertensive population

Enablers and barriers for implementing high-quality hypertension care in a rural primary care setting in Nigeria: perspectives of primary care staff and health insurance managers

Background: Hypertension is a highly prevalent risk factor for cardiovascular diseases in sub-Saharan Africa (SSA) that can be modified through timely and long-term treatment in primary care. Objective: We explored perspectives of primary care staff and health insurance managers on enablers and barriers for implementing high-quality hypertension care, in the context of a community-based health insurance programme in rural Nigeria. Design: Qualitative study using semi-structured individual interviews with primary care staff (n = 11) and health insurance managers (n=4). Data were analysed using standard qualitative techniques. Results: Both stakeholder groups perceived health insurance as an important facilitator for implementing high-quality hypertension care because it covered costs of care for patients and provided essential resources and incentives to clinics: guidelines, staff training, medications, and diagnostic equipment. Perceived inhibitors included the following: high staff workload; administrative challenges at facilities; discordance between healthcare provider and insurer on how health insurance and provider payment methods work; and insufficient fit between some guideline recommendations and tools for patient education and characteristics/needs of the local patient population. Perceived strategies to address inhibitors included the following: task-shifting; adequate provider payment benchmarking; good provider–insurer relationships; automated administration systems; and tailoring guidelines/patient education. Conclusions: By providing insights into perspectives of primary care providers and health insurance managers, this study offers information on potential strategies for implementing high-quality hypertension care for insured patients in SSA

Beliefs of Health Care Providers, Lay Health Care Providers and Lay Persons in Nigeria Regarding Hypertension. A Systematic Mixed Studies Review

<div><p>Background</p><p>Hypertension is a major health risk factor for mortality globally, resulting in about 13% of deaths worldwide. In Nigeria, the high burden of hypertension remains an issue for urgent attention. The control of hypertension, among other factors, is strongly determined by personal beliefs about the illness and recommended treatment.</p><p>Objective</p><p>The aim of this review is to systematically synthesize available data from all types of studies on beliefs of the Nigerian populace about hypertension</p><p>Methods</p><p>We searched the following electronic databases; Medline, EMBase, PsycInfo, AMED from their inception till date for all relevant articles. A modified Kleinman’s explanatory model for hypertension was used as a framework for extraction of data on beliefs about hypertension.</p><p>Results</p><p>The search yielded a total of 3,794 hits from which 16 relevant studies (2 qualitative, 11 quantitative and 3 mixed methods studies) met the inclusion criteria for the review. Overall, most health care providers (HCPs) believe that stress is a major cause of hypertension. Furthermore, reported cut-off point for uncomplicated hypertension differed widely among HCPs. Lay Health Care Providers such as Patent Medicine Vendors’ beliefs about hypertension seem to be relatively similar to health care professionals in areas of risk factors for hypertension, course of hypertension and methods of treatment. Among Lay persons, misconception about hypertension was quite high. Although some Nigerians believed that life style habits such as alcohol intake, exercise levels, cigarette smoking were risk factors for developing hypertension, there was discordance between belief and practice of control of risk factors. However, beliefs across numerous ethnic groups and settings (urban/rural) in Nigeria have not been explored.</p><p>Conclusion</p><p>In order to achieve control of hypertension in Nigeria, interventions should be informed, among other factors, by adequate knowledge of beliefs regarding hypertension across the numerous ethnic groups in Nigeria, settings (rural/urban), age and sex.</p></div