Uptake of Task-Strengthening Strategy for Hypertension (TASSH) control within Community-Based Health Planning Services in Ghana: study protocol for a cluster randomized controlled trial

Kwaku Poku Asante, Juliet Iwelunmor, Kingsley Apusiga, Joyce Gyamfi, Solomon Nyame, Kezia Gladys Amaning Adjei, Angela Aifah, Kwame Adjei, Deborah Onakomaiya, William F Chaplin, Gbenga Ogedegbe, Jacob Plange-Rhule, Kwaku Poku Asante, Juliet Iwelunmor, Kingsley Apusiga, Joyce Gyamfi, Solomon Nyame, Kezia Gladys Amaning Adjei, Angela Aifah, Kwame Adjei, Deborah Onakomaiya, William F Chaplin, Gbenga Ogedegbe, Jacob Plange-Rhule

Abstract

Background: Physician shortage is a major barrier to hypertension (HTN) control in Ghana, with only one physician to 10,000 patients in 2015, thus limiting its capacity for HTN control at the primary care level such as the Community Health Planning and Services (CHPS) compounds, where most Ghanaians receive care. A Task-Shifting Strategy for HTN control (TASSH) based on the WHO Cardiovascular (CV) Risk Package is an evidence-based strategy for mitigating provider- and systems-level barriers to optimal HTN control. Despite its effectiveness, TASSH remains untested in CHPS zones. Additionally, primary care practices in low- and middle-income countries (LMICs) lack resources and expertise needed to coordinate multilevel system changes without assistance. The proposed study will evaluate the effectiveness of practice facilitation (PF) as a quality improvement strategy for implementing TASSH within CHPS zones in Ghana.

Methods: Guided by the Consolidated Framework for Implementation Research and the Reach, Effectiveness, Adoption, Implementation, and Maintenance framework, we will evaluate, in a hybrid clinical effectiveness-implementation design, the effect of PF on the uptake of an evidence-based TASSH, among 700 adults who present to 70 CHPS zones with uncontrolled HTN. Components of the PF strategy include (a) an advisory board that provides leadership support for implementing the intervention within the CHPS zones and (b) trained task-strengthening facilitators (TSFs) who serve as practice coaches to provide training, and performance feedback to community health officers (CHOs) who will deliver TASSH at the CHPS zones. For this purpose, the TSFs are trained to identify, counsel, and refer adults with uncontrolled HTN to community health centers in Bono East Region of Ghana.

Discussion: Uptake of community-based evidence-supported interventions for hypertension control in Ghana is urgently needed to address the CVD epidemic and its associated morbidity, mortality, and societal costs. Findings from this study will provide policymakers and other stakeholders the "how to do it" empirical literature on the uptake of evidence-based task-strengthening interventions for HTN control in Ghana and will serve as a model for similar action in other low, middle-income countries.

Trial registration: ClinicalTrials.gov, NCT03490695 . Registered on 6 April 2018.

Protocol version and date: Version 1, date: 21 August, 2019.

Keywords: Community-Based Health Planning Services; Ghana; Hypertension control; Implementation science; Practice facilitation; Sub-Saharan Africa; Task strengthening.

Conflict of interest statement

The authors declare that they have no competing interest.

Figures

Fig. 1
Fig. 1
Trial implementation design (parallel)
Fig. 2
Fig. 2
TASSH SPIRIT figure

References

    1. Asamani JA, Amertil NP, Ismaila H, Francis AA, Chebere MM, Nabyonga-Orem J. Nurses and midwives demographic shift in Ghana—the policy implications of a looming crisis. Hum Resour Health. 2019;17(1):1–5. doi: 10.1186/s12960-019-0377-1.
    1. GHS . Human resource directorate annual report for 2017. Accra: Ghana Health Service, Human Resource Directorate; 2018.
    1. Awoonor-Williams JK, Tindana P, Dalinjong PA, Nartey H, Akazili J. Does the operations of the National Health Insurance Scheme (NHIS) in Ghana align with the goals of Primary Health Care? Perspectives of key stakeholders in northern Ghana. BMC Int Health Hum Rights. 2016;16(1):1–11. doi: 10.1186/s12914-016-0096-9.
    1. Kalipeni E, Semu LL, Mbilizi MA. The brain drain of health care professionals from sub-Saharan Africa: a geographic perspective. Prog Dev Stud. 2012;12(2–3):153–171. doi: 10.1177/146499341101200305.
    1. Naicker S, Plange-Rhule J, Tutt RC, Eastwood JB. Shortage of healthcare workers in developing countries--Africa. Ethn Dis. 2009;19(1):60.
    1. Gyamfi J, Plange-Rhule J, Iwelunmor J, Lee D, Blackstone SR, Mitchell A, et al. Training nurses in task-shifting strategies for the management and control of hypertension in Ghana: a mixed-methods study. BMC Health Serv Res. 2017;17(1):1–9. doi: 10.1186/s12913-016-1943-z.
    1. Twagirumukiza M, Van Bortel L. Management of hypertension at the community level in sub-Saharan Africa (SSA): towards a rational use of available resources. J Hum Hypertens. 2011;25(1):47–56. doi: 10.1038/jhh.2010.32.
    1. Labhardt ND, Balo J-R, Ndam M, Grimm J-J, Manga E. Task shifting to non-physician clinicians for integrated management of hypertension and diabetes in rural Cameroon: a programme assessment at two years. BMC Health Serv Res. 2010;10(1):339. doi: 10.1186/1472-6963-10-339.
    1. Lekoubou A, Awah P, Fezeu L, Sobngwi E, Kengne AP. Hypertension, diabetes mellitus and task shifting in their management in sub-Saharan Africa. Int J Environ Res Public Health. 2010;7(2):353–363. doi: 10.3390/ijerph7020353.
    1. Ogedegbe G, Plange-Rhule J, Gyamfi J, Chaplin W, Ntim M, Apusiga K, et al. A cluster-randomized trial of task shifting and blood pressure control in Ghana: study protocol. Implement Sci. 2014;9(1):1–10. doi: 10.1186/1748-5908-9-73.
    1. WHO . Task shifting to tackle health worker shortages. Geneva: WHO; 2007.
    1. Zachariah R, Ford N, Philips M, Lynch S, Massaquoi M, Janssens V, et al. Task shifting in HIV/AIDS: opportunities, challenges and proposed actions for sub-Saharan Africa. Trans R Soc Trop Med Hyg. 2009;103(6):549–558. doi: 10.1016/j.trstmh.2008.09.019.
    1. Ogedegbe G, Plange-Rhule J, Gyamfi J, Chaplin W, Ntim M, Apusiga K, et al. Health insurance coverage with or without a nurse-led task shifting strategy for hypertension control: a pragmatic cluster randomized trial in Ghana. PLoS Med. 2018;15(5):e1002561. doi: 10.1371/journal.pmed.1002561.
    1. Ogedegbe G, Gyamfi J, Plange-Rhule J, Surkis A, Rosenthal DM, Airhihenbuwa C, et al. Task shifting interventions for cardiovascular risk reduction in low-income and middle-income countries: a systematic review of randomised controlled trials. BMJ Open. 2014;4(10):1-8.
    1. Baskerville NB, Liddy C, Hogg W. Systematic review and meta-analysis of practice facilitation within primary care settings. Ann Fam Med. 2012;10(1):63–74. doi: 10.1370/afm.1312.
    1. Berta W, Cranley L, Dearing JW, Dogherty EJ, Squires JE, Estabrooks CA. Why (we think) facilitation works: insights from organizational learning theory. Implement Sci. 2015;10(1):1–13. doi: 10.1186/s13012-015-0323-0.
    1. Lessard S, Bareil C, Lalonde L, Duhamel F, Hudon E, Goudreau J, et al. External facilitators and interprofessional facilitation teams: a qualitative study of their roles in supporting practice change. Implement Sci. 2015;11(1):97. doi: 10.1186/s13012-016-0458-7.
    1. Pantoja T, Opiyo N, Lewin S, Paulsen E, Ciapponi A, Wiysonge CS, et al. Implementation strategies for health systems in low-income countries: an overview of systematic reviews. Cochrane Database Syst Rev. 2017;9(9):CD011086.
    1. Shelley DR, Ogedegbe G, Anane S, Wu WY, Goldfeld K, Gold HT, et al. Testing the use of practice facilitation in a cluster randomized stepped-wedge design trial to improve adherence to cardiovascular disease prevention guidelines: HealthyHearts NYC. Implement Sci. 2015;11(1):88. doi: 10.1186/s13012-016-0450-2.
    1. Parchman ML, Noel PH, Culler SD, Lanham HJ, Leykum LK, Romero RL, et al. A randomized trial of practice facilitation to improve the delivery of chronic illness care in primary care: initial and sustained effects. Implement Sci. 2013;8(1):93. doi: 10.1186/1748-5908-8-93.
    1. Curran GM, Bauer M, Mittman B, Pyne JM, Stetler C. Effectiveness-implementation hybrid designs: combining elements of clinical effectiveness and implementation research to enhance public health impact. Med Care. 2012;50(3):217. doi: 10.1097/MLR.0b013e3182408812.
    1. Damschroder LJ, Aron DC, Keith RE, Kirsh SR, Alexander JA, Lowery JC. Fostering implementation of health services research findings into practice: a consolidated framework for advancing implementation science. Implement Sci. 2009;4(1):1–15. doi: 10.1186/1748-5908-4-50.
    1. Glasgow RE, Emmons KM. How can we increase translation of research into practice? Types of evidence needed. Annu Rev Public Health. 2007;28:413–433. doi: 10.1146/annurev.publhealth.28.021406.144145.
    1. Glasgow RE, Lichtenstein E, Marcus AC. Why don’t we see more translation of health promotion research to practice? Rethinking the efficacy-to-effectiveness transition. Am J Public Health. 2003;93(8):1261–1267. doi: 10.2105/AJPH.93.8.1261.
    1. Glasgow RE, Vogt TM, Boles SM. Evaluating the public health impact of health promotion interventions: the RE-AIM framework. Am J Public Health. 1999;89(9):1322–1327. doi: 10.2105/AJPH.89.9.1322.
    1. Manu A, Hill Z, Ten Asbroek AH, Soremekun S, Weobong B, Gyan T, et al. Increasing access to care for sick newborns: evidence from the Ghana Newhints cluster-randomised controlled trial. BMJ Open. 2016;6(6):e008107. doi: 10.1136/bmjopen-2015-008107.
    1. Nyame S, Iwelunmor J, Ogedegbe G, Adjei KGA, Adjei K, Apusiga K, et al. Capacity and readiness for implementing evidence-based task-strengthening strategies for hypertension control in Ghana: a cross-sectional study. Glob Heart. 2019;14(2):129–134. doi: 10.1016/j.gheart.2019.05.008.
    1. Dosoo DK, Nyame S, Enuameh Y, Ayetey H, Danwonno H, Twumasi M, et al. Prevalence of hypertension in the middle belt of Ghana: a community-based screening study. Int J Hypertens. 2019;2019.
    1. Schulz KF, Altman DG, Moher D, Group C CONSORT 2010 statement: updated guidelines for reporting parallel group randomised trials. Trials. 2010;11(1):32. doi: 10.1186/1745-6215-11-32.
    1. Five major steps to intervention (The “5 A’s”). Content last reviewed December 2012. Available from: .
    1. Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo JL, Jr, et al. Seventh report of the joint national committee on prevention, detection, evaluation, and treatment of high blood pressure. Hypertension. 2003;42(6):1206–1252. doi: 10.1161/01.HYP.0000107251.49515.c2.
    1. Judge W, Douglas T. Organizational change capacity: the systematic development of a scale. J Organ Chang Manag. 2009;22(6):635–649. doi: 10.1108/09534810910997041.
    1. Aarons GA, Ehrhart MG, Farahnak LR. The implementation leadership scale (ILS): development of a brief measure of unit level implementation leadership. Implement Sci. 2014;9(1):1. doi: 10.1186/1748-5908-9-1.
    1. Ehrhart MG, Aarons GA, Farahnak LR. Assessing the organizational context for EBP implementation: the development and validity testing of the Implementation Climate Scale (ICS) Implement Sci. 2014;9(1):1. doi: 10.1186/s13012-014-0157-1.
    1. Glisson C, Landsverk J, Schoenwald S, Kelleher K, Hoagwood KE, Mayberg S, et al. Assessing the organizational social context (OSC) of mental health services: implications for research and practice. Adm Policy Ment Health Ment Health Serv Res. 2008;35(1–2):98. doi: 10.1007/s10488-007-0148-5.
    1. Glisson C, Williams NJ, Green P, Hemmelgarn A, Hoagwood K. The organizational social context of mental health Medicaid waiver programs with family support services: implications for research and practice. Adm Policy Ment Health Serv Res. 2014;41(1):32–42. doi: 10.1007/s10488-013-0517-1.
    1. Aarons GA, Glisson C, Green PD, Hoagwood K, Kelleher KJ, Landsverk JA, et al. The organizational social context of mental health services and clinician attitudes toward evidence-based practice: a United States national study. Implement Sci. 2012;7(1):56. doi: 10.1186/1748-5908-7-56.
    1. Rye M, Torres EM, Friborg O, Skre I, Aarons GA. The Evidence-based Practice Attitude scale-36 (EBPAS-36): a brief and pragmatic measure of attitudes to evidence-based practice validated in US and Norwegian samples. Implement Sci. 2017;12(1):44. doi: 10.1186/s13012-017-0573-0.
    1. Armenakis AA, Bernerth JB, Pitts JP, Walker HJ. Organizational change recipients’ beliefs scale: development of an assessment instrument. J Appl Behav Sci. 2007;43(4):481–505. doi: 10.1177/0021886307303654.
    1. Srivastava A, Thomson SB. Framework analysis: a qualitative methodology for applied policy research. 2009.
    1. Shenton AK. Strategies for ensuring trustworthiness in qualitative research projects. Educ Inf. 2004;22(2):63–75.
    1. Salim A, Mackinnon A, Christensen H, Griffiths K. Comparison of data analysis strategies for intent-to-treat analysis in pre-test–post-test designs with substantial dropout rates. Psychiatry Res. 2008;160(3):335–345. doi: 10.1016/j.psychres.2007.08.005.
    1. Patridge EF, Bardyn TP. Research electronic data capture (REDCap) J Med Libr Assoc. 2018;106(1):142. doi: 10.5195/JMLA.2018.319.
    1. Gliklich RE, Dreyer NA, Leavy MB. Adverse event detection, processing, and reporting. registries for evaluating patient outcomes: a user’s guide. 3. Rockville: Agency for Healthcare Research and Quality (US); 2014.
    1. Iwelunmor J, Blackstone S, Veira D, Nwaozuru U, Airhihenbuwa C, Munodawafa D, et al. Toward the sustainability of health interventions implemented in sub-Saharan Africa: a systematic review and conceptual framework. Implement Sci. 2015;11(1):43. doi: 10.1186/s13012-016-0392-8.
    1. Aarons GA, Sommerfeld DH, Chi BH, Ezeanolue EE, Sturke R, Guay L, et al. Concept mapping of PMTCT implementation challenges and solutions across 6 sub-Saharan African countries in the NIH-PEPFAR PMTCT implementation science alliance. J Acquir Immune Defic Syndr. 2016;72:S202–S2S6. doi: 10.1097/QAI.0000000000001064.
    1. WHO . World health statistics. 2015.
    1. Trochim W, Kane M. Concept mapping: an introduction to structured conceptualization in health care. Int J Qual Health Care. 2005;17(3):187–191. doi: 10.1093/intqhc/mzi038.

Source: PubMed

Sponsorit ja yhteistyökumppanit

Sairaudet

Huumeiden interventiot

3
Tilaa