Training nurses in task-shifting strategies for the management and control of hypertension in Ghana: a mixed-methods study
Identifieur interne : 000077 ( Pmc/Curation ); précédent : 000076; suivant : 000078Training nurses in task-shifting strategies for the management and control of hypertension in Ghana: a mixed-methods study
Auteurs : Joyce Gyamfi [États-Unis] ; Jacob Plange-Rhule [Ghana] ; Juliet Iwelunmor [États-Unis] ; Debbie Lee [États-Unis] ; Sarah R. Blackstone [États-Unis] ; Alicia Mitchell [États-Unis] ; Michael Ntim [Ghana] ; Kingsley Apusiga [Ghana] ; Bamidele Tayo [États-Unis] ; Kwasi Yeboah-Awudzi [Ghana] ; Richard Cooper [États-Unis] ; Gbenga Ogedegbe [États-Unis]Source :
- BMC Health Services Research [ 1472-6963 ] ; 2017.
Abstract
Nurses in Ghana play a vital role in the delivery of primary health care at both the household and community level. However, there is lack of information on task shifting the management and control of hypertension to community health nurses in low- and middle-income countries including Ghana. The purpose of this study was to assess nurses’ knowledge and practice of hypertension management and control pre- and post-training utilizing task-shifting strategies for hypertension control in Ghana (TASSH).
A pre- and post- test survey was administered to 64 community health nurses (CHNs) and enrolled nurses (ENs) employed in community health centers and district hospitals before and after the TASSH training, followed by semi-structured qualitative interviews that assessed nurses’ satisfaction with the training, resultant changes in practice and barriers and facilitators to optimal hypertension management.
A total of 64 CHNs and ENs participated in the TASSH training. The findings of the pre- and post-training assessments showed a marked improvement in nurses’ knowledge and practice related to hypertension detection and treatment. At pre-assessment 26.9% of the nurses scored 80% or more on the hypertension knowledge test, whereas this improved significantly to 95.7% post-training. Improvement of interpersonal skills and patient education were also mentioned by the nurses as positive outcomes of participation in the intervention.
Findings suggest that if all nurses receive even brief training in the management and control of hypertension, major public health benefits are likely to be achieved in low-income countries like Ghana. However, more research is needed to ascertain implementation fidelity and sustainability of interventions such as TASSH that highlight the potential role of nurses in mitigating barriers to optimal hypertension control in Ghana.
Trial registration for parent TASSH study:
Url:
DOI: 10.1186/s12913-017-2026-5
PubMed: 28148255
PubMed Central: 5288999
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wicri:level="1"><nlm:aff id="Aff3"><institution-wrap><institution-id institution-id-type="ISNI">0000000109466120</institution-id><institution-id institution-id-type="GRID">grid.9829.a</institution-id><institution>School of Medical Sciences,</institution><institution>Kwame Nkrumah University of Science and Technology,</institution></institution-wrap>Kumasi, Ghana</nlm:aff><country xml:lang="fr">Ghana</country><wicri:regionArea>Kumasi</wicri:regionArea></affiliation></author><author><name sortKey="Iwelunmor, Juliet" sort="Iwelunmor, Juliet" uniqKey="Iwelunmor J" first="Juliet" last="Iwelunmor">Juliet Iwelunmor</name><affiliation wicri:level="2"><nlm:aff id="Aff4"><institution-wrap><institution-id institution-id-type="ISNI">0000 0004 1936 9991</institution-id><institution-id institution-id-type="GRID">grid.35403.31</institution-id><institution></institution><institution>University of Illinois at Urbana-Champaign,</institution></institution-wrap>Urbana, IL 61801 USA</nlm:aff><country 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Medicine, NYU Langone Medical Center, New York</wicri:cityArea></affiliation></author><author><name sortKey="Ntim, Michael" sort="Ntim, Michael" uniqKey="Ntim M" first="Michael" last="Ntim">Michael Ntim</name><affiliation wicri:level="1"><nlm:aff id="Aff3"><institution-wrap><institution-id institution-id-type="ISNI">0000000109466120</institution-id><institution-id institution-id-type="GRID">grid.9829.a</institution-id><institution>School of Medical Sciences,</institution><institution>Kwame Nkrumah University of Science and Technology,</institution></institution-wrap>Kumasi, Ghana</nlm:aff><country xml:lang="fr">Ghana</country><wicri:regionArea>Kumasi</wicri:regionArea></affiliation></author><author><name sortKey="Apusiga, Kingsley" sort="Apusiga, Kingsley" uniqKey="Apusiga K" first="Kingsley" last="Apusiga">Kingsley Apusiga</name><affiliation wicri:level="1"><nlm:aff id="Aff3"><institution-wrap><institution-id institution-id-type="ISNI">0000000109466120</institution-id><institution-id institution-id-type="GRID">grid.9829.a</institution-id><institution>School of Medical Sciences,</institution><institution>Kwame Nkrumah University of Science and Technology,</institution></institution-wrap>Kumasi, Ghana</nlm:aff><country xml:lang="fr">Ghana</country><wicri:regionArea>Kumasi</wicri:regionArea></affiliation></author><author><name sortKey="Tayo, Bamidele" sort="Tayo, Bamidele" uniqKey="Tayo B" first="Bamidele" last="Tayo">Bamidele Tayo</name><affiliation wicri:level="2"><nlm:aff id="Aff5"><institution-wrap><institution-id institution-id-type="ISNI">0000 0001 1089 6558</institution-id><institution-id institution-id-type="GRID">grid.164971.c</institution-id><institution></institution><institution>Stritch School of Medicine, Loyola Chicago Medical Center,</institution></institution-wrap>Maywood, IL 60153 USA</nlm:aff><country xml:lang="fr">États-Unis</country><placeName><region type="state">Illinois</region></placeName><wicri:cityArea>Maywood</wicri:cityArea></affiliation></author><author><name sortKey="Yeboah Awudzi, Kwasi" sort="Yeboah Awudzi, Kwasi" uniqKey="Yeboah Awudzi K" first="Kwasi" last="Yeboah-Awudzi">Kwasi Yeboah-Awudzi</name><affiliation wicri:level="1"><nlm:aff id="Aff7"><institution-wrap><institution-id institution-id-type="ISNI">0000 0001 0582 2706</institution-id><institution-id institution-id-type="GRID">grid.434994.7</institution-id><institution></institution><institution>Ghana Health Service,</institution></institution-wrap>Kumasi, Ghana</nlm:aff><country xml:lang="fr">Ghana</country><wicri:regionArea>Kumasi</wicri:regionArea></affiliation></author><author><name sortKey="Cooper, Richard" sort="Cooper, Richard" uniqKey="Cooper R" first="Richard" last="Cooper">Richard Cooper</name><affiliation wicri:level="2"><nlm:aff id="Aff5"><institution-wrap><institution-id institution-id-type="ISNI">0000 0001 1089 6558</institution-id><institution-id institution-id-type="GRID">grid.164971.c</institution-id><institution></institution><institution>Stritch School of Medicine, Loyola Chicago Medical Center,</institution></institution-wrap>Maywood, IL 60153 USA</nlm:aff><country xml:lang="fr">États-Unis</country><placeName><region type="state">Illinois</region></placeName><wicri:cityArea>Maywood</wicri:cityArea></affiliation></author><author><name sortKey="Ogedegbe, Gbenga" sort="Ogedegbe, Gbenga" uniqKey="Ogedegbe G" first="Gbenga" last="Ogedegbe">Gbenga Ogedegbe</name><affiliation wicri:level="2"><nlm:aff id="Aff1">New York University School of Medicine, NYU Langone Medical Center, New York, NY 10016 USA</nlm:aff><country xml:lang="fr">États-Unis</country><placeName><region type="state">État de New York</region></placeName><wicri:cityArea>New York University School of Medicine, NYU Langone Medical Center, New York</wicri:cityArea></affiliation><affiliation wicri:level="2"><nlm:aff id="Aff2"><institution-wrap><institution-id institution-id-type="ISNI">0000 0004 1936 8753</institution-id><institution-id institution-id-type="GRID">grid.137628.9</institution-id><institution>NYU College of Global Public Health,</institution><institution>New York University,</institution></institution-wrap>New York, NY 10003 USA</nlm:aff><country xml:lang="fr">États-Unis</country><placeName><region type="state">État de New York</region></placeName><wicri:cityArea>New York</wicri:cityArea></affiliation></author></analytic><series><title level="j">BMC Health Services Research</title><idno type="eISSN">1472-6963</idno><imprint><date when="2017">2017</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec><title>Background</title><p>Nurses in Ghana play a vital role in the delivery of primary health care at both the household and community level. However, there is lack of information on task shifting the management and control of hypertension to community health nurses in low- and middle-income countries including Ghana. The purpose of this study was to assess nurses’ knowledge and practice of hypertension management and control pre- and post-training utilizing task-shifting strategies for hypertension control in Ghana (TASSH).</p></sec><sec><title>Methods</title><p>A pre- and post- test survey was administered to 64 community health nurses (CHNs) and enrolled nurses (ENs) employed in community health centers and district hospitals before and after the TASSH training, followed by semi-structured qualitative interviews that assessed nurses’ satisfaction with the training, resultant changes in practice and barriers and facilitators to optimal hypertension management.</p></sec><sec><title>Results</title><p>A total of 64 CHNs and ENs participated in the TASSH training. The findings of the pre- and post-training assessments showed a marked improvement in nurses’ knowledge and practice related to hypertension detection and treatment. At pre-assessment 26.9% of the nurses scored 80% or more on the hypertension knowledge test, whereas this improved significantly to 95.7% post-training. Improvement of interpersonal skills and patient education were also mentioned by the nurses as positive outcomes of participation in the intervention.</p></sec><sec><title>Conclusions</title><p>Findings suggest that if all nurses receive even brief training in the management and control of hypertension, major public health benefits are likely to be achieved in low-income countries like Ghana. However, more research is needed to ascertain implementation fidelity and sustainability of interventions such as TASSH that highlight the potential role of nurses in mitigating barriers to optimal hypertension control in Ghana.</p></sec><sec><title>Trial registration</title><p>Trial registration for parent TASSH study: <ext-link ext-link-type="uri" xlink:href="https://clinicaltrials.gov/ct2/show/NCT01802372">NCT01802372</ext-link>. Registered February 27, 2013.</p></sec></div></front><back><div1 type="bibliography"><listBibl><biblStruct><analytic><author><name sortKey="Cappuccio, Fp" uniqKey="Cappuccio F">FP Cappuccio</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Mendis, S" uniqKey="Mendis S">S Mendis</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Twagirumukiza, M" uniqKey="Twagirumukiza M">M Twagirumukiza</name></author><author><name sortKey="Van Bortel, Lm" uniqKey="Van Bortel L">LM Van Bortel</name></author></analytic></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct><analytic><author><name sortKey="Kalipeni, E" uniqKey="Kalipeni E">E Kalipeni</name></author><author><name sortKey="Semu, Ll" uniqKey="Semu L">LL Semu</name></author><author><name sortKey="Mbilizi, Ma" uniqKey="Mbilizi M">MA Mbilizi</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Bosu, Wk" uniqKey="Bosu W">WK 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<front><journal-meta><journal-id journal-id-type="nlm-ta">BMC Health Serv Res</journal-id><journal-id journal-id-type="iso-abbrev">BMC Health Serv Res</journal-id><journal-title-group><journal-title>BMC Health Services Research</journal-title></journal-title-group><issn pub-type="epub">1472-6963</issn><publisher><publisher-name>BioMed Central</publisher-name><publisher-loc>London</publisher-loc></publisher></journal-meta><article-meta><article-id pub-id-type="pmid">28148255</article-id><article-id pub-id-type="pmc">5288999</article-id><article-id pub-id-type="publisher-id">2026</article-id><article-id pub-id-type="doi">10.1186/s12913-017-2026-5</article-id><article-categories><subj-group subj-group-type="heading"><subject>Research Article</subject></subj-group></article-categories><title-group><article-title>Training nurses in task-shifting strategies for the management and control of hypertension in Ghana: a mixed-methods study</article-title></title-group><contrib-group><contrib contrib-type="author" corresp="yes"><name><surname>Gyamfi</surname><given-names>Joyce</given-names></name><address><phone>212-263-2613</phone><email>Joyce.gyamfi@nyumc.org</email></address><xref ref-type="aff" rid="Aff1">1</xref></contrib><contrib contrib-type="author"><name><surname>Plange-Rhule</surname><given-names>Jacob</given-names></name><address><email>jprhule@gmail.com</email></address><xref ref-type="aff" rid="Aff3">3</xref></contrib><contrib contrib-type="author"><name><surname>Iwelunmor</surname><given-names>Juliet</given-names></name><address><email>jiwez@illinois.edu</email></address><xref ref-type="aff" rid="Aff4">4</xref></contrib><contrib contrib-type="author"><name><surname>Lee</surname><given-names>Debbie</given-names></name><address><email>debbie.lee@stonybrookmedicine.edu</email></address><xref ref-type="aff" rid="Aff6">6</xref></contrib><contrib contrib-type="author"><name><surname>Blackstone</surname><given-names>Sarah R.</given-names></name><address><email>blackst1@illinois.edu</email></address><xref ref-type="aff" rid="Aff4">4</xref></contrib><contrib contrib-type="author"><name><surname>Mitchell</surname><given-names>Alicia</given-names></name><address><email>mitchella36@gmail.com</email></address><xref ref-type="aff" rid="Aff1">1</xref></contrib><contrib contrib-type="author"><name><surname>Ntim</surname><given-names>Michael</given-names></name><address><email>archangelmntim@gmail.com</email></address><xref ref-type="aff" rid="Aff3">3</xref></contrib><contrib contrib-type="author"><name><surname>Apusiga</surname><given-names>Kingsley</given-names></name><address><email>kingapus@yahoo.com</email></address><xref ref-type="aff" rid="Aff3">3</xref></contrib><contrib contrib-type="author"><name><surname>Tayo</surname><given-names>Bamidele</given-names></name><address><email>btayo@lumc.edu</email></address><xref ref-type="aff" rid="Aff5">5</xref></contrib><contrib contrib-type="author"><name><surname>Yeboah-Awudzi</surname><given-names>Kwasi</given-names></name><address><email>yawudzi@yahoo.com</email></address><xref ref-type="aff" rid="Aff7">7</xref></contrib><contrib contrib-type="author"><name><surname>Cooper</surname><given-names>Richard</given-names></name><address><email>rcooper@luc.edu</email></address><xref ref-type="aff" rid="Aff5">5</xref></contrib><contrib contrib-type="author"><name><surname>Ogedegbe</surname><given-names>Gbenga</given-names></name><address><email>Olugbenga.ogedegbe@nyumc.org</email></address><xref ref-type="aff" rid="Aff1">1</xref><xref ref-type="aff" rid="Aff2">2</xref></contrib><aff id="Aff1"><label>1</label>New York University School of Medicine, NYU Langone Medical Center, New York, NY 10016 USA</aff><aff id="Aff2"><label>2</label><institution-wrap><institution-id institution-id-type="ISNI">0000 0004 1936 8753</institution-id><institution-id institution-id-type="GRID">grid.137628.9</institution-id><institution>NYU College of Global Public Health,</institution><institution>New York University,</institution></institution-wrap>New York, NY 10003 USA</aff><aff id="Aff3"><label>3</label><institution-wrap><institution-id institution-id-type="ISNI">0000000109466120</institution-id><institution-id institution-id-type="GRID">grid.9829.a</institution-id><institution>School of Medical Sciences,</institution><institution>Kwame Nkrumah University of Science and Technology,</institution></institution-wrap>Kumasi, Ghana</aff><aff id="Aff4"><label>4</label><institution-wrap><institution-id institution-id-type="ISNI">0000 0004 1936 9991</institution-id><institution-id institution-id-type="GRID">grid.35403.31</institution-id><institution></institution><institution>University of Illinois at Urbana-Champaign,</institution></institution-wrap>Urbana, IL 61801 USA</aff><aff id="Aff5"><label>5</label><institution-wrap><institution-id institution-id-type="ISNI">0000 0001 1089 6558</institution-id><institution-id institution-id-type="GRID">grid.164971.c</institution-id><institution></institution><institution>Stritch School of Medicine, Loyola Chicago Medical Center,</institution></institution-wrap>Maywood, IL 60153 USA</aff><aff id="Aff6"><label>6</label><institution-wrap><institution-id institution-id-type="ISNI">0000 0001 2216 9681</institution-id><institution-id institution-id-type="GRID">grid.36425.36</institution-id><institution></institution><institution>Stony Brook University School of Medicine,</institution></institution-wrap>Stony Brook, NY 11797 USA</aff><aff id="Aff7"><label>7</label><institution-wrap><institution-id institution-id-type="ISNI">0000 0001 0582 2706</institution-id><institution-id institution-id-type="GRID">grid.434994.7</institution-id><institution></institution><institution>Ghana Health Service,</institution></institution-wrap>Kumasi, Ghana</aff></contrib-group><pub-date pub-type="epub"><day>2</day><month>2</month><year>2017</year></pub-date><pub-date pub-type="pmc-release"><day>2</day><month>2</month><year>2017</year></pub-date><pub-date pub-type="collection"><year>2017</year></pub-date><volume>17</volume><elocation-id>104</elocation-id><history><date date-type="received"><day>29</day><month>10</month><year>2015</year></date><date date-type="accepted"><day>17</day><month>1</month><year>2017</year></date></history><permissions><copyright-statement>© The Author(s). 2017</copyright-statement><license license-type="OpenAccess"><license-p><bold>Open Access</bold>This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (<ext-link ext-link-type="uri" xlink:href="http://creativecommons.org/licenses/by/4.0/">http://creativecommons.org/licenses/by/4.0/</ext-link>), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (<ext-link ext-link-type="uri" xlink:href="http://creativecommons.org/publicdomain/zero/1.0/">http://creativecommons.org/publicdomain/zero/1.0/</ext-link>) applies to the data made available in this article, unless otherwise stated.</license-p></license></permissions><abstract id="Abs1"><sec><title>Background</title><p>Nurses in Ghana play a vital role in the delivery of primary health care at both the household and community level. However, there is lack of information on task shifting the management and control of hypertension to community health nurses in low- and middle-income countries including Ghana. The purpose of this study was to assess nurses’ knowledge and practice of hypertension management and control pre- and post-training utilizing task-shifting strategies for hypertension control in Ghana (TASSH).</p></sec><sec><title>Methods</title><p>A pre- and post- test survey was administered to 64 community health nurses (CHNs) and enrolled nurses (ENs) employed in community health centers and district hospitals before and after the TASSH training, followed by semi-structured qualitative interviews that assessed nurses’ satisfaction with the training, resultant changes in practice and barriers and facilitators to optimal hypertension management.</p></sec><sec><title>Results</title><p>A total of 64 CHNs and ENs participated in the TASSH training. The findings of the pre- and post-training assessments showed a marked improvement in nurses’ knowledge and practice related to hypertension detection and treatment. At pre-assessment 26.9% of the nurses scored 80% or more on the hypertension knowledge test, whereas this improved significantly to 95.7% post-training. Improvement of interpersonal skills and patient education were also mentioned by the nurses as positive outcomes of participation in the intervention.</p></sec><sec><title>Conclusions</title><p>Findings suggest that if all nurses receive even brief training in the management and control of hypertension, major public health benefits are likely to be achieved in low-income countries like Ghana. However, more research is needed to ascertain implementation fidelity and sustainability of interventions such as TASSH that highlight the potential role of nurses in mitigating barriers to optimal hypertension control in Ghana.</p></sec><sec><title>Trial registration</title><p>Trial registration for parent TASSH study: <ext-link ext-link-type="uri" xlink:href="https://clinicaltrials.gov/ct2/show/NCT01802372">NCT01802372</ext-link>. Registered February 27, 2013.</p></sec></abstract><kwd-group xml:lang="en"><title>Keywords</title><kwd>Task-shifting strategies</kwd><kwd>Hypertension</kwd><kwd>Nurses</kwd><kwd>Sub-Saharan Africa</kwd><kwd>Ghana</kwd></kwd-group><funding-group><award-group><funding-source><institution-wrap><institution-id institution-id-type="FundRef">http://dx.doi.org/10.13039/100000050</institution-id><institution>National Heart, Lung, and Blood Institute (US)</institution></institution-wrap></funding-source><award-id>U01HL114198</award-id><principal-award-recipient><name><surname>Ogedegbe</surname><given-names>Gbenga</given-names></name></principal-award-recipient></award-group></funding-group><custom-meta-group><custom-meta><meta-name>issue-copyright-statement</meta-name><meta-value>© The Author(s) 2017</meta-value></custom-meta></custom-meta-group></article-meta></front></pmc></record>Pour manipuler ce document sous Unix (Dilib)
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