Uptake of task strengthening strategy for blood pressure control in community health planning services: a mixed methods study

Project summary

Uptake of community-based evidence-supported interventions for hypertension control in Ghana are urgently needed to address the CVD epidemic and its associated morbidity, mortality, and societal costs. Using a mixed methods (quantitative-qualitative) design, we will evaluate practice facilitation (PF) in 70 CHPS compounds utilizing the task-shifting strategies for hypertension control (TASSH) program.

The goal of this project is to improve the uptake of evidence-based TASSH in Community-Based Health Planning and Services (CHPS) compounds in Ghana. Findings from this study will provide policy makers and other stakeholders the “how to do it” empirical literature on the uptake of evidence-based interventions in Ghana, which may be applicable to other low-income countries.

Project goals

1. To identify practice capacity for the adoption of TAASH at CHPS compounds and develop a culturally tailored Practice Facilitation (PF) strategy using qualitative methods.
2. To evaluate in a cluster parallel RCT, the effect of the PF strategy vs. Usual Care (UC), on the uptake of TASSH (primary outcome) across the CHPS compounds at 12 months.
3. To compare in a cluster parallelRCT, the clinical effectiveness of the PF strategy vs. UC on systolic BP reduction (secondary outcome) among adults with uncontrolled hypertension at 12 months.
4. To evaluate the mediators of the uptake of TASSH across the CHPS compounds at 12 months.
5. To evaluate the sustainability of TASSH implementation across the participating CHPS compounds at 24 months (one year after completion of the trial).

Current status

The study is currently at the pilot phase. Key study activities are being piloted in Nkoranza South Municipality. Nkoranza South will be used as a pilot site and will not be included in the main study.

The study activities being piloted in Nkoranza South include: training of CHOs, training of practice facilitators, community sensitization, and implementation of task strengthening facilitation (TSF) intervention. As part of the pilot phase, the team has trained Community Health Officers (CHOs) in 7NKoranza South Community-based Health Planning and Services (CHPS) zones.

Seven community health nurses who took part in the initial TASSH study implemented in the Ashanti region will receive training in practice facilitation. Once the nurses are trained, the team is set to conduct community mobilization and sentization activities, followed by the implementation of the TSF intervention for 4 weeks starting on the 14th of January, 2019.

Strategy

Using a mixed-methods, “Hybrid Type II” Effectiveness-Implementation study design, we will conduct this study in three phases: A pre-implementation qualitative phase, in which we will use CFIR to assess inner setting variables and provider characteristics likely to influence the adoption of TASSH within the CHPS compounds.

This information will be used to develop a culturally tailored practice facilitation strategy for implementation of TASSH. An implementation phase, during which we will evaluate in a cluster parallelRCT, the effect of the PF strategy versus Usual Care, on the adoption of TASSH and its clinical effectiveness on systolic BP reduction at 12 months across the CHPS compounds.

We will also evaluate the mediators of the uptake of TASSH. A post-implementation phase, in which we will evaluate the sustainability of TASSH implementation across participating CHPS compounds at 24 months (one year after completion of the trial). Methodology and study outcomes for the implementation and the post-implementation phases will be guided by the RE-AIM framework. A pilot study to ascertain feasibility of the study will be carried out before implementation.

Dissemination

Findings from the study will be publicized through active stakeholder engagements, publications in high impact journals and the development of policy briefs to ensure buy-in.

Manuscripts will be submitted to journals with open access and whose publications are deposited in reference libraries such as Pubmed.

The investigators shall first present the key findings of this study to key agencies such as the Ghana Health Services, Ministry of Health, Ghana, Regional Health Directorates and other external stakeholders (Consortium members) prior to publication.

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