Ghana

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

Hy-TREC
Trainers and Trainees in Ghana

In Ghana, hypertension accounts for 70% of all heart failure and strokes and about 35% of all chronic kidney disease on of major barriers to optimum hypertension control in Ghana is the acute shortage of physicians.
It is imperative therefore that we adopt cost-effective strategies that are scalable such as task shiftings strategies for hypertension control.

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.

Dr. Plange-Rhule, the Principal investigator of the Ghana project, introduces aims and activities of the task strengthening strategy.

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).
Community Health workers sitting in a room for training.
Blood pressure measurement as part of the training program for community health workers in the Brong-Ahafo region.

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.

Location

The study takes place in 70 of the 97 CHPS zones in three contiguous districts within the Brong-Ahafo Region (Kintampo North, Kintampo South District, and Nkoranza North District) of Ghana. The study area is predominantly rural,multi-ethnic and mostly engaged in subsistent farming.The health system in the study area is basic and designed to reflect the Primary Health Care system in Ghana.

The CHPS zones are at the primary care and community levels and are operated mostly by CHOs. The next level is the community Health Centre (referred to as level B). The District Hospital is at level C.

Useful links

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.

Community Health Workers sit in a room and practice role play for counselling hypertensive patients
Community Health Workers role play identifying, counselling and referring a patient at risk of hypertension.

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.

Team Members

Our project has the support of 4 Principal Investigators and 5 Research Team members.

8 members of Ghana team standing in a group smiling
  • Juliet Iwelunmor

    Juliet Iwelunmor

    Principal Investigator Ghana project

    Dr. Iwelunmor is a Co-Investigator of the Ghana study and an Associate Professor; Behavioral Science and Health Education College for Public Health and Social Justice at Saint Louis University.

  • Gbenga Ogedegbe

    Gbenga Ogedegbe

    Principal Investigator Ghana project

    Dr. Gbenga Ogedegbe is a Co-Principal Investigator of the Ghana study and a Professor of Population Health & Medicine, Chief Division of Health & Behavior and Director Center for Healthful Behavior Change in the Department of Population Health at the NYU School of Medicine, NYU Langone Health

  • Jacob Plange-Rhule

    Jacob Plange-Rhule

    Principal Investigator Ghana project

    Professor Plange-Rhule is the Rector of the Ghana College of Physicians and Surgeons and the President of the Ghana Kidney Association. He has extensive experience in research, particularly, among populations of African origin, in the fields of hypertension, and cardiovascular disease.

  • Kwaku Poku-Asante

    Kwaku Poku-Asante

    Principal Investigator Ghana project

    Dr. Asante is a Co-Principal Investigator of the Ghana study and is currently the Agency Director at Kintampo Health Research Centre in Ghana. He is a clinical epidemiologist with interest in malaria, and their environmental determinants.

  • Joyce Gyamfi

    Senior Research Coordinator New York University School of Medicine, NYU Langone Health
  • Kingsley Apusiga

    Department Research Coordinator Kwame Nkrumah University of Science & Technology
  • Kezia Gladys Amaning Adjei

    Research Coordinator Kwame Nkrumah University of Science & Technology
  • Solomon Nyame

    Research Fellow Kintampo Health Research Centre
  • Kwame Adjei

    Research Fellow Kintampo Health Research Centre

[Currently there are no trainees asigned to this project]

Partner Organisations

We are pleased to partner with the following organisations:

Publications and References

These references document the history of research studies by this team

  • Ogedegbe G, Plange-Rhule J, Gyamfi J, Chaplin W, Ntim M, Apusiga K, Khurshid K, Cooper R. A cluster-randomized trial of task shifting and blood pressure control in Ghana: study protocol. Implementation Science. 2014 Dec;9(1):7