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Application of the Consolidated Framework for Implementation Research to examine nurses' perception of the task shifting strategy for hypertension control trial in Ghana.

应用实施研究综合框架检查护士对加纳高血压控制试验任务转移策略的看法。

  • 影响因子:2.26
  • DOI:10.1186/s12913-020-4912-5
  • 作者列表:"Gyamfi J","Allegrante JP","Iwelunmor J","Williams O","Plange-Rhule J","Blackstone S","Ntim M","Apusiga K","Peprah E","Ogedegbe G
  • 发表时间:2020-01-29
Abstract

BACKGROUND:The burden of hypertension in many low-and middle-income countries is alarming and requires effective evidence-based preventative strategies that is carefully appraised and accepted by key stakeholders to ensure successful implementation and sustainability. We assessed nurses' perceptions of a recently completed Task Shifting Strategy for Hypertension control (TASSH) trial in Ghana, and facilitators and challenges to TASSH implementation. METHODS:Focus group sessions and in-depth interviews were conducted with 27 community health nurses from participating health centers and district hospitals involved in the TASSH trial implemented in the Ashanti Region, Ghana, West Africa from 2012 to 2017. TASSH evaluated the comparative effectiveness of the WHO-PEN program versus provision of health insurance for blood pressure reduction in hypertensive adults. Qualitative data were analyzed using open and axial coding techniques with emerging themes mapped onto the Consolidated Framework for Implementation Research (CFIR). RESULTS:Three themes emerged following deductive analysis using CFIR, including: (1) Patient health goal setting- relative priority and positive feedback from nurses, which motivated patients to make healthy behavior changes as a result of their health being a priority; (2) Leadership engagement (i.e., medical directors) which influenced the extent to which nurses were able to successfully implement TASSH in their various facilities, with most directors being very supportive; and (3) Availability of resources making it possible to implement the TASSH protocol, with limited space and personnel time to carry out TASSH duties, limited blood pressure (BP) monitoring equipment, and transportation, listed as barriers to effective implementation. CONCLUSION:Assessing stakeholders' perception of the TASSH implementation process guided by CFIR is crucial as it provides a platform for the nurses to thoroughly evaluate the task shifting program, while considering the local context in which the program is implemented. The feedback from the nurses informed barriers and facilitators to implementation of TASSH within the current healthcare system, and suggested system level changes needed prior to scale-up of TASSH to other regions in Ghana with potential for long-term sustainment of the task shifting intervention. TRIAL REGISTRATION:Trial registration for parent TASSH study: NCT01802372. Registered February 27, 2013.

摘要

背景: 许多低收入和中等收入国家的高血压负担令人担忧,需要有效的循证预防策略,并得到主要利益攸关方的仔细评估和接受,以确保成功实施和可持续性。我们评估了护士对加纳最近完成的高血压控制任务转移策略 (TASSH) 试验的看法,以及 TASSH 实施的促进因素和挑战。 方法: 对参与在加纳阿尚提地区实施的 TASSH 试验的 27 名参与健康中心和地区医院的社区卫生护士进行焦点小组会议和深入访谈, 西非 2012年 2017年。TASSH 评价了 WHO-PEN 项目与提供健康保险降低高血压成人血压的比较有效性。使用开放和轴向编码技术分析定性数据,将新兴主题映射到实施研究综合框架 (CFIR) 上。 结果: 使用 CFIR 进行演绎分析后出现了三个主题,包括 :( 1) 患者健康目标设定-相对优先和护士的积极反馈, 这促使患者做出健康行为改变,因为他们的健康是一个优先事项; (2) 领导参与 (i。 e., 医务主任)这影响了护士在各种设施中成功实施 TASSH 的程度,大多数主任都非常支持; 和 (3) 资源的可用性使得实施 TASSH 协议成为可能,有限的空间和人员时间来执行 TASSH 职责,有限的血压 (BP)监测设备和运输,被列为有效实施的障碍。 结论: 评估利益相关者对 CFIR 指导下的 TASSH 实施过程的感知至关重要,因为它为护士彻底评估任务转移计划提供了一个平台, 同时考虑程序实现的本地上下文。护士的反馈告知障碍和促进者在当前医疗保健系统内实施 TASSH, 并建议在 TASSH 扩大到加纳其他地区之前需要进行系统水平的改变,这可能会长期维持任务转移干预。 试用注册: 父母 TASSH 研究的试用注册: NCT01802372.2013年2月27日注册。

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METHODS:BACKGROUND:'Neuronal precursor cell expressed developmentally down-regulated 4-like' (NEDD4L) is considered a candidate gene for hypertension-both functionally and genetically-through the regulation of the ubiquitination of the epithelial sodium channel (ENaC). This study explores the relationship between genetic variation in NEDD4L and hypertension with chronic kidney disease (CKD) in the southeastern Han Chinese population. METHODS:We recruited 623 CKD patients and measured ambulatory blood pressure monitoring (ABPM), and the rs4149601 and rs2288774 polymorphisms in NEDD4L were genotyped using qPCR. RESULTS:For rs4149601, significant differences in genotype frequencies in an additive model (GG vs GA vs AA) were observed between normotensive patients and hypertensive patients when hypertension was classified into ambulatory hypertension, clinical hypertension and ambulatory systolic hypertension (P = 0.038, 0.005 and 0.006, respectively). In a recessive model (GG+GA vs AA), the frequency of the AA genotype of rs4149601 in the hypertension groups were all higher than that in the normotensive groups. The genotype distribution of rs2288774 did not differ significantly between the normotensive and hypertensive patients. In both the full cohort and the propensity score matching (PSM) cohort, the AA genotype of rs4149601 (compared to the GG+GA genotype group) was independently correlated with ambulatory hypertension, clinical hypertension and ambulatory systolic hypertension by multivariate logistic regression analysis. CONCLUSIONS:The present study indicates that the AA genotype of rs4149601 associates with hypertension in CKD. Consequently, the rs4149601 A allele might be a risk factor for hypertension with CKD.

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发表时间:2020-01-29
DOI:10.1186/s12913-020-4912-5
作者列表:["Gyamfi J","Allegrante JP","Iwelunmor J","Williams O","Plange-Rhule J","Blackstone S","Ntim M","Apusiga K","Peprah E","Ogedegbe G"]

METHODS:BACKGROUND:The burden of hypertension in many low-and middle-income countries is alarming and requires effective evidence-based preventative strategies that is carefully appraised and accepted by key stakeholders to ensure successful implementation and sustainability. We assessed nurses' perceptions of a recently completed Task Shifting Strategy for Hypertension control (TASSH) trial in Ghana, and facilitators and challenges to TASSH implementation. METHODS:Focus group sessions and in-depth interviews were conducted with 27 community health nurses from participating health centers and district hospitals involved in the TASSH trial implemented in the Ashanti Region, Ghana, West Africa from 2012 to 2017. TASSH evaluated the comparative effectiveness of the WHO-PEN program versus provision of health insurance for blood pressure reduction in hypertensive adults. Qualitative data were analyzed using open and axial coding techniques with emerging themes mapped onto the Consolidated Framework for Implementation Research (CFIR). RESULTS:Three themes emerged following deductive analysis using CFIR, including: (1) Patient health goal setting- relative priority and positive feedback from nurses, which motivated patients to make healthy behavior changes as a result of their health being a priority; (2) Leadership engagement (i.e., medical directors) which influenced the extent to which nurses were able to successfully implement TASSH in their various facilities, with most directors being very supportive; and (3) Availability of resources making it possible to implement the TASSH protocol, with limited space and personnel time to carry out TASSH duties, limited blood pressure (BP) monitoring equipment, and transportation, listed as barriers to effective implementation. CONCLUSION:Assessing stakeholders' perception of the TASSH implementation process guided by CFIR is crucial as it provides a platform for the nurses to thoroughly evaluate the task shifting program, while considering the local context in which the program is implemented. The feedback from the nurses informed barriers and facilitators to implementation of TASSH within the current healthcare system, and suggested system level changes needed prior to scale-up of TASSH to other regions in Ghana with potential for long-term sustainment of the task shifting intervention. TRIAL REGISTRATION:Trial registration for parent TASSH study: NCT01802372. Registered February 27, 2013.

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