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Exploring contextual factors influencing the implementation of evidence-based care for hypertension in Rwanda : a cross-sectional study using the COACH questionnaire

Baumann, Ana A. (author)
Washington Univ, Brown Sch Social Work, St Louis, MO 63110 USA.
Hooley, Cole (author)
Brigham Young Univ, Sch Social Work, Provo, UT 84602 USA.
Goss, Charles W. (author)
Washington Univ, Div Biostat, St Louis, MO 63110 USA.
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Mutabazi, Vincent (author)
Reg Alliance Sustainable Dev, Kigali, Rwanda.
Brown, Angela L. (author)
Washington Univ, Dept Med, Cardiovasc Div, St Louis, MO 63130 USA.
Schechtman, Kenneth B. (author)
Washington Univ, Div Biostat, St Louis, MO 63110 USA.
Twagirumukiza, Marc (author)
Reg Alliance Sustainable Dev, Kigali, Rwanda.;Univ Rwanda, Coll Med & Hlth Sci, Kigali, Rwanda.
de las Fuentes, Lisa (author)
Washington Univ, Div Biostat, St Louis, MO 63110 USA.;Washington Univ, Sch Med, Dept Med, Cardiovasc Div, St Louis, MO 63110 USA.
Reeds, Dominic (author)
Ctr Human Nutr, Dept Med, Div Geriatr & Nutr Sci, St Louis, MO USA.
Williams, Makeda (author)
NHLBI, Bldg 10, Bethesda, MD 20892 USA.
Mutimura, Eugene (author)
Reg Alliance Sustainable Dev, Kigali, Rwanda.;Natl Council Sci & Technol, Kigali, Rwanda.;Reg Alliance Sustainable Dev, Kigali, Rwanda.
Bergström, Anna, 1983- (author)
Uppsala universitet,Global hälsa - implementering och hållbarhet
Nishimwe, Aurore (author)
Reg Alliance Sustainable Dev, Kigali, Rwanda.;Univ Rwanda, Coll Med & Hlth Sci, Kigali, Rwanda.
Ingabire, Cecile (author)
Reg Alliance Sustainable Dev, Kigali, Rwanda.;Univ Rwanda, Coll Med & Hlth Sci, Kigali, Rwanda.
Davila-Roman, Victor G. (author)
Washington Univ, Dept Med, Cardiovasc Div, St Louis, MO 63130 USA.
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Washington Univ, Brown Sch Social Work, St Louis, MO 63110 USA Brigham Young Univ, Sch Social Work, Provo, UT 84602 USA. (creator_code:org_t)
2021-09-21
2021
English.
In: BMJ Open. - : BMJ Publishing Group Ltd. - 2044-6055. ; 11:9
  • Journal article (peer-reviewed)
Abstract Subject headings
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  • ImportanceHypertension is the largest contributor to the Global Burden of Disease. In Rwanda, as in most low-income and middle-income countries, an increasing prevalence of hypertension and its associated morbidity and mortality is causing major healthcare and economic impact. Understanding healthcare systems context in hypertension care is necessary.ObjectiveTo study the hypertension healthcare context as perceived by healthcare providers using the Context Assessment for Community Health (COACH) tool.DesignA cross-sectional cohort responded to the COACH questionnaire and a survey about hypertension training.SettingThree tertiary care hospitals in Rwanda.ParticipantsHealthcare professionals (n=223).Primary outcome(s) and measure(s)The COACH tool consists of 49 items with eight subscales: resources, community engagement, commitment to work, informal payment, leadership, work culture, monitoring services for action (5-point Likert Scale) and sources of knowledge (on a 0-1 scale). Four questions surveyed training on hypertension.ResultsResponders (n=223, 75% women; 56% aged 20-35 years) included nurses (n=142, 64%, midwives (n=42, 19%), primary care physicians (n=28, 13%) and physician specialists (n=11, 5%)). The subscales commitment to work, leadership, work culture and informal payment scored between 4.7 and 4.1 and the community engagement, monitoring services for action and organizational resources scored between 3.1 and 3.5. Sources of knowledge had a mean score of 0.6 +/- 0.3. While 73% reported having attended a didactic hypertension seminar in the past year, only 28% had received long-term training and 51% had <3-year experience working with hypertension care delivery. The majority (99%) indicated a need for additional training in hypertension care.ConclusionsThere is a need for increased and continuous training in Rwanda. Healthcare responders stated a commitment to work and reported supportive leadership, while acknowledging limited resources and no monitoring systems. The COACH tool provides contextual guidance to develop training strategies prior to the implementation of a sustainable hypertension care programme.

Subject headings

MEDICIN OCH HÄLSOVETENSKAP  -- Hälsovetenskap -- Hälso- och sjukvårdsorganisation, hälsopolitik och hälsoekonomi (hsv//swe)
MEDICAL AND HEALTH SCIENCES  -- Health Sciences -- Health Care Service and Management, Health Policy and Services and Health Economy (hsv//eng)
MEDICIN OCH HÄLSOVETENSKAP  -- Hälsovetenskap -- Folkhälsovetenskap, global hälsa, socialmedicin och epidemiologi (hsv//swe)
MEDICAL AND HEALTH SCIENCES  -- Health Sciences -- Public Health, Global Health, Social Medicine and Epidemiology (hsv//eng)

Keyword

hypertension
education & training (see medical education & training)
quality in healthcare

Publication and Content Type

ref (subject category)
art (subject category)

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