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. 2021 Aug 30;2(1):97.
doi: 10.1186/s43058-021-00197-8.

Stakeholder perspectives to inform adaptation of a hypertension treatment program in primary healthcare centers in the Federal Capital Territory, Nigeria: a qualitative study

Rosemary C B Okoli  1 , Gabriel Shedul  2 , Lisa R Hirschhorn  3 , Ikechukwu A Orji  2 , Tunde M Ojo  2 , Nonye Egenti  2 , Kasarachi Omitiran  2 , Blessing Akor  2 , Abigail S Baldridge  3 , Mark D Huffman  3 , Dike Ojji  2 , Namratha R Kandula  4
Affiliations

Stakeholder perspectives to inform adaptation of a hypertension treatment program in primary healthcare centers in the Federal Capital Territory, Nigeria: a qualitative study

Rosemary C B Okoli et al. Implement Sci Commun. .

Abstract

Background: Implementing an evidence-based hypertension program in primary healthcare centers (PHCs) in the Federal Capital Territory, Nigeria is an opportunity to improve hypertension diagnosis, treatment, and control and reduce deaths from cardiovascular diseases. This qualitative research study was conducted in Nigerian PHCs with patients, non-physician health workers, administrators and primary care physicians to inform contextual adaptations of Kaiser Permanente Northern California's hypertension model and the World Health Organization's HEARTS technical package for the system-level, Hypertension Treatment in Nigeria (HTN) Program.

Methods: Purposive sampling in 8 PHCs identified patients (n = 8), non-physician health workers (n = 12), administrators (n = 3), and primary care physicians (n = 6) for focus group discussions and interviews. The Primary Health Care Performance Initiative (PHCPI) conceptual framework and Consolidated Framework for Implementation Research (CFIR) domains were used to develop semi-structured interviews (Appendix 1, Supplemental Materials) and coding guides. Content analysis identified multilevel factors that would influence program implementation.

Results: Participants perceived the need to strengthen four major health system inputs across CFIR domains for successful adaptation of the HTN Program components: (1) reliable drug supply and blood pressure measurement equipment, (2) enable and empower community healthcare workers to participate in team-based care through training and education, (3) information systems to track patients and medication supply chain, and (4) a primary healthcare system that could offer a broader package of health services to meet patient needs. Specific features of the PHCPI framework considered important included: accessible and person-centered care, provider availability and competence, coordination of care, and proactive community outreach. Participants also identified patient-level factors, such as knowledge and beliefs about hypertension, and financial and transportation barriers that could be addressed with better communication, home visits, and drug financing. Participants recommended using existing community structures, such as village health committees and popular opinion leaders, to improve knowledge and demand for the HTN Program.

Conclusions: These results provide information on specific primary care and community contextual factors that can support or hinder implementation and sustainability of an evidence-based, system-level hypertension program in the Federal Capital Territory, Nigeria, with the ultimate aim of scaling it to other parts of the country.

Keywords: Evidence-based; Hypertension; Implementation; Noncommunicable diseases; Primary care; Qualitative.

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Conflict of interest statement

In the past 3 years, MDH received funding from the World Heart Federation to serve as its senior program advisor for the Emerging Leaders program, which is supported by Boehringer Ingelheim and Novartis with previous support from BUPA and AstraZeneca. MDH also received support from the American Heart Association, Verily, and AstraZeneca and American Medical Association for work unrelated to this research. The George Institute for Global Health’s wholly owned enterprise, George Health Enterprises, has received investment funds to develop fixed-dose combination products containing aspirin, statin, and blood pressure lowering drugs. MDH plans to submit patents for heart failure polypills.

Figures

Fig. 1
Fig. 1
The PHCPI conceptual framework
Fig. 2
Fig. 2
Word cloud of dominant themes in interviews
See this image and copyright information in PMC

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