Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2024 Aug 1;7(8):e2430213.
doi: 10.1001/jamanetworkopen.2024.30213.

Community-Based Participatory Research and System Dynamics Modeling for Improving Retention in Hypertension Care

Jiancheng Ye  1   2 , Ikechukwu A Orji  3 , Michelle A Birkett  2 , Lisa R Hirschhorn  2   4 , Theresa L Walunas  2 , Justin D Smith  5 , Namratha R Kandula  2 , Gabriel L Shedul  3 , Mark D Huffman  2   6   7 , Dike B Ojji  3   8
Affiliations

Community-Based Participatory Research and System Dynamics Modeling for Improving Retention in Hypertension Care

Jiancheng Ye et al. JAMA Netw Open. .

Abstract

Importance: The high prevalence of hypertension calls for broad, multisector responses that foster prevention and care services, with the goal of leveraging high-quality treatment as a means of reducing hypertension incidence. Health care system improvements require stakeholder input from across the care continuum to identify gaps and inform interventions that improve hypertension care service, delivery, and retention; system dynamics modeling offers a participatory research approach through which stakeholders learn about system complexity and ways to model sustainable system-level improvements.

Objective: To assess the association of simulated interventions with hypertension care retention rates in the Nigerian primary health care system using system dynamics modeling.

Design, setting, and participants: This decision analytical model used a participatory research approach involving stakeholder workshops conducted in July and October 2022 to gather insights and inform the development of a system dynamics model designed to simulate the association of various interventions with retention in hypertension care. The study focused on the primary health care system in Nigeria, engaging stakeholders from various sectors involved in hypertension care, including patients, community health extension workers, nurses, pharmacists, researchers, administrators, policymakers, and physicians.

Exposure: Simulated intervention packages.

Main outcomes and measures: Retention rate in hypertension care at 12, 24, and 36 months, modeled to estimate the effectiveness of the interventions.

Results: A total of 16 stakeholders participated in the workshops (mean [SD] age, 46.5 [8.6] years; 9 [56.3%] male). Training of health care workers was estimated to be the most effective single implementation strategy for improving retention in hypertension care in Nigeria, with estimated retention rates of 29.7% (95% CI, 27.8%-31.2%) at 12 months and 27.1% (95% CI, 26.0%-28.3%) at 24 months. Integrated intervention packages were associated with the greatest improvements in hypertension care retention overall, with modeled retention rates of 72.4% (95% CI, 68.4%-76.4%), 68.1% (95% CI, 64.5%-71.7%), and 67.1% (95% CI, 64.5%-71.1%) at 12, 24, and 36 months, respectively.

Conclusions and relevance: This decision analytical model study showed that community-based participatory research could be used to estimate the potential effectiveness of interventions for improving retention in hypertension care. Integrated intervention packages may be the most promising strategies.

PubMed Disclaimer

Conflict of interest statement

Conflict of Interest Disclosures: Dr Orji reported receiving grants from the National Institutes of Health (NIH) during the conduct of the study and outside the submitted work. Dr Birkett reported receiving grants from the NIH during the conduct of this study and outside the submitted work. Dr Walunas reported receiving grants from Gilead Sciences outside the submitted work. Dr Kandula reported receiving grants from the NIH during the conduct of the study. Dr Shedul reported receiving grants from the Fogarty International Center outside the submitted work. Dr Huffman reported having an appointment at The George Institute for Global Health, which has a patent, license, and has received investment funding with intent to commercialize fixed-dose combination therapy through its social enterprise business, George Medicines, and having pending patents for heart failure polypills. No other disclosures were reported.

Figures

Figure 1.
Figure 1.. Implementation Research Logic Model for Retention in Hypertension Care
Determinants were mapped on the Consolidated Framework for Implementation Research, version 2.0. Contextual factors in the left column are barriers and in the right column, facilitators. Implementation strategies were sorted by priority. CHEW indicates community health care extension worker; DSD, differentiated service delivery; PHC, primary health care center.
Figure 2.
Figure 2.. Causal Loop Diagram for Retention in Hypertension Care
This diagram shows 3 reinforcing feedback structures (R) and 3 balancing feedback structures (B) that collectively represent hypertension care retention in primary care in relation to contextual factors. Positively associated connections (+) indicate variables that changed in the same direction; negatively associated connections (−) indicate variables that changed in the opposite directions. CHEW indicates community health care extension worker; PHC, primary health care center.
Figure 3.
Figure 3.. Simulation Results of the Retention Pattern for Each Intervention
See this image and copyright information in PMC

References

    1. Wang H, et al. ; GBD 2016 Mortality Collaborators . Global, regional, and national under-5 mortality, adult mortality, age-specific mortality, and life expectancy, 1970-2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet. 2017;390(10100):1084-1150. doi:10.1016/S0140-6736(17)31833-0 - DOI - PMC - PubMed
    1. Havas S, Roccella EJ, Lenfant C. Reducing the public health burden from elevated blood pressure levels in the United States by lowering intake of dietary sodium. Am J Public Health. 2004;94(1):19-22. doi:10.2105/AJPH.94.1.19 - DOI - PMC - PubMed
    1. Ye J, Orji IA, Baldridge AS, et al. ; Hypertension Treatment in Nigeria Program Investigators . Characteristics and patterns of retention in hypertension care in primary care settings from the Hypertension Treatment in Nigeria Program. JAMA Netw Open. 2022;5(9):e2230025. doi:10.1001/jamanetworkopen.2022.30025 - DOI - PMC - PubMed
    1. Fox AD, Anderson MR, Bartlett G, Valverde J, Starrels JL, Cunningham CO. Health outcomes and retention in care following release from prison for patients of an urban post-incarceration transitions clinic. J Health Care Poor Underserved. 2014;25(3):1139-1152. doi:10.1353/hpu.2014.0139 - DOI - PMC - PubMed
    1. Vedanthan R, Kamano JH, Naanyu V, et al. . Optimizing linkage and retention to hypertension care in rural Kenya (LARK hypertension study): study protocol for a randomized controlled trial. Trials. 2014;15(1):143. doi:10.1186/1745-6215-15-143 - DOI - PMC - PubMed

Publication types