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Training nurses in task-shifting strategies for the management and control of hypertension in Ghana: a mixed-methods study
Background
Nurses in Ghana play a vital role in the delivery of primary health care at both the household and community level. However, there is lack of information on task shifting the management and control of hypertension to community health nurses in low- and middle-income countries including Ghana. The purpose of this study was to assess nurses’ knowledge and practice of hypertension management and control pre- and post-training utilizing task-shifting strategies for hypertension control in Ghana (TASSH).
Methods
A pre- and post- test survey was administered to 64 community health nurses (CHNs) and enrolled nurses (ENs) employed in community health centers and district hospitals before and after the TASSH training, followed by semi-structured qualitative interviews that assessed nurses’ satisfaction with the training, resultant changes in practice and barriers and facilitators to optimal hypertension management.
Results
A total of 64 CHNs and ENs participated in the TASSH training. The findings of the pre- and post-training assessments showed a marked improvement in nurses’ knowledge and practice related to hypertension detection and treatment. At pre-assessment 26.9% of the nurses scored 80% or more on the hypertension knowledge test, whereas this improved significantly to 95.7% post-training. Improvement of interpersonal skills and patient education were also mentioned by the nurses as positive outcomes of participation in the intervention.
Conclusions
Findings suggest that if all nurses receive even brief training in the management and control of hypertension, major public health benefits are likely to be achieved in low-income countries like Ghana. However, more research is needed to ascertain implementation fidelity and sustainability of interventions such as TASSH that highlight the potential role of nurses in mitigating barriers to optimal hypertension control in Ghana.
Trial registration
Trial registration for parent TASSH study:
NCT01802372
. Registered February 27, 2013.
Journal Article
Application of the Consolidated Framework for Implementation Research to examine nurses’ perception of the task shifting strategy for hypertension control trial in Ghana
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.
Journal Article
Cost-effectiveness of PoNDER health visitor training for mothers at lower risk of depression: findings on prevention of postnatal depression from a cluster-randomised controlled trial
There is evidence for the cost-effectiveness of health visitor (HV) training to assess postnatal depression (PND) and deliver psychological approaches to women at risk of depression. Whether this approach is cost-effective for lower-risk women is unknown. There is a need to know the cost of HV-delivered universal provision, and how much it might cost to improve health-related quality of life for postnatal women. A sub-study of a cluster-randomised controlled trial in the former Trent region (England) previously investigated the effectiveness of PoNDER HV training in mothers at lower risk of PND. We conducted a parallel cost-effectiveness analysis at 6-months postnatal for all mothers with lower-risk status attributed to an Edinburgh Postnatal Depression Scale (EPDS) score <12 at 6-weeks postnatal.
Intervention HVs were trained in assessment and cognitive behavioural or person-centred psychological support techniques to prevent depression. Outcomes examined: quality-adjusted life-year (QALY) gains over the period between 6 weeks and 6 months derived from SF-6D (from SF-36); risk-of-depression at 6 months (dichotomising 6-month EPDS scores into lower risk (<12) and at-risk (⩾12).
In lower-risk women, 1474 intervention (63 clusters) and 767 control participants (37 clusters) had valid 6-week and 6-month EPDS scores. Costs and outcomes data were available for 1459 participants. 6-month adjusted costs were £82 lower in intervention than control groups, with 0.002 additional QALY gained. The probability of cost-effectiveness at £20 000 was very high (99%).
PoNDER HV training was highly cost-effective in preventing symptoms of PND in a population of lower-risk women and cost-reducing over 6 months.
Journal Article
Awareness, perceptions, and willingness regarding internet-based home care services and associated factors among community nurses in China
The provision of Internet-based home care (IHC) services by community nurses has emerged as a promising strategy to enhance healthcare accessibility and efficiency, but awareness, perceptions and willingness of them to implement IHC remain under-researched. This study aimed to assess community nurses’ awareness, perceptions, and willingness to IHC services in China and identify its associated factors. From May to June 2023, we conducted a convenience sampling survey of 161 eligible nurses from nine hospitals in Nanchong, Southwest China. Data were analyzed using descriptive statistics, Mann-Whitney U Test or Kruskal-Wallis H Test, and ordinal multiple logistic regression analysis. The results showed that respondents’ awareness and perceived benefits for IHC services scored 3.44 and 4.06, with 120 (74.5%) willing to participate; key reasons for rejections or hesitancies included medical risks, work intensity and personal safety, medical disputes, and competency. Logistic regression revealed significant associations between nurses’ awareness (OR = 1.413) and competency (OR = 1.026) of IHC services and willingness. Most participants preferred providing IHC services within 2 km (71.4%) during weekdays (64.4%) and charging based on government standards (57.8%). Key service preferences included basic nursing and chronic disease management. Most participants emphasized the necessity for pre-service risk assessments (93.2%), written consent (93.8%), audio/video recordings (80.1%), accompaniment (94.4%), and insurance (93.8%). In conclusion, community nurses favor providing low-risk IHC services locally, with significant requests for support systems in place. Policymakers should enhance IHC service publicity, plan services considering nurses’ and clients’ needs, and create training plans to boost community nurses’ competency, improving service willingness and quality.
Journal Article
Effects of brief family psychoeducation on family caregiver burden of people with schizophrenia provided by psychiatric visiting nurses: a cluster randomised controlled trial
Background
The purpose of this study was to examine the effects of a brief family psychoeducation (BFP) programme provided by psychiatric visiting nurses on caregiver burden of family caregivers of people with schizophrenia through a cluster randomised controlled trial (cRCT).
Methods
The study was a two-arm, parallel-group cRCT. Forty-seven psychiatric visiting nurse agencies were randomly allocated to the BFP programme group (intervention group) or treatment as usual group (TAU; control group). Caregivers of people with schizophrenia were recruited by psychiatric visiting nurses using a randomly ordered list. The primary outcome was caregiver burden, measured using the Japanese version of the Zarit Burden Interview. Outcome assessments were conducted at baseline, 1-month follow-up, and 6-month follow-up. Intention-to-treat analysis was conducted to examine the effects of the BFP programme on caregiver burden.
Results
Thirty-four psychiatric visiting nurse agencies and 83 family caregivers of people with schizophrenia participated in the study. The participant attrition rate was less than 20%. Adherence to the program was 100%. Compared with TAU group, the BFP programme group had decreased caregiver burden. However, this improvement was not significant at 1-month follow-up (adjusted mean difference [aMD] = 0.27, 95% CI = − 5.48 to 6.03,
p
= 0.93,
d
= 0.01) or 6-month follow-up (aMD = − 2.12, 95% CI = − 7.80 to 3.56,
p
= 0.45,
d
= 0.11).
Conclusions
The BFP programme provided by psychiatric visiting nurses did not achieve significant decreases in caregiver burden. This result may be attributed to the difficulty in continuing the research due to the COVID-19 pandemic, which prevented us from achieving the targeted sample size necessary to meet the statistical power requirements, as well as to the participation of caregivers with relatively low burden. However, the program had the advantage of high adherence to treatment plan. Further studies should be conducted with a larger sample size and a more diverse sample that includes caregivers with a higher care burden.
Trial registration
The study protocol was registered in the University Hospital Medical Information Network Clinical Trials Registry (UMIN000038044) on 2019/09/18.
Journal Article
Effectiveness of a nurse-led hospital-to-home transitional care intervention for older adults with multimorbidity and depressive symptoms: A pragmatic randomized controlled trial
To evaluate the effectiveness of a nurse-led hospital-to-home transitional care intervention versus usual care on mental functioning (primary outcome), physical functioning, depressive symptoms, anxiety, perceived social support, patient experience, and health service use costs in older adults with multimorbidity ([greater than or equal to] 2 comorbidities) and depressive symptoms. Pragmatic multi-site randomized controlled trial conducted in three communities in Ontario, Canada. Participants were allocated into two groups of intervention and usual care (control). 127 older adults ([greater than or equal to] 65 years) discharged from hospital to the community with multimorbidity and depressive symptoms. This evidence-based, patient-centred intervention consisted of individually tailored care delivery by a Registered Nurse comprising in-home visits, telephone follow-up and system navigation support over 6-months. The primary outcome was the change in mental functioning, from baseline to 6-months. Secondary outcomes were the change in physical functioning, depressive symptoms, anxiety, perceived social support, patient experience, and health service use cost, from baseline to 6-months. Intention-to-treat analysis was performed using ANCOVA modeling. Of 127 enrolled participants (63-intervention, 64-control), 85% had six or more chronic conditions. 28 participants were lost to follow-up, leaving 99 (47 -intervention, 52-control) participants for the complete case analysis. No significant group differences were seen for the baseline to six-month change in mental functioning or other secondary outcomes. Older adults in the intervention group reported receiving more information about health and social services (p = 0.03) compared with the usual care group. Although no significant group differences were seen for the primary or secondary outcomes, the intervention resulted in improvements in one aspect of patient experience (information about health and social services). The study sample fell below the target sample (enrolled 127, targeted 216), which can account for the non-significant findings. Further research on the impact of the intervention and factors that contribute to the results is recommended.
Journal Article
Effects of nurse-home visiting on intimate partner violence and maternal income, mental health and self-efficacy by 24 months postpartum: a randomised controlled trial (British Columbia Healthy Connections Project)
ObjectiveTo evaluate the impact of Nurse-Family Partnership (NFP), a home-visiting programme, on exploratory maternal outcomes in British Columbia (BC), Canada.DesignPragmatic, parallel arm, randomised controlled trial conducted October 2013–November 2019. Random allocation of participants (1:1) to comparison (existing services) or NFP (plus existing services). Researchers were naïve to allocation.Setting26 local health areas across four of five BC regional health authorities.Participants739 young (<25 years), first-time mothers (enrolled <28 weeks gestation), experiencing socioeconomic disadvantage.InterventionPublic health nurses with NFP education offered home visits (up to 64) during pregnancy and until children’s second birthday plus existing services on offer in BC.Outcome measuresPrespecified exploratory outcomes included exposure to intimate partner violence (IPV), income (annual from employment) and not in education, employment or training (NEET) by 24 months postpartum, and psychological distress and self-efficacy across five time points (34–36 weeks gestation, 2, 10, 18 and 24 months postpartum).ResultsA total of 739 participants were randomised (368 NFP, 371 comparison) and analysed via an intention-to-treat analysis. At 24 months postpartum, for participants receiving NFP, a lower percentage reported IPV (group difference −7.14; 95% CI: –14.17, –0.10); incomes were larger ($1629.74, 95% CI: $5.20, $3254.28) after adjusting for baseline differences and no difference in percentage of NEET (−2.41, 95% CI: −10.11, 5.30). For participants receiving NFP, psychological distress was lower across time points (−1.59, 95% CI: −2.35 to –0.84); self-efficacy was greater at 34–36 weeks gestation (0.78, 95% CI: 0.34, 1.22), then decreasing and becoming insignificant by 24 months postpartum (0.29, 95% CI: −0.18, 0.75). No unanticipated serious adverse events were reported.ConclusionRelying on the maternal report, at 24 months postpartum, the NFP group had reduced IPV exposure and increased incomes. Benefits observed in late pregnancy were sustained to study end for psychological distress, but not self-efficacy. Longer-term follow-up is recommended.Trial registration NCT01672060.
Journal Article