Journal Article

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, Nishimwe, Aurore, Bergström, Anna, Hooley, Cole, Mutimura, Eugene, Goss, Charles W, Davila-Roman, Victor G, Schechtman, Kenneth B, Twagirumukiza, Marc, Williams, Makeda, Mutabazi, Vincent, de las Fuentes, Lisa, Reeds, Dominic, Brown, Angela L, Ingabire, Cecile

2021

Overview

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.

• Publisher: British Medical Journal Publishing Group,BMJ Publishing Group LTD,BMJ Publishing Group
• Subject: Adaptation / Cardiovascular Medicine / Community / Community involvement / Corporate culture / Cross-Sectional Studies / Economic impact / education & training (see medical education & training) / Evidence-Based Medicine / Female / Health care / Hospitals / Humans / Hypertension / Hypertension - epidemiology / Hypertension - therapy / Infectious diseases / Intervention / Male / Medical personnel / Midwifery / Monitoring systems / Physicians, Primary Care / quality in healthcare / Questionnaires / Rwanda - epidemiology / Surveys and Questionnaires / Training