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Gyamfi J, Iwelunmor J, Patel S, Irazola V, Aifah A, Rakhra A, Butler M, Vedanthan R, Hoang GN, Nyambura M, Nguyen H, Nguyen C, Asante KP, Nyame S, Adjei K, Amoah J, Apusiga K, Adjei KGA, Ramierz-Zea M, Hernandez D, Fort M, Sharma H, Jarhyan P, Peprah E, Ogedegbe G. Implementation outcomes and strategies for delivering evidence-based hypertension interventions in lower-middle-income countries: Evidence from a multi-country consortium for hypertension control. PLoS One 2023; 18:e0286204. [PMID: 37228144 PMCID: PMC10212179 DOI: 10.1371/journal.pone.0286204] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 05/11/2023] [Indexed: 05/27/2023] Open
Abstract
Guidance on contextually tailored implementation strategies for the prevention, treatment, and control of hypertension is limited in lower-middle income countries (Lower-MIC). To address this limitation, we compiled implementation strategies and accompanying outcomes of evidence-based hypertension interventions currently being implemented in five Lower-MIC. The Global Research on Implementation and Translation Science (GRIT) Coordinating Center (CC) (GRIT-CC) engaged its global network sites at Ghana, Guatemala, India, Kenya, and Vietnam. Purposively sampled implementation science experts completed an electronic survey assessing implementation outcomes, in addition to implementation strategies used in their ongoing hypertension interventions from among 73 strategies within the Expert Recommendations for Implementing Change (ERIC). Experts rated the strategies based on highest priority to their interventions. We analyzed the data by sorting implementation strategies utilized by sites into one of the nine domains in ERIC and summarized the data using frequencies, proportions, and means. Seventeen implementation experts (52.9% men) participated in the exercise. Of Proctor's implementation outcomes identified across sites, all outcomes except for appropriateness were broadly assessed by three or more countries. Overall, 59 out of 73 (81%) strategies were being utilized in the five countries. The highest priority implementation strategies utilized across all five countries focused on evaluative and iterative strategies (e.g., identification of context specific barriers and facilitators) to delivery of patient- and community-level interventions, while the lowest priority was use of financial and infrastructure change strategies. More capacity building strategies (developing stakeholder interrelationships, training and educating stakeholders, and supporting clinicians) were incorporated into interventions implemented in India and Vietnam than Ghana, Kenya, and Guatemala. Although robust implementation strategies are being used in Lower -MICs, there is minimum use of financial and infrastructure change strategies. Our study contributes to the growing literature that demonstrates the use of Expert Recommendations for Implementing Change (ERIC) implementation strategies to deliver evidence-based hypertension interventions in Lower-MICs and will inform future cross-country data harmonization activities in resource-constrained settings.
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Affiliation(s)
- Joyce Gyamfi
- School of Global Public Health, New York University, New York, New York, United States of America
| | - Juliet Iwelunmor
- Saint Louis University, Saint Louis, Missouri, United States of America
| | - Shivani Patel
- Department of Global Health, Emory University, Atlanta, Georgia, United States of America
| | - Vilma Irazola
- Institute for Clinical Effectiveness and Health Policy (IECS), Buenos Aires, Argentina
| | - Angela Aifah
- Section for Global Health, Institute for Excellence in Health Equity, NYU Grossman School of Medicine, New York, New York, United States of America
| | - Ashlin Rakhra
- Section for Global Health, Institute for Excellence in Health Equity, NYU Grossman School of Medicine, New York, New York, United States of America
| | - Mark Butler
- Center for Personalized Health, Feinstein Institutes for Medical Research, Northwell Health, New York, New York, United States of America
| | - Rajesh Vedanthan
- Section for Global Health, Institute for Excellence in Health Equity, NYU Grossman School of Medicine, New York, New York, United States of America
| | - Giang Nguyen Hoang
- Health Strategy and Policy Institute, Vietnam Ministry of Health, Hanoi, Vietnam
| | | | - Hoa Nguyen
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worchester, Massachusetts, United States of America
| | - Cuc Nguyen
- Health Strategy and Policy Institute, Vietnam Ministry of Health, Hanoi, Vietnam
| | | | | | - Kwame Adjei
- Kintampo Health Research Centre, Kintampo, Ghana
| | - John Amoah
- Kintampo Health Research Centre, Kintampo, Ghana
| | - Kingsley Apusiga
- Department of Physiology, Kwame Nkrumah University of Science and Technology (KNUST), Kumasi, Ghana
| | | | - Manuel Ramierz-Zea
- Institute of Nutrition of Central America and Panama (INCAP), Guatemala City, Guatemala, United States of America
| | - Diego Hernandez
- Institute of Nutrition of Central America and Panama (INCAP), Guatemala City, Guatemala, United States of America
| | - Meredith Fort
- Department of Health Systems, Management & Policy, Colorado School of Public Health, Aurora, Colorado, United States of America
| | | | | | - Emmanuel Peprah
- School of Global Public Health, New York University, New York, New York, United States of America
| | - Gbenga Ogedegbe
- Section for Global Health, Institute for Excellence in Health Equity, NYU Grossman School of Medicine, New York, New York, United States of America
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Pardoel ZE, Reijneveld SA, Lensink R, Widyaningsih V, Probandari A, Stein C, Hoang GN, Koot JAR, Fenenga CJ, Postma M, Landsman JA. Core health-components, contextual factors and program elements of community-based interventions in Southeast Asia - a realist synthesis regarding hypertension and diabetes. BMC Public Health 2021; 21:1917. [PMID: 34686171 PMCID: PMC8539840 DOI: 10.1186/s12889-021-11244-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Accepted: 06/09/2021] [Indexed: 11/30/2022] Open
Abstract
Background In Southeast Asia, diabetes and hypertension are on the rise and have become major causes of death. Community-based interventions can achieve the required behavioural change for better prevention. The aims of this review are 1) to assess the core health-components of community-based interventions and 2) to assess which contextual factors and program elements affect their impact in Southeast Asia. Methods A realist review was conducted, combining empirical evidence with theoretical understanding. Documents published between 2009 and 2019 were systematically searched in PubMed/Medline, Web of Science, Cochrane Library, Google Scholar and PsycINFO and local databases. Documents were included if they reported on community-based interventions aimed at hypertension and/or diabetes in Southeast Asian context; and had a health-related outcome; and/or described contextual factors and/or program elements. Results We retrieved 67 scientific documents and 12 grey literature documents. We identified twelve core health-components: community health workers, family support, educational activities, comprehensive programs, physical exercise, telehealth, peer support, empowerment, activities to achieve self-efficacy, lifestyle advice, activities aimed at establishing trust, and storytelling. In addition, we found ten contextual factors and program elements that may affect the impact: implementation problems, organized in groups, cultural sensitivity, synergy, access, family health/worker support, gender, involvement of stakeholders, and referral and education services when giving lifestyle advice. Conclusions We identified a considerable number of core health-components, contextual influences and program elements of community-based interventions to improve diabetes and hypertension prevention. The main innovative outcomes were, that telehealth can substitute primary healthcare in rural areas, storytelling is a useful context-adaptable component, and comprehensive interventions can improve health-related outcomes. This extends the understanding of promising core health-components, including which elements and in what Southeast Asian context. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-11244-3.
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Affiliation(s)
- Zinzi E Pardoel
- Department of Health Sciences, University of Groningen, University Medical Center Groningen, Hanzeplein 1, Building 3217, 9700 RB, Groningen, The Netherlands.
| | - Sijmen A Reijneveld
- Department of Health Sciences, University of Groningen, University Medical Center Groningen, Hanzeplein 1, Building 3217, 9700 RB, Groningen, The Netherlands
| | - Robert Lensink
- Faculty of Economics and Business, University of Groningen, Groningen, The Netherlands
| | - Vitri Widyaningsih
- Department of Public Health, Faculty of Medicine, Universitas Sebelas Maret, Surakarta, Indonesia
| | - Ari Probandari
- Department of Public Health, Faculty of Medicine, Universitas Sebelas Maret, Surakarta, Indonesia
| | | | | | - Jaap A R Koot
- Department of Health Sciences, University of Groningen, University Medical Center Groningen, Hanzeplein 1, Building 3217, 9700 RB, Groningen, The Netherlands
| | - Christine J Fenenga
- Department of Health Sciences, University of Groningen, University Medical Center Groningen, Hanzeplein 1, Building 3217, 9700 RB, Groningen, The Netherlands
| | - Maarten Postma
- Department of Health Sciences, University of Groningen, University Medical Center Groningen, Hanzeplein 1, Building 3217, 9700 RB, Groningen, The Netherlands.,Faculty of Economics and Business, University of Groningen, Groningen, The Netherlands.,Department of Pharmacology and Therapy, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia.,Center of Excellence in Higher Education for Pharmaceutical Care Innovation, Universitas Padjadjaran, Bandung, Indonesia
| | - Johanna A Landsman
- Department of Health Sciences, University of Groningen, University Medical Center Groningen, Hanzeplein 1, Building 3217, 9700 RB, Groningen, The Netherlands
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Hoang GN, Erickson RV. Guidelines for providing medical care to Southeast Asian refugees. JAMA 1982; 248:710-4. [PMID: 7097923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Almost 500,000 Southeast Asian refugees have arrived in the United States since 1975. While these refugees have not presented substantial public health problems, they have important personal health problems frequently requiring medical attention. Medical care providers in this country need to be aware of disease patterns and prevalence among these refugees. As well, they need to be aware of the cultural and religious backgrounds and previous medical practices of this refugee population, particularly as these practice influence the refugees' ability to obtain and maintain medical services provided in this country. Historical, cultural, religious, ethical, and medical information is provided to help US health care facilities develop culturally appropriate medical care services for Southeast Asian refugees.
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