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Implementation outcomes and strategies for delivering evidence-based hypertension interventions in lower-middle-income countries: Evidence from a multi-country consortium for hypertension control

Author

Listed:
  • Joyce Gyamfi
  • Juliet Iwelunmor
  • Shivani Patel
  • Vilma Irazola
  • Angela Aifah
  • Ashlin Rakhra
  • Mark Butler
  • Rajesh Vedanthan
  • Giang Nguyen Hoang
  • Monicah Nyambura
  • Hoa Nguyen
  • Cuc Nguyen
  • Kwaku Poku Asante
  • Solomon Nyame
  • Kwame Adjei
  • John Amoah
  • Kingsley Apusiga
  • Kezia Gladys Amaning Adjei
  • Manuel Ramierz-Zea
  • Diego Hernandez
  • Meredith Fort
  • Hanspria Sharma
  • Prashant Jarhyan
  • Emmanuel Peprah
  • Gbenga Ogedegbe

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.

Suggested Citation

  • Joyce Gyamfi & Juliet Iwelunmor & Shivani Patel & Vilma Irazola & Angela Aifah & Ashlin Rakhra & Mark Butler & Rajesh Vedanthan & Giang Nguyen Hoang & Monicah Nyambura & Hoa Nguyen & Cuc Nguyen & Kwak, 2023. "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, Public Library of Science, vol. 18(5), pages 1-18, May.
  • Handle: RePEc:plo:pone00:0286204
    DOI: 10.1371/journal.pone.0286204
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    References listed on IDEAS

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    2. Glasgow, R.E. & Vogt, T.M. & Boles, S.M., 1999. "Evaluating the public health impact of health promotion interventions: The RE-AIM framework," American Journal of Public Health, American Public Health Association, vol. 89(9), pages 1322-1327.
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    4. Michael Käser & Christine Maure & Beatrice M M Halpaap & Mahnaz Vahedi & Sara Yamaka & Pascal Launois & Núria Casamitjana, 2016. "Research Capacity Strengthening in Low and Middle Income Countries – An Evaluation of the WHO/TDR Career Development Fellowship Programme," PLOS Neglected Tropical Diseases, Public Library of Science, vol. 10(5), pages 1-13, May.
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