An implementation science study to enhance cardiovascular disease prevention in Mukono and Buikwe districts in Uganda: a stepped-wedge design.
Adolescent
Adult
Aged
Blood Pressure Determination
/ standards
Cardiovascular Diseases
/ prevention & control
Delivery of Health Care
/ standards
Female
Health Facilities
/ supply & distribution
Health Planning
Health Promotion
/ organization & administration
Humans
Hypertension
/ prevention & control
Implementation Science
Male
Middle Aged
Primary Health Care
/ standards
Quality of Life
Risk Factors
Uganda
Young Adult
Cardiovascular diseases
Implementation
Risk prevention
Uganda
Journal
BMC health services research
ISSN: 1472-6963
Titre abrégé: BMC Health Serv Res
Pays: England
ID NLM: 101088677
Informations de publication
Date de publication:
25 Apr 2019
25 Apr 2019
Historique:
received:
02
02
2019
accepted:
12
04
2019
entrez:
27
4
2019
pubmed:
27
4
2019
medline:
18
6
2019
Statut:
epublish
Résumé
Uganda is experiencing a shift in major causes of death with cases of stroke, heart attack, and heart failure reportedly on the rise. In a study in Mukono and Buikwe in Uganda, more than one in four adults were reportedly hypertensive. Moreover, very few (36.5%) reported to have ever had a blood pressure measurement. The rising burden of CVD is compounded by a lack of integrated primary health care for early detection and treatment of people with increased risk. Many people have less access to effective and equitable health care services which respond to their needs. Capacity gaps in human resources, equipment, and drug supply, and laboratory capabilities are evident. Prevention of risk factors for CVD and provision of effective and affordable treatment to those who require it prevent disability and death and improve quality of life. The aim of this study is to improve health profiles for people with intermediate and high risk factors for CVD at the community and health facility levels. The implementation process and effectiveness of interventions will be evaluated. The overall study is a type 2-hybrid stepped-wedge (SW) design. The design employs mixed methods evaluations with incremental execution and adaptation. Sequential crossover take place from control to intervention until all are exposed. The study will take place in Mukono and Buikwe districts in Uganda, home to more than 1,000,000 people at the community and primary healthcare facility levels. The study evaluation will be guided by; 1) RE-AIM an evaluation framework and 2) the CFIR a determinant framework. The primary outcomes are implementation - acceptability, adoption, appropriateness, feasibility, fidelity, implementation cost, coverage, and sustainability. The study is envisioned to provide important insight into barriers and facilitators of scaling up CVD prevention in a low income context. This project is registered at the ISRCTN Registry with number ISRCTN15848572. The trial was first registered on 03/01/2019.
Sections du résumé
BACKGROUND
BACKGROUND
Uganda is experiencing a shift in major causes of death with cases of stroke, heart attack, and heart failure reportedly on the rise. In a study in Mukono and Buikwe in Uganda, more than one in four adults were reportedly hypertensive. Moreover, very few (36.5%) reported to have ever had a blood pressure measurement. The rising burden of CVD is compounded by a lack of integrated primary health care for early detection and treatment of people with increased risk. Many people have less access to effective and equitable health care services which respond to their needs. Capacity gaps in human resources, equipment, and drug supply, and laboratory capabilities are evident. Prevention of risk factors for CVD and provision of effective and affordable treatment to those who require it prevent disability and death and improve quality of life. The aim of this study is to improve health profiles for people with intermediate and high risk factors for CVD at the community and health facility levels. The implementation process and effectiveness of interventions will be evaluated.
METHODS
METHODS
The overall study is a type 2-hybrid stepped-wedge (SW) design. The design employs mixed methods evaluations with incremental execution and adaptation. Sequential crossover take place from control to intervention until all are exposed. The study will take place in Mukono and Buikwe districts in Uganda, home to more than 1,000,000 people at the community and primary healthcare facility levels. The study evaluation will be guided by; 1) RE-AIM an evaluation framework and 2) the CFIR a determinant framework. The primary outcomes are implementation - acceptability, adoption, appropriateness, feasibility, fidelity, implementation cost, coverage, and sustainability.
DISCUSSION
CONCLUSIONS
The study is envisioned to provide important insight into barriers and facilitators of scaling up CVD prevention in a low income context. This project is registered at the ISRCTN Registry with number ISRCTN15848572. The trial was first registered on 03/01/2019.
Identifiants
pubmed: 31023311
doi: 10.1186/s12913-019-4095-0
pii: 10.1186/s12913-019-4095-0
pmc: PMC6482572
doi:
Types de publication
Clinical Trial
Journal Article
Multicenter Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
253Subventions
Organisme : Horizon 2020
ID : 733356 - SPICES - H2020-SC1-2016-2017/H2020-SC1-2016-RTD
Références
Circulation. 2001 Nov 27;104(22):2746-53
pubmed: 11723030
PLoS One. 2015 Sep 25;10(9):e0138991
pubmed: 26406462
Indian Pediatr. 2015 Sep;52(9):750-2
pubmed: 26519707
Eur Heart J. 2010 Mar;31(6):642-8
pubmed: 20176800
Health Aff (Millwood). 2015 Sep;34(9):1506-13
pubmed: 26355052
Bull World Health Organ. 2007 Jun;85(6):432-40
pubmed: 17639240
Eur J Cardiovasc Nurs. 2011 Jul;10 Suppl 2:S5-13
pubmed: 21762852
BMJ. 2001 Oct 27;323(7319):945-6
pubmed: 11679369
Am J Public Health. 2013 Jun;103(6):e38-46
pubmed: 23597377
Nurs Res. 2009 Jan-Feb;58(1):2-12
pubmed: 19092550
PLoS Med. 2006 Nov;3(11):e442
pubmed: 17132052
BMJ Open. 2017 Nov 3;7(11):e015529
pubmed: 29101131
PLoS One. 2013 Apr 17;8(4):e62236
pubmed: 23614041
J Trop Med. 2012;2012:349312
pubmed: 23209477
Implement Sci. 2015 Apr 21;10:53
pubmed: 25895742
Implement Sci. 2015 May 12;10:68
pubmed: 25962598
Implement Sci. 2009 Aug 07;4:50
pubmed: 19664226
PLoS One. 2015 Nov 11;10(11):e0142312
pubmed: 26560131
J Clin Epidemiol. 2011 Sep;64(9):936-48
pubmed: 21411284
Glob Heart. 2014 Dec;9(4):431-43
pubmed: 25592798
BMJ. 2015 Feb 06;350:h391
pubmed: 25662947
Am J Public Health. 1999 Sep;89(9):1322-7
pubmed: 10474547
Rev Panam Salud Publica. 2002 Jul;12(1):71-4
pubmed: 12202028
Global Health. 2014 Nov 19;10:77
pubmed: 25406738
Prev Med Rep. 2017 Apr 04;6:322-328
pubmed: 28451518
Lancet. 2008 Sep 13;372(9642):940-9
pubmed: 18790317
Adm Policy Ment Health. 2011 Mar;38(2):65-76
pubmed: 20957426
Eur Heart J. 2014 Nov 7;35(42):2929
pubmed: 25381246
BMC Nurs. 2015 Aug 12;14:43
pubmed: 26269693