Assessment of blood pressure skills and belief in clinical readings

The role of community health workers in the management of hypertension in Nigeria

BACKGROUND

Hypertension is the number one risk factor for cardiovascular death worldwide and its prevalence has been on the increase in LMICs including Nigeria. There is an increasing awareness and recognition of the contributions of the community health workers (CHWs) in the healthcare system. This study assessed their current role in the management of hypertension and patient satisfaction with the care received.

METHODS

A mixed method study (cross-sectional study of 381 CHWs and key informant interview of 14 patients with hypertension selected using multi-stage and purposive sampling respectively) was conducted across five states in different geopolitical zones of Nigeria to assess the role of CHWs in hypertension management and the patients' level of satisfaction with services of CHWs. Chi-square test was used to assess relationship between categorical variables. A p-value ≤ 0.05 was considered statistically significant. Thematic analysis of the text data from the KII was done using Nvivo® version 12 pro.

RESULTS

A total of 381 CHWs completed the study. They were predominantly males (63%) with mean age of 40.96 ± 12.51 years. Only about one-third of the CHWs (31%) could correctly diagnose hypertension while only 15% knew the base-line investigations to be requested. Being female (FE = 9.205, p = 0.008) and resident in northwest geopolitical region (χ2 = 20.920, p < 0.001) had statistically significant associations with appropriate diagnostic skills for hypertension. Being supervised by doctors was associated with appropriate knowledge of baseline investigations for hypertension (χ2 = 5.534, p = 0.019). Mostly, hypertensive patients reported positive experiences and satisfaction with the services provided by the CHWs.

CONCLUSIONS

Community health workers currently have critical contributions in the management of hypertension in Nigeria. Hypertensive patients generally reported satisfactory experience with CHWs managing them. The services rendered by CHWs can be improved upon by adequate supervision and training.

Effects of an educational program using a virtual social network on nurses' knowledge and performance of blood pressure measurement: a randomized controlled trial

BACKGROUND

Hypertension diagnosis, treatment, and follow-up depend on accurate blood pressure measurement; however, inaccurate measurement techniques are common among healthcare providers. To improve professional performance, continuous education is necessary. Distance education through virtual social network can be used as it is easy to use and accessible.

METHODS

This study adopted a randomized controlled trial design and was conducted at two hospitals in Mansoura, Egypt. The subjects were selected from two hospitals using Stratified random sampling method in proportion to the total number of nurses. Seventy nurses were included in this study and were randomly divided into the intervention (n = 35) and control (n = 35) groups using block randomization. Data were gathered before and after intervention using a blood pressure measurement knowledge questionnaire and a blood pressure measurement observation checklist. The blood pressure measurement error (the difference between the BP determined by each observer and the reference BP) was calculated for the randomly selected recordings in both groups. The intervention group received 24 blood pressure measurement education sessions using WhatsApp, while the control group received only routine education using traditional lecture.

RESULTS

No statistically significant differences in pretest knowledge scores, performance scores, and range of error were found between both groups, whereas, after intervention, knowledge scores were higher in the intervention group than those in the control group (p < 0.001). The range of error of systolic and diastolic blood pressure values significantly reduced after the intervention in the intervention group, and the posttest performance scores were higher than the pretest performance scores; however, the difference was not statistically significant.

CONCLUSIONS

The blood pressure measurement education program via WhatsApp was effective in increasing nurses' knowledge and reducing the range of error; however, a multimodal approach may be required to improve performance scores.

TRIAL REGISTRATION

Prospectively registered with ClinicalTrials.gov on 09/03/2021; registration number NCT04789642.