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Dele-Ojo BF, Oseni TIA, Duodu F, Echieh CP, Blankson PK, Alabi BS, Sarpong DF, Tayo BO, Boima V, Coleman MA, Ogedegbe G. The effect of mobile health technology on blood pressure control among patients with hypertension in Ghana and Nigeria. RESEARCH SQUARE 2023:rs.3.rs-3272069. [PMID: 37790348 PMCID: PMC10543310 DOI: 10.21203/rs.3.rs-3272069/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/05/2023]
Abstract
Background More than half of patients with hypertension in sub-Saharan African do not achieve blood pressure control. This study determined the effect of mobile health technology on systolic blood pressure reduction and blood pressure (BP) control among patients with hypertension in Nigeria and Ghana. Methods A randomised control trial of 225 adults with hypertension attending two General/Medical Outpatient Clinics each in Nigeria and Ghana was randomized into intervention (n = 116) and control (n = 109) arm respectively. Patients in the intervention arm received messages twice weekly from a mobile app for six months in addition to the usual care while the control arm received usual care only. The study outcomes were systolic blood pressure (SBP) reduction and blood pressure control at six months, while the secondary outcome was medication adherence at six months. Data were collected at 0 and 6 months, it was analysed using SPSS-21 software at a significance level of p < 0.05. Binary logistic regression was used to generate the predictors of good blood pressure control. Results The mean age for the control and intervention were 60.2 ± 13.5 and 62.6 ± 10.8 years respectively; p-value = 0.300. The intervention group had greater reductions in SBP (-18.7mmHg vs -3.9mmHg; p < 0.001) and greater BP control rate (44.3% vs 24.8%; p-value 0.002). Conclusions The mobile health intervention resulted in significant SBP reduction rate and improvement in BP control rate in the 6th month. However, improvement in adherence level in the 3rd month and was not sustained in the 6th month. The addition of mobile health technology may be extended for use in the national hypertension control plan. Female gender, formal education and being in the intervention arm were predictors of blood pressure control.
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Basheikh ZO, Jumbe T, Kulwa K. Perception and attitudes of street food vendors toward the healthiness of meals prepared and sold in Dodoma. Food Sci Nutr 2023; 11:3885-3897. [PMID: 37457159 PMCID: PMC10345679 DOI: 10.1002/fsn3.3374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Revised: 03/28/2023] [Accepted: 03/30/2023] [Indexed: 07/18/2023] Open
Abstract
Consumption of street meals among urban dwellers has become inevitable, especially in low- and middle-income countries. It has been linked to higher incidence of dietary-related diseases. Vendors' perceptions and attitudes toward the healthiness of meals can influence nutritional quality of the offered meals. Therefore, the study aimed to assess perceptions and attitudes of vendors toward healthy and unhealthy meals as well as the healthiness of meals they prepare and sell. A cross-sectional study was carried out among 384 street food vendors. Face-to-face interviews were conducted using semistructured questionnaire. Pearson Chi-square test and logistic regression analysis were used in comparing and testing for the association of perceptions and attitudes to vendors' characteristics. Street food vendors that took part in this study demonstrated good perceptions based on what they perceived to be healthy meals (58.33%) and positive attitudes (95.57%) toward preparation and provision of healthy meals. Perceptions were associated with sex (p = .007), education level (p = .002), and investment cost (p = .000). Results from logistic regression showed that better perceptions of healthy meals were associated with being female (OR = 2.46, p-value < .031), having higher education (OR = 11.88, p-value < .042), and vending experience of 1-5 years and more than 5 years (OR = 3.17, 2.95, p-value < .019, .039, respectively) while having moderate investment cost showed significant lower chances of having better perceptions (OR = 0.33, p-value < .001). Attitudes were associated with sex (p = .002), age (p = .002), marital status (p = .013), education (p = .009), and vending experience (p = .008). Female vendors, having 25 years of age and above, living with partners, with tertiary education, and having vending experience of more than 1 year had shown to have more positive attitudes toward healthy meals. Generally, street food vendors had good perceptions and attitudes toward healthy meals. This implies possible room for change and adoption of better ways of preparing meals. These findings could be used as a stepping stone in improving nutritional and healthy quality of street meals. Increased efforts are needed on the inclusion of nutritional aspects of healthy meals as they were merely considered by vendors. Future interventions on these vendors should focus more on male vendors, vendors with little vending experience, and little education as they had shown to have relatively poorer attitudes and perceptions compared to other groups.
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Affiliation(s)
- Zalia Omary Basheikh
- Department of Human Nutrition and Consumer Sciences Sokoine University of Agriculture Morogoro Tanzania
| | - Theresia Jumbe
- Department of Human Nutrition and Consumer Sciences Sokoine University of Agriculture Morogoro Tanzania
| | - Kissa Kulwa
- Department of Human Nutrition and Consumer Sciences Sokoine University of Agriculture Morogoro Tanzania
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Nakwafila O, Sartorius B, Shumba TW, Dzinamarira T, Mashamba-Thompson TP. Stakeholder's perspectives on acceptable interventions for promoting hypertension medication adherence in Namibia: nominal group technique. BMJ Open 2023; 13:e068238. [PMID: 37192796 DOI: 10.1136/bmjopen-2022-068238] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/18/2023] Open
Abstract
OBJECTIVE To determine the most acceptable hypertension intervention package to promote hypertension adherence based on stakeholders' perspectives. DESIGN We employed the nominal group technique method and purposively sampled and invited key stakeholders offering hypertension services and patients with hypertension. Phase 1 was focused on determining barriers to hypertension adherence, phase 2 on enablers and phase 3 on the strategies. We employed the ranking method based on a maximum of 60 scores to establish consensus regarding hypertension adherence barriers, enablers and proposed strategies. SETTING AND PARTICIPANTS 12 key stakeholders were identified and invited to participate in the workshop in Khomas region. Key stakeholders included subject matter experts in non-communicable diseases, family medicine and representatives of our target population (hypertensive patients). RESULTS The stakeholders reported 14 factors as barriers and enablers to hypertension adherence. The most important barriers were: lack of knowledge on hypertension (57 scores), unavailability of drugs (55 scores) and lack of social support (49 scores). Patient education emerged as the most important enabler (57 scores), availability of drugs emerged second (53 scores) and third having a support system (47 scores). Strategies were 17 and ranked as follows: continuous patient education as the most desirable (54 scores) strategy to help promote hypertension adherence, followed by developing a national dashboard to primarily monitor stock (52 scores) and community support groups for peer counselling (49 scores). CONCLUSIONS Multifaceted educational intervention package targeting patient and healthcare system factors may be considered in implementing Namibia's most acceptable hypertension package. These findings will offer an opportunity to promote adherence to hypertension therapy and reduce cardiovascular outcomes. We recommend a follow-up study to evaluate the proposed adherence package's feasibility.
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Affiliation(s)
- Olivia Nakwafila
- Discipline of Public Health Medicine,School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
- School of Nursing and Public Health,Department of Public Health, University of Namibia, Oshakati campus, Namibia
| | - Benn Sartorius
- Discipline of Public Health Medicine,School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
- Centre for Tropical Medicine and Global Health,Nuffield Department of medicine, University of Oxford, Oxford, UK
| | - Tonderai Washington Shumba
- School of Allied Health Sciences, Department of Occupational therapy and Physiotherapy, University of Namibia, Hage Geingob Campus, Namibia
| | - Tafadzwa Dzinamarira
- School of Health Systems&Public Health, University of Pretoria, Pretoria 0002, South Africa
| | - Tivani Phosa Mashamba-Thompson
- Discipline of Public Health Medicine,School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
- Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
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Al-Alaili MK, Abdi AM, Basgut B. Test performance of self-report adherence tools in patients with hypertension: A systematic review and a meta-analysis. J Clin Pharm Ther 2022; 47:1932-1944. [PMID: 36401121 DOI: 10.1111/jcpt.13805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 10/30/2022] [Accepted: 11/02/2022] [Indexed: 11/20/2022]
Abstract
WHAT IS KNOWN AND OBJECTIVES Adherence has proved to have a positive influence on achieving plausible treatment outcomes. Self-report questionnaires are widely used in evaluating adherence, creating thus a high-powered research field. This review aims to provide an update of scales used in hypertension, which are compared and analysed against reliability and validity. METHODS PubMed, Web of Science and Cochrane Library were searched in May 2022 to identify studies. We extracted the study characteristics and evaluated their quality. A random-effects model with subgroup analysis was used to calculate estimates and heterogeneity parameters as well as regressions, funnel and forest plots. A bivariate model was selected to conduct validity analyses and draw receiver operating characteristic (ROC) curves. RESULTS AND DISCUSSION Fifty-five articles were identified and classified into 22 different reliable and validated tools. Pooled analyses predicted an overall good Cronbach's alpha of 0.76 (95%CI:0.67-0.83), a good ICC of 0.8 (95%CI:0.72-0.86) and an excellent correlation coefficient of 0.91 (95%CI:0.86-0.95), which all showed high heterogeneity and slight detection of asymmetry. Regression analyses showed that only time and the number of items/scale type influenced significantly retest and alpha, respectively. Overall validity showed acceptable sensitivity of 0.65 (95%CI:0.53-0.75) and specificity of 0.57 (95%CI:0.47-0.67) with a good Area Under Curve (AUC) of 0.637. Upon comparison, four tools showed superiority over Morisky's scale. WHAT IS NEW AND CONCLUSION Adherence is a multi-dimensional phenomenon, which deems scales to be highly variable or complex; thus, complicating the selection process. Adherence to Refills and Medications Scale (ARMS) is the most promising free non-inferior alternative to Morisky, the most used scale.
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Affiliation(s)
| | - Abdikarim Mohamed Abdi
- Department of Clinical Pharmacy, Faculty of Pharmacy, Near East University, Mersin, Turkey.,Department of Clinical Pharmacy, Faculty of Pharmacy, Yeditepe University, Ankara, Turkey
| | - Bilgen Basgut
- Department of Clinical Pharmacy, Faculty of Pharmacy, Near East University, Mersin, Turkey.,Department of Pharmacology, Faculty of Pharmacy, Başkent University, Ankara, Turkey
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Pallangyo P, Komba M, Mkojera ZS, Kisenge PR, Bhalia S, Mayala H, Kifai E, Richard MK, Khanbhai K, Wibonela S, Millinga J, Yeyeye R, Njau NF, Odemary TK, Janabi M. Medication Adherence and Blood Pressure Control Among Hypertensive Outpatients Attending a Tertiary Cardiovascular Hospital in Tanzania: A Cross-Sectional Study. Integr Blood Press Control 2022; 15:97-112. [PMID: 35991354 PMCID: PMC9390787 DOI: 10.2147/ibpc.s374674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 07/08/2022] [Indexed: 11/23/2022] Open
Abstract
Background Notwithstanding the availability of effective treatments, asymptomatic nature and the interminable treatment length, adherence to medication remains a substantial challenge among patients with hypertension. Suboptimal adherence to BP-lowering agents is a growing global concern that is associated with the substantial worsening of disease, increased service utilization and health-care cost escalation. This study aimed to explore medication adherence and its associated factors among hypertension outpatients attending a tertiary-level cardiovascular hospital in Tanzania. Methods The pill count adherence ratio (PCAR) was used to compute adherence rate. In descriptive analyses, adherence was dichotomized and consumption of less than 80% of the prescribed medications was used to denote poor adherence. Logistic regression analyses was used to determine factors associated with adherence. Results A total of 849 outpatients taking antihypertensive drugs for ≥1 month prior to recruitment were randomly enrolled in this study. The mean age was 59.9 years and about two-thirds were females. Overall, a total of 653 (76.9%) participants had good adherence and 367 (43.2%) had their blood pressure controlled. Multivariate logistic regression analysis showed; lack of a health insurance (OR 0.5, 95% CI 0.3–0.7, p<0.01), last BP measurement >1 week (OR 0.6, 95% CI 0.4–0.8, p<0.01), last clinic attendance >1 month (OR 0.4, 95% CI 0.3–0.6, p<0.001), frequent unavailability of drugs (OR 0.6, 95% CI 0.3–0.9, p = 0.03), running out of medication before the next appointment (OR 0.6, 95% CI 0.4–0.9, p = 0.01) and stopping medications when asymptomatic (OR 0.6, 95% CI 0.4–0.8, p<0.001) to be independent associated factors for poor adherence. Conclusion A substantial proportion of hypertensive outpatients in this tertiary-level setting had good medication adherence. Nonetheless, observed suboptimal blood pressure control regardless of a fairly satisfactory adherence rate suggests that lifestyle modification plays a central role in hypertension management.
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Affiliation(s)
- Pedro Pallangyo
- Unit of Research and Training, Jakaya Kikwete Cardiac Institute, Dar es Salaam, Tanzania.,Directorate of Cardiology, Jakaya Kikwete Cardiac Institute, Dar es Salaam, Tanzania
| | - Makrina Komba
- Unit of Research and Training, Jakaya Kikwete Cardiac Institute, Dar es Salaam, Tanzania
| | - Zabella S Mkojera
- Unit of Research and Training, Jakaya Kikwete Cardiac Institute, Dar es Salaam, Tanzania
| | - Peter R Kisenge
- Unit of Research and Training, Jakaya Kikwete Cardiac Institute, Dar es Salaam, Tanzania.,Directorate of Cardiology, Jakaya Kikwete Cardiac Institute, Dar es Salaam, Tanzania
| | - Smita Bhalia
- Directorate of Cardiology, Jakaya Kikwete Cardiac Institute, Dar es Salaam, Tanzania
| | - Henry Mayala
- Directorate of Clinical Support Services, Jakaya Kikwete Cardiac Institute, Dar es Salaam, Tanzania
| | - Engerasiya Kifai
- Directorate of Clinical Support Services, Jakaya Kikwete Cardiac Institute, Dar es Salaam, Tanzania
| | - Mwinyipembe K Richard
- Directorate of Cardiology, Jakaya Kikwete Cardiac Institute, Dar es Salaam, Tanzania
| | - Khuzeima Khanbhai
- Unit of Research and Training, Jakaya Kikwete Cardiac Institute, Dar es Salaam, Tanzania.,Directorate of Cardiology, Jakaya Kikwete Cardiac Institute, Dar es Salaam, Tanzania
| | - Salma Wibonela
- Directorate of Nursing, Jakaya Kikwete Cardiac Institute, Dar es Salaam, Tanzania
| | - Jalack Millinga
- Directorate of Nursing, Jakaya Kikwete Cardiac Institute, Dar es Salaam, Tanzania
| | - Robert Yeyeye
- Directorate of Nursing, Jakaya Kikwete Cardiac Institute, Dar es Salaam, Tanzania
| | - Nelson F Njau
- Directorate of Clinical Support Services, Jakaya Kikwete Cardiac Institute, Dar es Salaam, Tanzania
| | - Thadei K Odemary
- Directorate of Clinical Support Services, Jakaya Kikwete Cardiac Institute, Dar es Salaam, Tanzania
| | - Mohamed Janabi
- Directorate of Cardiology, Jakaya Kikwete Cardiac Institute, Dar es Salaam, Tanzania
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