Development and evaluation of a patient-centered cardiovascular health education program among insured primary care patients with hypertension in rural Nigeria: The QUICK-II study

Background: Cardiovascular diseases (CVD) are increasingly common in Nigeria and sub Saharan Africa (SSA). Poverty is rampant and quality of primary care substandard. Moreover adherence capacity for prescribed anti-hypertensive treatment is limited and blood pressure (BP) control consequently poor. To limit CVD affordable high-quality hypertension care and patient-centered cardiovascular health education program (CHEP) are important but lacking. This thesis investigates outcomes of providing low-income hypertensive patients from rural Nigeria with the suggested interventions.
Objectives: Development, implementation and evaluation of CHEP among patients with access to high-quality hypertension care in a primary care hospital in rural Nigeria.
Methods: CHEP was developed based on qualitative interview studies among: 40 hypertensive patients; 11 healthcare professionals; 4 insurance managers, (July-December 2010). CHEP was evaluated using quantitative (pre/post) study among 149 insured patients with uncontrolled hypertension and/or medication non-adherence, (February-September 2012). Data management was assisted with MAXQDA and STATA software.
Results: CHEP development: Patient-identified facilitators/inhibitors of medication adherence: patient-related (e.g. trust in orthodox/western pills); healthcare-related (e.g. long waiting times); medication-related (e.g. medication side-effects); socio-cultural (e.g. negative cultural body images). Provider/insurer-identified enablers/barriers of high-quality hypertension care: availability/non-availability of necessary resources (e.g. health insurance); healthy stakeholders’ relationships. CHEP protocol. CHEP evaluation: more participants reported high adherence to medications, healthy behaviors; participants with controlled BP doubled; improved medication adherence was significantly associated with decreased medication concerns and improved medication self-efficacy.
Conclusion: Implementing CHEP in context of insured high-quality hypertension care improved medication/behavioral adherence and BP control. Such interventions have potential to limit CVD among SSA’s growing hypertensive population.