Abstract:
Background:
Hypertension is the leading
global risk for mortality. Poor treatment and
control of hypertension in low- and middle-
income countries is due to several reasons,
including insufficient human resources.
Nurse management of hypertension is
a novel approach to address the human
resource challenge. However, specific bar
-
riers and facilitators to this strategy are not
known.
Objective:
To evaluate barriers and facilita-
tors to nurse management of hypertensive
patients in rural western Kenya, using a
qualitative research approach.
Methods:
Six key informant interviews
(five men, one woman) and seven focus
group discussions (24 men, 33 women)
were conducted among physicians, clinical
officers, nurses, support staff, patients, and
community leaders. Content analysis was
performed using Atlas.ti 7.0, using deduc-
tive and inductive codes that were then
grouped into themes representing barriers
and facilitators. Ranking of barriers and fa-
cilitators was performed using triangulation
of density of participant responses from the
focus group discussions and key informant
interviews, as well as investigator assess
-
ments using a two-round Delphi exercise.
Results:
We identified a total of 23 barriers
and nine facilitators to nurse management
of hypertension, spanning the following
categories of factors: health systems, envi-
ronmental, nurse-specific, patient-specific,
emotional, and community. The Delphi
results were generally consistent with the
findings from the content analysis.
Conclusion:
Nurse management of hyper
-
tension is a potentially feasible strategy to
address the human resource challenge of
hypertension control in low-resource set-tings. However, successful implementation
will be contingent upon addressing barriers
such as access to medications, quality of
care, training of nurses, health education,
and stigma.
