Browsing by Author "Xiong, Shangzhi"

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Open Access
Feasibility assessment of invigorating grassrooTs primary healthcare for prevention and management of cardiometabolic diseases in resource-limited settings in China, Kenya, Nepal, Vietnam (the FAITH study): rationale and design.
(Global health research and policy, 2019-01) Gong, Enying; Lu, Hongsheng; Shao, Shuai; Tao, Xuanchen; Peoples, Nicholas; Kohrt, Brandon A; Xiong, Shangzhi; Kyobutungi, Catherine; Haregu, Tilahun Nigatu; Khayeka-Wandabwa, Christopher; Van Minh, Hoang; Hanh, Tran Thi Duc; Koirala, Suraj; Gautam, Kamal; Yan, Lijing L
Background:Cardiometabolic diseases are the leading cause of death and disability in many low- and middle-income countries. As the already severe burden from these conditions continues to increase in low- and middle-income countries, cardiometabolic diseases introduce new and salient public health challenges to primary health care systems. In this mixed-method study, we aim to assess the capacity of grassroots primary health care facilities to deliver essential services for the prevention and control of cardiometabolic diseases. Built on this information, our goal is to propose evidence-based recommendations to promote a stronger primary health care system in resource-limited settings. Methods:The study will be conducted in resource-limited settings in China, Kenya, Nepal, and Vietnam using a mixed-method approach that incorporates a literature review, surveys, and in-depth interviews. The literature, statistics, and document review will extract secondary data on the burden of cardiometabolic diseases in each country, the existing policies and interventions related to strengthening primary health care services, and improving care related to non-communicable disease prevention and control. We will also conduct primary data collection. In each country, ten grassroots primary health care facilities across representative urban-rural regions will be selected. Health care professionals and patients recruited from these facilities will be invited to participate in the facility assessment questionnaire and patients' survey. Stakeholders - including patients, health care professionals, policymakers at the local, regional, and national levels, and local authorities - will be invited to participate in in-depth interviews. A standard protocol will be designed to allow for adaption and localization in data collection instruments and procedures within each country. Discussion:With a special focus on the capacity of primary health care facilities in resource-limited settings in low- and middle-income countries, this study has the potential to add new evidence for policymakers and academia by identifying the most common and significant barriers primary health care services face in managing and preventing cardiometabolic diseases. With these findings, we will generate evidence-based recommendations on potential strategies that are feasible for resource-limited settings in combating the increasing challenges of cardiometabolic diseases.
Open Access
The Relationship between Family Support and Medication Adherence among Hypertensive Patients in Kenya
(2018) Xiong, Shangzhi
Background
Hypertension (HTN) is a serious public health problem causing an enormous disease burden globally. Non-adherence to medication among hypertensive patients has been identified as one of the major contributors to the poor control of blood pressure (BP). Despite the paucity of reliable, up-to-date data on hypertension in Kenya, existing literature suggests high HTN prevalence in that nation. Additionally, the control of hypertension in Kenya faces many challenges, including the low medication adherence rates among its hypertensive population.
Hypertension as a chronic disease requires long-term disease management, including taking medication daily and making important lifestyle changes. The role of family support for patients during this life-long process has been a topic of interest among many researchers.
The overarching goal of this study is to determine the quantitative and qualitative association between family support and medication adherence among hypertensive patients in Kenya.
Methods
A mixed-method cross-sectional study was conducted in three healthcare facilities in Nairobi, Kenya. A questionnaire and in-depth follow-up interview were included to achieve the quantitative and qualitative goals respectively.
The questionnaire consisted of five sections: demographic information; health and medical information; medication adherence measurements; family support and family function measurements; and BP measurements.
The in-depth follow-up interview was conducted among patients who were willing to participate after the questionnaire survey. An interview guide was designed to lead the semi-structured individual interview with a focus on exploring how family members may contribute to patients’ HTN management.
Descriptive statistics were used to describe the patient profiles; Fisher’s exact test and Chi-square test were used to compare the level of medication adherence and family support among different subgroups of patients; bivariate logistic regression was used to determine the predictors of medication adherence; and multiple logistic regression was used to examine the independent association between family support/function and medication adherence. Grounded theory was used to guide the thematic analysis of the qualitative data.
Results
A total of 104 patients participated in the study. The majority of participants were female (n = 71, 68.27%) and urban residents (n = 95, 91.35%), with a mean age of 56.61 (SD = 11.70).
The overall control rate of HTN among the patients was low, with only 33.98% of them under control. The percentage of highly adherent patients determined by the Morisky Green Scale was 55.77% and was 26.92% as determined by the Hill-Bone Scale. Based on the Perceived Social Support from Family Scale, most of the patients (82.69%) reported strong family support. The majority of patients (77.88%) were determined to have “functional” families by the Family Function APGAR Scale, and 22.12% had dysfunctional families. Both the bivariate logistic regression and multiple logistic regression generated non-significant results for the association between family support/function and medication adherence using either scale.
Three major themes were generated from the qualitative analysis: patients’ family relationship and situation, patients’ perceptions about HTN and medication, and patients’ family in HTN management. The qualitative results suggested that patients’ support from their family members is promising in improving HTN control and medication adherence. However, a low level of health knowledge among patients and their families may present substantial barriers to HTN patients’ medication adherence.
Conclusion
Despite strong family support and a good family function level, HTN patients in Kenya have low medication adherence and are in a critical situation concerning BP control. Lack of health knowledge, limited involvement in patients’ HTN care, and unavailability and unaffordability of antihypertensive medicines are important obstacles that compromise the positive effects of family support on HTN control in Kenya. Future HTN control interventions in Kenya should prioritize providing better health education to the patients and their families, raising people’s awareness for hypertension screening and treatment, and further engaging patients’ families in HTN care. Additionally, the Kenyan government should enhance its healthcare system to ensure people’s accessibility to hypertension medicines and services.