Browsing by Subject "Barriers"

Background: Hypertension and related complications are major contributors to deaths and disabilities in Nepal. We aim to explore existing work flows, needs and challenges to hypertension care coordination and assess feasibility of establishing a FCHV-based hypertension management program in Kavre, Nepal.

Design: We conducted 23 in depth-interviews and one focus group discussion that consists of nine patients with hypertension, six health workers, four health officials, and 12 FCHVs in two village development committees of Kavre district, Nepal. Applied thematic analysis was performed using NVivo 12.

Results: Health literacy related to hypertension was low. Delay in treatment initiation and lost to follow up were common patterns despite comply with antihypertensive medication. Underutilization of primary healthcare institutions, communication gap and lack of grass-roots level educational campaigns were identified as major health system-related barriers. Community pharmacies, monthly health camps and increasing governmental attention to NCDs were favorable for hypertension management. This study also showed FCHVs have the potential to promote hypertension educational, screening and referral in their catchments, with adequate training and proper motivation.

Conclusions: Barriers and facilitators identified in this study have implications for future hypertension management intervention design. We recommend grassroot level hypertension education and screening across the Nepal. FCHVs have the potential to take on these responsibilities, once they are empowered with appropriate training and motivated by proper incentives.

Keywords: hypertension management, barriers, facilitators, community health workers, female community health volunteers, Nepal, qualitative research

Introduction: Chronic diseases have been increasing globally for decades, while the leading chronic diseases worldwide are cancer, cardiovascular disease (CVD), chronic respiratory disease, and diabetes.1 Behavioral risk factors of chronic diseases that can be modified include physical activity, diet, alcohol consumption and tobacco use.3 4 Several guidelines for screening and prevention recommend that family health history (FHH) is collected by primary care providers for disease risk stratification and management.6 7 MeTree, developed in 2014, is a computerized, patient-facing program that collects information about family health history and generates decision support for providers and patients.6 15 There are several potential barriers to implementation of an online FHH software tool including health literacy, computer skills, and behavioral components. This study collects FHH information through MeTree in a rural population in North Carolina through a unique implementation process using research assistants to manually and verbally assist participants. The aims of this study are to characterize the quality of pedigrees collected and to estimate familial disease aggregation among the families of participants.

Methods: This study enrolled 44 participants from an ongoing study conducted by collaborators from Duke University Health System, Duke Clinical Research Institute,

University of North Carolina Pembroke, and Southeastern Regional Medical Center. To collect FHH information, participants constructed family pedigree in MeTree, one family member at a time with the help of one study research assistant. Once participants created a full family pedigree, an individual risk assessment was generated by MeTree.

Results: More than half of the participants were female (n= 30, 68.2%). The ethnic group that composed the largest part of our study population were Lumbee Indians (n=23, 52.3%) followed by White/Caucasians (n=13, 29.5%) and African Americans (n=7, 15.9%). For quality, the average score across all pedigrees was higher than 65% for all seven components of the criteria. The total number of diseases present among all participants and relatives in the study was 930 (Table 3). Cancer was present in 81.8% of pedigrees and made up 12.2% of all reported diseases. Twenty-five percent of all pedigrees had at least one family member that was diagnosed with lung cancer. Diabetes was also frequently reported and was observed in 75% of all pedigrees. Kidney Disease was reported in at least one or more relatives in 52.3% of pedigrees.

Conclusions: Using a patient-facing online Health Information Technology tool such as MeTree could potentially lead to better health outcomes due to risk assessment and individually-targeted prevention strategies. MeTree may be an important tool to use to address the large burden of chronic diseases in this region.

Background: Thalassemia is a devastating inherited hematological disorder, and as a result of population migration, has become a global public health problem. Thailand has one of the highest burdens of thalassemia in the world and has developed a successful prevention and control program, but nearly 4 million migrants living in Thailand are excluded. Strategies for thalassemia screening in migrants are needed. This study aims to characterize migrants' awareness and knowledge of and attitudes toward thalassemia screening. Methods: 300 adult Myanmar or Cambodian migrant workers and 200 adult Thai citizens residing in the industrial province of Chonburi, Thailand were enrolled and given a demographic and KAP (Knowledge, Attitudes, and Practices) survey on thalassemia. Descriptive statistics, tabulations, Wilcoxon Rank Sum Tests, Kruskal-Wallis Test, and Chi-Square analysis were used to compare socio-demographic variables and levels of thalassemia awareness between migrant and Thai subjects. Results: Myanmar and Cambodian subjects had very low awareness of thalassemia, in contrast with Thai subjects (4.1% vs 79.6%, respectively). Migrants also had lower knowledge of thalassemia, but showed strong interest in thalassemia screening. Gender and education level predicted thalassemia awareness in Thai subjects, but length of residence in Thailand was the only demographic variable associated with awareness in migrants. Conclusions: This study revealed a tremendous awareness gap between Thai and migrant populations surrounding thalassemia, suggesting that public education is a crucial starting point for a thalassemia prevention and control program in migrants. A number of structural and cultural barriers identified in this study will also need to be addressed.

Background: Barriers to surgical care in low- and middle-income countries have basis in theoretical frameworks, but are often left undefined and understudied. Based on the Access Evaluation Framework and Healthcare Barrier Model, this study implemented two consumer decision tools and a qualitative interview to elucidate significant barriers to seeking surgical care in Uganda.

Methods: Participants were recruited from a convenience sample within the surgical wards of one national referral hospital and one regional referral hospital in Uganda. Individuals selected for the study answered a brief questionnaire and a ranking and rating exercise followed by an in-depth semi-structured interview. The questionnaire evaluated demographic, economic, transportation, and care-seeking characteristics, while the ranking and rating exercises assessed potential barriers to surgical care. Descriptive statistics were used to assess characteristics of the sample. Ranking and rating medians were compared between the two exercises for each barrier.

Results: Among the 214 participants, cost of surgery, distance to hospital, and transportation to hospital were identified as the most significant barriers to care. Language barrier, no control over decision making, and no caretaker available at the hospital were identified as the least significant barriers to care. Mulago National Referral Hospital had significantly greater costs and transportation times indicating larger scale barriers to care than Jinja Regional Referral Hospital even though top barriers were similar.

Conclusions: Both the ranking and rating exercises and interviews indicated that cost was the most significant barrier to surgical care among care-seekers in Uganda. Transportation to the hospital and distance from the hospital remain large barriers that need to be considered as well. These complementary analysis tools provide evidence that future policies and research need to consider mitigating cost, distance, and transportation issues for patients that need a surgical intervention. Next steps in determining more granular level differences between barriers will help understand how best to address these issues.

Background: Increasing evidence suggests that early diagnosis of Alzheimer’s disease and related diseases (ADRD) offers opportunities for access to supportive services and disease management. However, most cases of ADRD are diagnosed in the later stages of the disease limiting the benefits of supportive services and increasing challenges related to the disease. This study aimed to understand facilitators and barriers to early ADRD diagnosis among Black and White individuals seeking racial differences in this process. Methods: Our sample included 21 racially diverse caregivers (n= 21) of older adults with ADRD, including Black caregivers (n=11) and White caregivers (n= 10). Semi-structured interviews were conducted individually with participants. Duke University Health System (DUHS). Data were coded for emerging themes and analyzed through the lens of the life course framework using NVIVO analysis software. Results: Facilitators and barriers along the diagnosis process were shaped by the individual, family/caregiver, and interactions with the healthcare system. Racial differences were particularly evident regarding family/caregiver's lower knowledge about ADRD, care approach offered to the care recipient, and prevalent negative interactions with the healthcare system among Black caregivers. Conclusions: The diagnosis process pathways were lengthy, characterized by caregivers' persistence, challenges to receiving an adequate cognitive assessment, and limited access to supportive services. Black caregivers experienced a more prolonged process, lower knowledge about ADRD, and challenging interactions with the healthcare system.