Development and evaluation of a patient centered cardiovascular health education program for insured patients in rural Nigeria (QUICK-II)
Background: In sub-Saharan Africa, the incidence of hypertension and other modifiable cardiovascular risk factors is growing rapidly. Poor adherence to prescribed prevention and treatment regimens by patients can compromise treatment outcomes. Patient-centered cardiovascular health education is likely to improve shortcomings in adherence. This paper describes a study that aims to develop a cardiovascular health education program for
patients participating in a subsidized insurance plan in Nigeria and to evaluate the applicability and effectiveness in patients at increased risk for cardiovascular disease.
Methods/Design: The study has two parts. Part 1 will develop a cardiovascular health education program, using qualitative interviews with stakeholders. Part 2 will evaluate the effectiveness of the program in patients, using a prospective (pre-post) observational design.
Setting: A rural primary health center in Kwara State, Nigeria.
Population: For part 1: 40 patients, 10 healthcare professionals, and 5 insurance managers. For part 2: 150 patients with uncontrolled hypertension or other cardiovascular risk factors after one year of treatment.
Intervention: Part 2: patient-centered cardiovascular health education program.
Measurements: Part 1: Semi-structured interviews to identify stakeholder perspectives. Part 2: Pre- and postintervention assessments including patients’ demographic and socioeconomic data, blood pressure, body mass index and self-reporting measures on medication adherence and perception of care. Feasibility of the intervention will be measured using process data.
Outcomes: For program development (part 1): overview of healthcare professionals’ perceptions on barriers and facilitators to care, protocol for patient education, and protocol implementation plan. For program evaluation (part 2): changes in patients’ scores on adherence to medication and life style changes, blood pressure, and other physiological and self-reporting measures at six months past baseline.
Analysis: Part 1: content analytic technique utilizing MAXQDA software. Part 2: univariate and multilevel analysis to assess outcomes of intervention.
Discussion: Diligent implementation of patient-centered education should enhance adherence to cardiovascular disease prevention and management programs in low income countries.
Trial Registration: ISRCTN47894401
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