Facilitators and Barriers in the Implementation of Community Health Workers-Led Multicomponent Intervention to Control Hypertension at Selected Health Centers in Rwanda: Qualitative Research

Abstract Introduction Hypertension (HTN) is a leading cause of cardiovascular disease and mortality, with the majority of deaths occurring in LMICs. New models for hypertension care are imperative. Community health worker (CHW)-led multicomponent intervention (MCI) is a model for controlling HTN at the community level. We explored the facilitators and barriers related to the implementation of CHW-led MCI to control hypertension in two districts and selected health centers within the catchment area. Materials and methods Two focus group discussions and in-depth interviews were conducted with 48 participants, comprising health center NCD nurses, health center managers, community health workers, and hypertensive patients, as well as two key informant interviews in Gasabo and Bugesera districts, Rwanda, between January and March 2025. The qualitative data were digitally recorded, transcribed verbatim and analyzed via multistepthematic analysis. Results The facilitators include financial motivation, training, and increasing CHWs' level of education, and barriers include insufficient financial support, a lack of training, being overwhelmed with responsibilities, a low level of education, and a lack of training specific to hypertension. The scale-up of HTN management from district hospitals to health centers was reported to be generally successful in Rwanda. Conclusions This study's findings revealed some facilitators and barriers in the implementation of CHW-led MCI for the management of hypertension in the community. The scale-up of hypertension management from hospitals to health centers was reported to be a successful step in the management of NCDs in selected study settings, which can be a basis for scaling up management to the community level, as this step will be validatedby a quantitative study under investigation, which will highlight the effectiveness of CHW-led MCI in the management of uncontrolled hypertension in the community. Registry: Clinicaltrials.gov,TRN: NCT06959134, Registration date: 5 May 2025