Key result
Formative evaluation reveals staffing and trust barriers in community hypertension care, driving targeted training adaptations.
Why the study?
In rural KwaZulu-Natal Province, South Africa, less than 25 % of persons with hypertension have controlled blood pressure, requiring identification of barriers and facilitators to inform implementation of a community-based intervention.
A formative qualitative evaluation identified critical health system and individual barriers to hypertension care in rural South Africa, informing necessary adaptations for a community-based intervention trial.
Pre-trial formative evaluations may optimize community hypertension interventions in rural settings; leaves open effects on trial outcomes and scalability.
Background: In rural KwaZulu-Natal Province, South Africa, less than 25 % of persons with hypertension have controlled blood pressure. We conducted a formative evaluation of current clinic-based care to identify barriers and facilitators that could impact effective implementation of a community-based hypertension intervention (IMPACT-BP). Methods: We conducted individual interviews and group discussions with clinic managers, nurses, community health workers (CHWs), community leaders, and patients to identify barriers and facilitators experienced in clinic-based hypertension care, which could affect the acceptability, feasibility, and implementation of the IMPACT-BP intervention. The Conceptual Model of Implementation Research and the Theoretical Framework of Acceptability guided the design of data collection instruments and analysis. Qualitative data collection was performed by trained social science research assistants, recorded, transcribed, translated, and analyzed using thematic analysis. Results: Forty-one participants (92 % women) participated in group discussions (n = 32) or individual interviews (n = 9). Barriers to intervention acceptability and feasibility included inadequate levels of staffing, high patient volumes, distrust of CHWs' work at clinics and in the community, and insufficient training and equipment for CHWs. Facilitators included home delivery of medications by CHWs. Conclusions: Our findings allowed us to identify specific adaptations to the intervention implementation strategy to make the proposed community-based intervention acceptable and feasible in this setting. Adaptations included employing dedicated CHWs and nurses for trial-related activities, developing an expanded CHW training module on hypertension knowledge, teaching CHWs to measure blood pressure and subsequently train patients to do the same, and training CHWs to educate patients about hypertension management.
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Abrahams‐Gessel et al. (2025) studied Hypertension (n=41). IMPACT-BP community-based hypertension care program vs. Clinic-based care was evaluated on Barriers and facilitators to intervention acceptability and feasibility. A formative evaluation identified barriers to community-based hypertension care, such as inadequate staffing and distrust of community health workers, leading to specific adaptations like dedicated trial staff and expanded training.
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