Barriers and facilitators of hypertension screening and referral by village health teams in Eastern Uganda: a COM-B analysis

The study explored the barriers and facilitators to Village Health Teams’ involvement in hypertension screening and referral to a health facility in Eastern Uganda. This was an exploratory qualitative study in June 2023 in Bugembe town council, Jinja city, Eastern Uganda. We conducted in-depth interviews with VHTs from four villages guided by the Capability, Opportunity, Motivation behavioral change (COM-B) model framework. Interviews were conducted in both English and Lusoga, the local dialect, and were audio-recorded, transcribed verbatim, and then translated into English. The data was thematically analyzed, and themes on barriers and facilitators were mapped onto the COM-B model. We interviewed 12 VHT members, predominantly female (83.3%), with a median age of 48 years. The participants demonstrated various limitations in both knowledge and practical experience on hypertension screening. Notably, VHTs needed a comprehensive understanding of hypertension, especially in interpreting blood pressure readings, and many demonstrated inexperience with blood pressure devices. Other barriers included societal misconceptions and stigma about hypertension and the lack of blood pressure machines. Motivationally, VHTs expressed feelings of undervaluation and the impact of societal attitudes towards hypertension in their work. Despite these challenges, there were facilitators, such as a basic understanding of hypertension, community trust, and support from non-governmental organizations (NGOs). Their openness to training and intrinsic motivation to improve community health were notable strengths. Village health teams in Uganda need enhanced training on hypertension prevention and control, improved resource allocation, and motivation strategies to contribute to a reduction of its burden.