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- Title
Community-Based Participatory Research and System Dynamics Modeling for Improving Retention in Hypertension Care.
- Authors
Ye, Jiancheng; Orji, Ikechukwu A.; Birkett, Michelle A.; Hirschhorn, Lisa R.; Walunas, Theresa L.; Smith, Justin D.; Kandula, Namratha R.; Shedul, Gabriel L.; Huffman, Mark D.; Ojji, Dike B.
- Abstract
This decision analytical model uses system dynamics modeling to investigate whether various interventions gathered from workshops with stakeholders are associated with improved rates of retention in hypertension care in Nigeria. Key Points: Question: What types of interventions are associated with improved retention in hypertension care in the Nigerian primary care system? Findings: In this decision analytical model including 16 stakeholders and using system dynamics modeling and simulation interventions, training of health care workers was estimated to be the most effective single implementation strategy for improving retention in hypertension care in Nigeria. Integrated intervention packages were associated with the greatest improvements in hypertension retention overall. Meaning: The findings suggest that system dynamics modeling and community-based participatory research could be used to assess potential outcomes of interventions to improve retention in hypertension care and that integrated intervention packages may be the most promising strategies. Importance: The high prevalence of hypertension calls for broad, multisector responses that foster prevention and care services, with the goal of leveraging high-quality treatment as a means of reducing hypertension incidence. Health care system improvements require stakeholder input from across the care continuum to identify gaps and inform interventions that improve hypertension care service, delivery, and retention; system dynamics modeling offers a participatory research approach through which stakeholders learn about system complexity and ways to model sustainable system-level improvements. Objective: To assess the association of simulated interventions with hypertension care retention rates in the Nigerian primary health care system using system dynamics modeling. Design, Setting, and Participants: This decision analytical model used a participatory research approach involving stakeholder workshops conducted in July and October 2022 to gather insights and inform the development of a system dynamics model designed to simulate the association of various interventions with retention in hypertension care. The study focused on the primary health care system in Nigeria, engaging stakeholders from various sectors involved in hypertension care, including patients, community health extension workers, nurses, pharmacists, researchers, administrators, policymakers, and physicians. Exposure: Simulated intervention packages. Main Outcomes and Measures: Retention rate in hypertension care at 12, 24, and 36 months, modeled to estimate the effectiveness of the interventions. Results: A total of 16 stakeholders participated in the workshops (mean [SD] age, 46.5 [8.6] years; 9 [56.3%] male). Training of health care workers was estimated to be the most effective single implementation strategy for improving retention in hypertension care in Nigeria, with estimated retention rates of 29.7% (95% CI, 27.8%-31.2%) at 12 months and 27.1% (95% CI, 26.0%-28.3%) at 24 months. Integrated intervention packages were associated with the greatest improvements in hypertension care retention overall, with modeled retention rates of 72.4% (95% CI, 68.4%-76.4%), 68.1% (95% CI, 64.5%-71.7%), and 67.1% (95% CI, 64.5%-71.1%) at 12, 24, and 36 months, respectively. Conclusions and Relevance: This decision analytical model study showed that community-based participatory research could be used to estimate the potential effectiveness of interventions for improving retention in hypertension care. Integrated intervention packages may be the most promising strategies.
- Subjects
NIGERIA; MEDICAL care research; PATIENT compliance; RESEARCH funding; HYPERTENSION; PRIMARY health care; CONTINUUM of care; DECISION making; SYSTEM analysis; SIMULATION methods in education; MATHEMATICAL models; ACTION research; ADULT education workshops; THEORY; STAKEHOLDER analysis; DATA analysis software; CONFIDENCE intervals; QUALITY assurance; INTEGRATED health care delivery; SENSITIVITY &; specificity (Statistics)
- Publication
JAMA Network Open, 2024, Vol 7, Issue 8, pe2430213
- ISSN
2574-3805
- Publication type
Article
- DOI
10.1001/jamanetworkopen.2024.30213