title: Barriers and Facilitators to Nurse Management of Hypertension: A Qualitative Analysis from Western Kenya.
abstract: Hypertension is the leading global risk for mortality. Poor treatment and control of hypertension in low- and middle-income countries is due to several reasons, including insufficient human resources. Nurse management of hypertension is a novel approach to address the human resource challenge. However, specific barriers and facilitators to this strategy are not known.
  
  
  
  To evaluate barriers and facilitators to nurse management of hypertensive patients in rural western Kenya, using a qualitative research approach.
  
  
  
  Six key informant interviews (five men, one woman) and seven focus group discussions (24 men, 33 women) were conducted among physicians, clinical officers, nurses, support staff, patients, and community leaders. Content analysis was performed using Atlas.ti 7.0, using deductive and inductive codes that were then grouped into themes representing barriers and facilitators. Ranking of barriers and facilitators was performed using triangulation of density of participant responses from the focus group discussions and key informant interviews, as well as investigator assessments using a two-round Delphi exercise.
  
  
  
  We identified a total of 23 barriers and nine facilitators to nurse management of hypertension, spanning the following categories of factors: health systems, environmental, nurse-specific, patient-specific, emotional, and community. The Delphi results were generally consistent with the findings from the content analysis.
  
  
  
  Nurse management of hypertension is a potentially feasible strategy to address the human resource challenge of hypertension control in low-resource settings. However, successful implementation will be contingent upon addressing barriers such as access to medications, quality of care, training of nurses, health education, and stigma.
authors.affiliation: Icahn School of Medicine at Mount Sinai, New York, USA.
authors.forename: Rajesh
authors.initials: R
authors.lastname: Vedanthan
authors.affiliation: Academic Model Providing Access to Healthcare, Eldoret, Kenya.
authors.forename: Nelly
authors.initials: N
authors.lastname: Tuikong
authors.affiliation: Icahn School of Medicine at Mount Sinai, New York, USA.
authors.forename: Claire
authors.initials: C
authors.lastname: Kofler
authors.affiliation: Icahn School of Medicine at Mount Sinai, New York, USA.
authors.forename: Evan
authors.initials: E
authors.lastname: Blank
authors.affiliation: Academic Model Providing Access to Healthcare, Eldoret, Kenya; Moi University College of Health Sciences, School of Medicine, Eldoret, Kenya.
authors.forename: Jemima H
authors.initials: JH
authors.lastname: Kamano
authors.affiliation: Moi University College of Health Sciences, School of Medicine, Eldoret, Kenya.
authors.forename: Violet
authors.initials: V
authors.lastname: Naanyu
authors.affiliation: Academic Model Providing Access to Healthcare, Eldoret, Kenya; Moi University College of Health Sciences, School of Medicine, Eldoret, Kenya.
authors.forename: Sylvester
authors.initials: S
authors.lastname: Kimaiyo
authors.affiliation: Moi University College of Health Sciences, School of Medicine, Eldoret, Kenya; Indiana University School of Medicine, Indianapolis, USA.
authors.forename: Thomas S
authors.initials: TS
authors.lastname: Inui
authors.affiliation: Icahn School of Medicine at Mount Sinai, New York, USA.
authors.forename: Carol R
authors.initials: CR
authors.lastname: Horowitz
authors.affiliation: Icahn School of Medicine at Mount Sinai, New York, USA; Centro Nacional de Investigaciones Cardiovasculares, Madrid, Spain.
authors.forename: Valentin
authors.initials: V
authors.lastname: Fuster
mesh_terms: D019468:Disease Management; D005260:Female; D017144:Focus Groups; D006266:Health Education; D006801:Humans; D006973:Hypertension / Q000451:nursing*; D007182:Income; D007630:Kenya; D008297:Male; D008875:Middle Aged; D009732:Nursing Care; D036301:Qualitative Research; D012424:Rural Population
keywords: Cardiovascular Disease; Community-Based Participatory Research; Focus Groups; Hypertension; Kenya; Nurses; Qualitative Research