Training nurses in task-shifting strategies for the management and control of hypertension in Ghana: a mixed-methods study.
Nurses in Ghana play a vital role in the delivery of primary health care at both the household and community level. However, there is lack of information on task shifting the management and control of hypertension to community health nurses in low- and middle-income countries including Ghana. The purpose of this study was to assess nurses' knowledge and practice of hypertension management and control pre- and post-training utilizing task-shifting strategies for hypertension control in Ghana (TASSH).



A pre- and post- test survey was administered to 64 community health nurses (CHNs) and enrolled nurses (ENs) employed in community health centers and district hospitals before and after the TASSH training, followed by semi-structured qualitative interviews that assessed nurses' satisfaction with the training, resultant changes in practice and barriers and facilitators to optimal hypertension management.



A total of 64 CHNs and ENs participated in the TASSH training. The findings of the pre- and post-training assessments showed a marked improvement in nurses' knowledge and practice related to hypertension detection and treatment. At pre-assessment 26.9% of the nurses scored 80% or more on the hypertension knowledge test, whereas this improved significantly to 95.7% post-training. Improvement of interpersonal skills and patient education were also mentioned by the nurses as positive outcomes of participation in the intervention.



Findings suggest that if all nurses receive even brief training in the management and control of hypertension, major public health benefits are likely to be achieved in low-income countries like Ghana. However, more research is needed to ascertain implementation fidelity and sustainability of interventions such as TASSH that highlight the potential role of nurses in mitigating barriers to optimal hypertension control in Ghana.



Trial registration for parent TASSH study: NCT01802372 . Registered February 27, 2013.
New York University School of Medicine, NYU Langone Medical Center, New York, NY, 10016, USA. Joyce.gyamfi@nyumc.org.
Joyce
J
Gyamfi
School of Medical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.
Jacob
J
Plange-Rhule
University of Illinois at Urbana-Champaign, Urbana, IL, 61801, USA.
Juliet
J
Iwelunmor
Stony Brook University School of Medicine, Stony Brook, NY, 11797, USA.
Debbie
D
Lee
University of Illinois at Urbana-Champaign, Urbana, IL, 61801, USA.
Sarah R
SR
Blackstone
New York University School of Medicine, NYU Langone Medical Center, New York, NY, 10016, USA.
Alicia
A
Mitchell
School of Medical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.
Michael
M
Ntim
School of Medical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.
Kingsley
K
Apusiga
Stritch School of Medicine, Loyola Chicago Medical Center, Maywood, IL, 60153, USA.
Bamidele
B
Tayo
Ghana Health Service, Kumasi, Ghana.
Kwasi
K
Yeboah-Awudzi
Stritch School of Medicine, Loyola Chicago Medical Center, Maywood, IL, 60153, USA.
Richard
R
Cooper
New York University School of Medicine, NYU Langone Medical Center, New York, NY, 10016, USA.|NYU College of Global Public Health, New York University, New York, NY, 10003, USA.
Gbenga
G
Ogedegbe
D000328:Adult; D002983:Clinical Competence / Q000592:standards; D016000:Cluster Analysis; D003151:Community Health Centers / Q000458:organization & administration; D003152:Community Health Nursing / Q000193:education* / Q000592:standards; D005260:Female; D005869:Ghana; D007722:Health Knowledge, Attitudes, Practice; D006767:Hospitals, District; D006801:Humans; D006973:Hypertension / Q000451:nursing* / Q000517:prevention & control; D008297:Male; D009723:Nurse-Patient Relations; D064691:Nurses, Community Health / Q000193:education* / Q000592:standards; D011320:Primary Health Care / Q000458:organization & administration; D011795:Surveys and Questionnaires
Ghana; Hypertension; Nurses; Sub-Saharan Africa; Task-shifting strategies