TY - JOUR
T1 - Challenges to hypertension and diabetes management in rural Uganda
T2 - A qualitative study with patients, village health team members, and health care professionals
AU - Chang, Haeyoon
AU - Hawley, Nicola L.
AU - Kalyesubula, Robert
AU - Siddharthan, Trishul
AU - Checkley, William
AU - Knauf, Felix
AU - Rabin, Tracy L.
N1 - Funding Information:
This research was funded by the Maureen and Antoine Chiquet Fund for Global Health Fellowship [HC] from Yale School of Public Health, Coca-Cola World Fund at Yale [HC], Yale Global Health Leadership Institute Hecht-Albert Global Health Pilot Innovation Award for Junior Faculty [TLR], and the Else Kröner-Fresenius-Stiftung grant to establish a center of excellence for patient-centered care and non-communicable disease management in Uganda (2016_HA44).
Funding Information:
This research was supported by the African Community Center for Social Sustainability (ACCESS), Makerere University-Yale University (MUYU) Collaboration, the Nakaseke Community - Based Cohort for Non-Communicable Diseases: Community Based Models of Prevention, Care and Management for NonCommunicable Diseases (NCD Study) study team from Johns Hopkins University and Makerere University, the Yale School of Public Health (YSPH), and Yale School of Medicine (YSM). The authors would like to thank the residents, health care professionals, and village health team members of Nakaseke District for their incredible support and participation in our study. We thank Marvin Ddumba for his tremendous dedication to the data collection process, and for transcribing and translating the interviews conducted. We also wish to thank the staff of ACCESS (Faith Nasali and Dr. Richard Munana) for their assistance and consultations. We thank the staff of MUYU (Susan Nalugo), the Makerere Lung Institute (Dr. Bruce Kirenga and Dr. Patricia Alupo) and the Uganda Initiative for Integrated Management of NCDs [UINCD] (Dr. Ann Rose Akiteng) for their assistance and consultations. The authors thank Nicholaus Johnson (NJ) and Margaret Rice (MR) for their assistance with the coding process, and Annet Nnaybuya for the initial stage of data collection. We thank Johns Hopkins students and faculty (Emily Nagourney, Reuben Matthew, Dr. Suzanne Pollard) for their assistance. Lastly, we thank our Yale faculty colleagues (Dr. Danya Keene and Dr. Jeremy Schwartz).
Publisher Copyright:
© 2019 The Author(s).
PY - 2019/2/28
Y1 - 2019/2/28
N2 - Background: The prevalence of hypertension and diabetes are expected to increase in sub-Saharan Africa over the next decade. Some studies have documented that lifestyle factors and lack of awareness are directly influencing the control of these diseases. Yet, few studies have attempted to understand the barriers to control of these conditions in rural settings. The main objective of this study was to understand the challenges to hypertension and diabetes care in rural Uganda. Methods: We conducted semi-structured interviews with 24 patients with hypertension and/or diabetes, 11 health care professionals (HCPs), and 12 community health workers (known as village health team members [VHTs]) in Nakaseke District, Uganda. Data were coded using NVivo software and analyzed using a thematic approach. Results: The results replicated several findings from other settings, and identified some previously undocumented challenges including patients' knowledge gaps regarding the preventable aspects of HTN and DM, patients' mistrust in the Ugandan health care system rather than in individual HCPs, and skepticism from both HCPs and patients regarding a potential role for VHTs in HTN and DM management. Conclusions: In order to improve hypertension and diabetes management in this setting, we recommend taking actions to help patients to understand NCDs as preventable, for HCPs and patients to advocate together for health system reform regarding medication accessibility, and for promoting education, screening, and monitoring activities to be conducted on a community level in collaboration with village health team members.
AB - Background: The prevalence of hypertension and diabetes are expected to increase in sub-Saharan Africa over the next decade. Some studies have documented that lifestyle factors and lack of awareness are directly influencing the control of these diseases. Yet, few studies have attempted to understand the barriers to control of these conditions in rural settings. The main objective of this study was to understand the challenges to hypertension and diabetes care in rural Uganda. Methods: We conducted semi-structured interviews with 24 patients with hypertension and/or diabetes, 11 health care professionals (HCPs), and 12 community health workers (known as village health team members [VHTs]) in Nakaseke District, Uganda. Data were coded using NVivo software and analyzed using a thematic approach. Results: The results replicated several findings from other settings, and identified some previously undocumented challenges including patients' knowledge gaps regarding the preventable aspects of HTN and DM, patients' mistrust in the Ugandan health care system rather than in individual HCPs, and skepticism from both HCPs and patients regarding a potential role for VHTs in HTN and DM management. Conclusions: In order to improve hypertension and diabetes management in this setting, we recommend taking actions to help patients to understand NCDs as preventable, for HCPs and patients to advocate together for health system reform regarding medication accessibility, and for promoting education, screening, and monitoring activities to be conducted on a community level in collaboration with village health team members.
KW - Chronic diseases
KW - Diabetes
KW - Hypertension
KW - Qualitative
KW - Rural health
KW - Uganda
KW - Village health team
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U2 - 10.1186/s12939-019-0934-1
DO - 10.1186/s12939-019-0934-1
M3 - Article
C2 - 30819193
AN - SCOPUS:85062347330
SN - 1475-9276
VL - 18
JO - International journal for equity in health
JF - International journal for equity in health
IS - 1
M1 - 38
ER -