Evidence map›Paper›PMID 34548353›Full record

ArticleBMJ open2021

Exploring contextual factors influencing the implementation of evidence-based care for hypertension in Rwanda: a cross-sectional study using the COACH questionnaire.

Ana A Baumann, Cole Hooley, Charles W Goss, Vincent Mutabazi, Angela L Brown, Kenneth B Schechtman, Marc Twagirumukiza, Lisa de las Fuentes, Dominic Reeds, Makeda Williams and 5 more

Open access · goldAbstract read
In one paragraph

Article in BMJ open, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers.

0numbers the graph read from it
0cells of the map it votes in
4citing papers in PubMed
1.2field-weighted citation impact, top 18% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

4 citing papers in PubMed, 5 citations in OpenAlex.

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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

15 authors at 6 institutions in 3 countries.

Ana A BaumannBrown School of Social Work, Washington University in St. Louis, St. Louis, Missouri, USA.ORCID 0000-0002-4523-0147
Cole HooleySchool of Social Work, Brigham Young University, Provo, Utah, USA.
Charles W GossDivision of Biostatistics, Washington University in St. Louis, St Louis, Missouri, USA.
Vincent MutabaziRegional Alliance for Sustainable Development, Kigali, Rwanda.
Angela L BrownCardiovascular Division, Department of Medicine, Washington University in St. Louis, St Louis, Missouri, USA.
Kenneth B SchechtmanDivision of Biostatistics, Washington University in St. Louis, St. Louis, Missouri, USA.
Marc TwagirumukizaRegional Alliance for Sustainable Development, Kigali, Rwanda.
Lisa de las FuentesWashington University in St. Louis, Division of Biostatistics, St. Louis, MO, USA.
Dominic ReedsCenter for Human Nutrition, Division of Geriatrics and Nutritional Science, Department of Medicine, St. Louis, MO, USA.
Makeda WilliamsNational Heart Lung and Blood Institute, Bethesda, Maryland, USA.
Eugene MutimuraRegional Alliance for Sustainable Development, Kigali, Rwanda.
Anna BergströmUppsala Global Health Research on Implementation and Sustainability (UGHRIS), Dept of Women's and Children's Health, Uppsala Universitet, Uppsala, Sweden.
Aurore NishimweRegional Alliance for Sustainable Development, Kigali, Rwanda.
Cecile IngabireRegional Alliance for Sustainable Development, Kigali, Rwanda.
Victor G Davila-RomanCardiovascular Division, Department of Medicine, Washington University in St. Louis, St Louis, Missouri, USA vdavila@wustl.edu.
Washington University in St. Louis · USUniversity of Rwanda · RWRwanda Development Board · RWBrigham Young University · USNational Heart Lung and Blood Institute · USUppsala University · SE

Funding

Washington University Center for Diabetes Translation Research P30DK092950 · NIDDK · WASHINGTON UNIVERSITY · PI Ross C Brownson, Debra Haire-Joshu · 2011 to 2026
$11.7M
The Implementation of Cognitive Screening and Educational Support to Improve Outcomes of Adolescents and Young Adults with Sickle Cell Disease: From Clinic to the Community and BackU01HL133994 · NHLBI · WASHINGTON UNIVERSITY · PI KING, ALLISON A · 2016 to 2021
$5.2M
HIV- and ART-ASSOCIATED CARDIOMETABOLIC RESEARCH TRAINING IN RWANDAD43TW010335 · FIC · RASD RWANDA · PI MUTIMURA, EUGENE · 2016 to 2020
$1.3M
Developing T4 Translational Research Capacity for Control of Hypertension in RwandaU24HL136790 · NHLBI · RASD RWANDA · PI MUTIMURA, EUGENE · 2017 to 2020
$596k
FIC NIH HHS D43 TW010335NHLBI NIH HHS U01 HL133994NHLBI NIH HHS U24 HL136790NIDDK NIH HHS P30 DK092950
6 · The paper itself

Abstract

importanceHypertension is the largest contributor to the Global Burden of Disease. In Rwanda, as in most low-income and middle-income countries, an increasing prevalence of hypertension and its associated morbidity and mortality is causing major healthcare and economic impact. Understanding healthcare systems context in hypertension care is necessary.

objectiveTo study the hypertension healthcare context as perceived by healthcare providers using the Context Assessment for Community Health (COACH) tool.

designA cross-sectional cohort responded to the COACH questionnaire and a survey about hypertension training.

settingThree tertiary care hospitals in Rwanda.

participantsHealthcare professionals (n=223). PRIMARY OUTCOMES AND MEASURES: The COACH tool consists of 49 items with eight subscales: resources, community engagement, commitment to work, informal payment, leadership, work culture, monitoring services for action (5-point Likert Scale) and sources of knowledge (on a 0-1 scale). Four questions surveyed training on hypertension.

resultsResponders (n=223, 75% women; 56% aged 20-35 years) included nurses (n=142, 64%, midwives (n=42, 19%), primary care physicians (n=28, 13%) and physician specialists (n=11, 5%)). The subscales commitment to work, leadership, work culture and informal payment scored between 4.7 and 4.1 and the community engagement, monitoring services for action and organizational resources scored between 3.1 and 3.5. Sources of knowledge had a mean score of 0.6±0.3. While 73% reported having attended a didactic hypertension seminar in the past year, only 28% had received long-term training and 51% had <3-year experience working with hypertension care delivery. The majority (99%) indicated a need for additional training in hypertension care.

conclusionsThere is a need for increased and continuous training in Rwanda. Healthcare responders stated a commitment to work and reported supportive leadership, while acknowledging limited resources and no monitoring systems. The COACH tool provides contextual guidance to develop training strategies prior to the implementation of a sustainable hypertension care programme.

Indexed as

HypertensionPhysicians, Primary CareCross-Sectional StudiesEvidence-Based MedicineFemaleHumansMaleRwandaSurveys and Questionnaireseducation & training (see medical education & training)hypertensionquality in healthcare

Identifiers

PMID34548353
PMCPMC8458329
OpenAlexW3200179163

What OpenQuestion holds

Textmetadata
LicenceCC BY-NC
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.