An implementation science study to enhance cardiovascular disease prevention in Mukono and Buikwe districts in Uganda: a stepped-wedge design
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Date
2019
Journal Title
Journal ISSN
Volume Title
Publisher
BMC health services research
Abstract
Uganda is experiencing a shift in major causes of death with cases of stroke, heart attack, and heart
failure reportedly on the rise. In a study in Mukono and Buikwe in Uganda, more than one in four adults were
reportedly hypertensive. Moreover, very few (36.5%) reported to have ever had a blood pressure measurement. The
rising burden of CVD is compounded by a lack of integrated primary health care for early detection and treatment
of people with increased risk. Many people have less access to effective and equitable health care services which
respond to their needs. Capacity gaps in human resources, equipment, and drug supply, and laboratory capabilities
are evident. Prevention of risk factors for CVD and provision of effective and affordable treatment to those who
require it prevent disability and death and improve quality of life. The aim of this study is to improve health profiles
for people with intermediate and high risk factors for CVD at the community and health facility levels. The
implementation process and effectiveness of interventions will be evaluated. The overall study is a type 2-hybrid stepped-wedge (SW) design. The design employs mixed methods evaluations with incremental execution and adaptation. Sequential crossover take place from control to intervention until all are exposed. The study will take place in Mukono and Buikwe districts in Uganda, home to more than 1,000,000 people at the community and primary healthcare facility levels. The study evaluation will be guided by; 1) RE-AIM an evaluation framework and 2) the CFIR a determinant framework. The primary outcomes are implementation
– acceptability, adoption, appropriateness, feasibility, fidelity, implementation cost, coverage, and sustainability.
Discussion: The study is envisioned to provide important insight into barriers and facilitators of scaling up CVD
prevention in a low income context. This project is registered at the ISRCTN Registry with number ISRCTN15848572.
The trial was first registered on 03/01/2019.
Description
Keywords
Implementation, Risk prevention, Cardiovascular diseases, Uganda
Citation
Musinguzi, G., Wanyenze, R. K., Ndejjo, R., Ssinabulya, I., van Marwijk, H., Ddumba, I., ... & Nuwaha, F. (2019). An implementation science study to enhance cardiovascular disease prevention in Mukono and Buikwe districts in Uganda: a stepped-wedge design. BMC health services research, 19(1), 1-10.https://doi.org/10.1186/s12913-019-4095-0