Study of Hypertension Treatment in Ghana Moves Forward.
NB: This is a reproduction of an article originally written and published by the Johns Hopkins Alliance for a Healthier World on September 23, 2018. Visit the original article for links and supplemental images.
STUDY OF HYPERTENSION TREATMENT IN GHANA MOVES FORWARD
By Alyssa Wooden, AHW Global Health Scholar
Hypertension is responsible for approximately 7.5 million annual deaths worldwide, and the greatest burden is found in sub-Saharan Africa – a region that also suffers from a shortage of healthcare providers. To combat this problem, School of Nursing Assistant Professor Yvonne Commodore-Mensah is leading the Addressing Hypertension Care in Africa (ADHINCRA) study, which consists of a task-shifting intervention that trains nurses to manage hypertension, as well as a mobile health application that allows patients to self-monitor their blood pressure.
Commodore-Mensah and two of her team members -- Ruth-Alma Turkson-Ocran, a post-doctoral fellow in the School of Medicine, and Bloomberg School of Public Health PhD candidate Kathryn Foti -- recently returned from a site visit to Kumasi, Ghana, where they conducted trainings and began to recruit patients for the study, which is funded by an Impact Grant from the Alliance for a Healthier World.
The study ultimately aims to expand the role of nurses in patient care and leverage the ubiquity of smartphones among the Ghanaian population – according to Commodore-Mensah, many people in Ghana own at least two mobile phones.
“We want to take a device that is used frequently and see whether including this app in their daily lives will help control hypertension by having people measure their blood pressure every day and send those values to their providers to allow them to track and monitor their progress,” Commodore-Mensah said.
Turkson-Ocran noted that because there are so few physicians in Ghana, giving nurses more authority in treating hypertension could improve patient outcomes. In Ghana, there were nine nurses and one physician per 10,000 people in 2015, compared to 49 nurses and 19 physicians per 10,000 people in the United States.
“We wanted to give nurses autonomy to say, ‘Ok, I’m reviewing patients’ blood pressures, they are not controlled, so as a nurse I am going to communicate with the participant a little bit more to see what’s going on,’” Turkson-Ocran said.
She explained that during the visit, the team met with different stakeholders and they also trained nurses on how to carry out the study protocol.
“Seeing the patients who had suffered a stroke solidified our drive and our passion for doing this work and continuing down this line of research.
— Yvonne Commodore-Mensah
“We met with Medtronic Health, who are the developers of the mobile health app, and then we also met with physicians and those in charge of the hospitals,” Turkson-Ocran said. “After we did those meetings, we did the training portion: The nurses came in over several days and all of us took part in the standardized training and showed them how to take blood pressures using the study devices according to the study protocol.”
The multidisciplinary ADHINCRA team also includes Lisa Cooper, a Bloomberg Distinguished Professor at the Schools of Medicine, Public Health and Nursing; Michael Degani, an assistant professor of Anthropology at the Krieger School of Arts & Sciences; Cheryl Dennison Himmelfarb, a professor at the School of Nursing; Linda Mobula, an Assistant Professor at the School of Medicine; Kathryn Carson, a biostatistician at the School of Public Health; and Nancy Mollelo, the program director for the Johns Hopkins Center for Health Equity.
For Commodore-Mensah, collaborating with people across multiple Hopkins divisions has made the entire process run much more smoothly.
“This whole project was birthed out of a conversation that happened at an Alliance event at the Peabody library in 2017,” Commodore-Mensah said, noting that at the event, she and Cooper and Mobula discussed the opportunity for a new collaboration to address hypertension in Africa.
When creating the hypertension treatment protocols, the ADHINCRA team adapted World Health Organization protocols for treating high blood pressure to make them more suitable for the Ghanaian context where certain brands of medications are more prescribed more frequently. The app is already in use in Kenya.
“As a team, we’ve adapted one of the standard hypertension treatment protocols for the study, which takes into account the local context in terms of what medications providers usually prescribe,” Commodore-Mensah said. “That way it really suits the context and we’re not just taking a standard template that may not be used in that setting.”
Foti said that being able to visit the hypertension clinics in person helped the team develop and refine the intervention protocol.
“I think we had ideas about how the patient flow, the recruitment, the screening process, and the enrollment would work, so it was really valuable to be there physically and see the space – how everything was laid out,” she said. “A good portion of our time was also spent ironing out the protocol with the staff that are going to be implementing it.”
Once patients are recruited for the study, they will undergo a six-month active intervention phase during which nurses will give feedback to the patients on how to manage their blood pressure based on the data received from the app. After that, nurses will stop giving feedback for a six-month follow up phase. Commodore-Mensah plans to examine whether patients continue to adhere to treatment and prescribed behavior during this phase.
“We’re going to leave the blood pressure monitor and smartphone with [the patients] and see what they do and see how they’re able to manage on their own,” she said. “Hopefully at that point they should continue some of these self-management behaviors that the nurses have reinforced for the first six months.”
Front row L-R: Chemu Langa’at (Medtronic Health), Co-PI Dr. Fred Stephen Sarfo of the Kwame Nkrumah University of Science & Technology, Dr. Yvonne Commodore-Mensah, Kathryn Foti, Dr. Ruth-Alma Turkson-Ocran Second row L-R: Shadrack Asibey, Evans Owusu, Gideon Nyamekye (Medtronic Health), Kwaku Buadu, Gideon Agyemang, David Acheampong (Medtronic Health), Eric Angula (Medtronic Health)
ADD IMAGE Front row L-R: Chemu Langa’at (Medtronic Health), Co-PI Dr. Fred Stephen Sarfo of the Kwame Nkrumah University of Science & Technology, Dr. Yvonne Commodore-Mensah, Kathryn Foti, Dr. Ruth-Alma Turkson-Ocran Second row L-R: Shadrack Asibey, Evans Owusu, Gideon Nyamekye (Medtronic Health), Kwaku Buadu, Gideon Agyemang, David Acheampong (Medtronic Health), Eric Angula (Medtronic Health)
Both phases will be completed by July 2020, at which time the team will begin to analyze the data and disseminate the findings. In addition to change in blood pressure and adherence to medication, Commodore-Mensah will also look at how the patients responded to the technology.
“Sometimes technology is great and we think it’s the answer to all our problems, but in some cases it may not work as intended,” she said. “We also want to understand the patients’ experience using the app and whether they had any difficulties so that the app can be further refined.”
Foti feels that the Ghana visit taught her valuable lessons about how to design a research study and how to adapt health interventions to different situations.
“Being there brought the context to life – showing up at the clinic sites and seeing probably close to 100 patients waiting for their visits, and trying to get your head around how many patients the nurses see in a day and how our research is going to fit into their clinic workflow,” she said. “[The nurses] were really interested in being involved in the research study, but we also recognize that it doesn’t stop their other patients from needing to be seen.”
Commodore-Mensah agreed that it was helpful to visit the clinics in person and take a critical look at the protocol with different stakeholders. She also feels that the visit fueled her team’s passion for working on this project.
“As we went through all the hospitals, just seeing the patients who had suffered a stroke solidified our drive and our passion for doing this work and continuing down this line of research,” she said. “We need to address hypertension to prevent the costly and deadly complications.”
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Article by AHW Global Health Scholar, Alyssa Wooden. Alyssa is majoring in Public Health Studies and minoring in Environmental Studies. She served as the editor for the Johns Hopkins News-Letter and has worked with a local organization to prepare policy briefs for environmental impacts on child health.
FURTHER RESOURCES
Visit the original article for links and supplemental images.