A formative evaluation of potential barriers and facilitators to inform effective implementation of a community-based hypertension care program in rural South Africa: The IMPACT-BP trial

Abrahams-Gessel, Shafika, Manyaapelo, Thabang, Sithole, Nsika, Dlamini, Siphephelelo, Mpanza, Nondumiso, Mjilo, Thabilsile, Orne-Gliemann, Joanna, Bachmann, Max, Magula, Nombulelo, Castle, Alison, Siedner, Mark J. and Gaziano, Thomas (2025) A formative evaluation of potential barriers and facilitators to inform effective implementation of a community-based hypertension care program in rural South Africa: The IMPACT-BP trial. Social Science and Medicine - Health Systems, 5.

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Abstract

Background: In rural KwaZulu-Natal Province, South Africa, less than 25 % of persons with hypertension have controlled blood pressure. We conducted a formative evaluation of current clinic-based care to identify barriers and facilitators that could impact effective implementation of a community-based hypertension intervention (IMPACT-BP). Methods: We conducted individual interviews and group discussions with clinic managers, nurses, community health workers (CHWs), community leaders, and patients to identify barriers and facilitators experienced in clinic-based hypertension care, which could affect the acceptability, feasibility, and implementation of the IMPACT-BP intervention. The Conceptual Model of Implementation Research and the Theoretical Framework of Acceptability guided the design of data collection instruments and analysis. Qualitative data collection was performed by trained social science research assistants, recorded, transcribed, translated, and analyzed using thematic analysis. Results: Forty-one participants (92 % women) participated in group discussions (n = 32) or individual interviews (n = 9). Barriers to intervention acceptability and feasibility included inadequate levels of staffing, high patient volumes, distrust of CHWs’ work at clinics and in the community, and insufficient training and equipment for CHWs. Facilitators included home delivery of medications by CHWs. Conclusions: Our findings allowed us to identify specific adaptations to the intervention implementation strategy to make the proposed community-based intervention acceptable and feasible in this setting. Adaptations included employing dedicated CHWs and nurses for trial-related activities, developing an expanded CHW training module on hypertension knowledge, teaching CHWs to measure blood pressure and subsequently train patients to do the same, and training CHWs to educate patients about hypertension management.

Item Type:	Article
Additional Information:	Funding information: The IMPACT-BP trial was funded by the National Heart, Lung, and Blood Institute of the US National Institutes of Health (R01 HL144848). MJS also reports funding from the National Heart, Lung, and Blood Institute (K24 HL166024), and ACC reports funding from the Fogarty International Center (D43 TW010543), the National Institute of Allergy and Infectious Diseases (T32 AI007433), and the National Institute of Mental Health (K23 MH136873). This research was also funded in part, by Wellcome [Grant number Wellcome Strategic Core award: 201433/Z/16/A]. For the purpose of open access, the author has applied a CC BY public copyright license to any Author Accepted Manuscript version arising from this submission. The funders had no role in study design; in the collection, analysis, and interpretation of data; in the writing of the manuscript; or in the decision to submit the manuscript for publication. The contents of this publication are solely the responsibility of the authors and do not necessarily represent the official view of the National Institutes of Health.
Faculty \ School:	Faculty of Medicine and Health Sciences > Norwich Medical School
UEA Research Groups:	Faculty of Science > Research Groups > Norwich Epidemiology Centre Faculty of Medicine and Health Sciences > Research Groups > Norwich Epidemiology Centre Faculty of Medicine and Health Sciences > Research Centres > Norwich Institute for Healthy Aging Faculty of Medicine and Health Sciences > Research Groups > Health Services and Primary Care Faculty of Medicine and Health Sciences > Research Centres > Public Health Faculty of Medicine and Health Sciences > Research Centres > Population Health (former - to 2025)
Depositing User:	LivePure Connector
Date Deposited:	06 Aug 2025 16:30
Last Modified:	08 Aug 2025 00:29
URI:	https://ueaeprints.uea.ac.uk/id/eprint/100091
DOI:	10.1016/j.ssmhs.2025.100086

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