Stakeholder's perspectives on acceptable interventions for promoting hypertension medication adherence in Namibia: nominal group technique.

OBJECTIVE: To determine the most acceptable hypertension intervention package to promote hypertension adherence based on stakeholders' perspectives. DESIGN: We employed the nominal group technique method and purposively sampled and invited key stakeholders offering hypertension services and patients with hypertension. Phase 1 was focused on determining barriers to hypertension adherence, phase 2 on enablers and phase 3 on the strategies. We employed the ranking method based on a maximum of 60 scores to establish consensus regarding hypertension adherence barriers, enablers and proposed strategies. SETTING AND PARTICIPANTS: 12 key stakeholders were identified and invited to participate in the workshop in Khomas region. Key stakeholders included subject matter experts in non-communicable diseases, family medicine and representatives of our target population (hypertensive patients). RESULTS: The stakeholders reported 14 factors as barriers and enablers to hypertension adherence. The most important barriers were: lack of knowledge on hypertension (57 scores), unavailability of drugs (55 scores) and lack of social support (49 scores). Patient education emerged as the most important enabler (57 scores), availability of drugs emerged second (53 scores) and third having a support system (47 scores). Strategies were 17 and ranked as follows: continuous patient education as the most desirable (54 scores) strategy to help promote hypertension adherence, followed by developing a national dashboard to primarily monitor stock (52 scores) and community support groups for peer counselling (49 scores). CONCLUSIONS: Multifaceted educational intervention package targeting patient and healthcare system factors may be considered in implementing Namibia's most acceptable hypertension package. These findings will offer an opportunity to promote adherence to hypertension therapy and reduce cardiovascular outcomes. We recommend a follow-up study to evaluate the proposed adherence package's feasibility.

Justice implications of health and food security policies for Indigenous peoples facing COVID-19: a qualitative study and policy analysis in Peru.

The spread of COVID-19 in Peru resulted in the declaration of a national health emergency, in which Indigenous peoples were identified as being particularly vulnerable due to their pre-existing poor health indicators and disadvantaged social conditions. The aim of this paper is to examine how the Peruvian government responded to the health and food needs of the Shawi and Ashaninka Indigenous peoples of Peru during the first 18 months of the pandemic (March 2020-August 2021). This study uses both official policy documents and real-world experiences to evaluate policy responses in terms of their immediate impact and their longer-term sustainability and contribution to the improvement of health, well-being and justice for Indigenous communities. Four health and food security responses were evaluated: the Amazon Health Plan and Indigenous Command; food aid; cash aid; and COVID-19 vaccination. We employed the Multidimensional Injustice Framework to analyse the justice implications of the design and implementation of responses. Data collection included 71 interviews with government officials (n = 7), Indigenous leaders (n = 31) and community members (n = 33). The results show how national and regional governments released policies to address the health and food needs of Indigenous peoples directly or indirectly, as part of a broader focus on vulnerable people. However, justice implications were not sufficiently addressed in the design or implementation of the responses. On the distributive dimension, Indigenous communities were prioritized to receive health goods and services, nevertheless, the distribution had shortcomings that impeded their collection and Indigenous food systems and livelihoods were largely overlooked. On the procedural dimension, Indigenous representatives were included to provide culturally sensitive feedback on health interventions, but without funding, and furthermore, the community members had only passive participation. This paper points out the importance of considering and addressing justice implications for more effective and fairer health and food policy responses to current and future health crises.

A Cross-Sectional Study on Hypertension Medication Adherence in a High-Burden Region in Namibia: Exploring Hypertension Interventions and Validation of the Namibia Hill-Bone Compliance Scale.

In Namibia, the prevalence of hypertension among women and men aged 35−64 years is high, ranging from 44% to 57%. In this study, we aimed to determine adherence and predictors to antihypertensive therapy in Khomas region, Namibia. A cross-sectional study was performed to consecutively sample 400 patients from urban and peri-urban settings in Namibia. Results were validated using the Hill-Bone Compliance to High Blood Pressure Therapy Scale. Crude associations between predictors of adherence and compliance were tested using the Pearson chi-square test. A multivariable logistic regression analysis was then performed on adherence variables found to be significant to adjust for confounders, and the results are presented as adjusted odds ratios (aOR) with 95% confidence intervals. A total of 400 patients participated in this study. The participants' mean age and standard deviation were Mean ± SD = 48.9 ± 12.5. In this study, 351 (87.7%) patients were estimated to have good adherence. Education, employment, and the presence of other chronic diseases were associated with adherence. Following multivariate adjustment, the following factors were significantly associated and are therefore predictors of adherence (95%CI, p < 0.005): receiving enough medication at last check-up until next one (OR = 5.44, CI 1.76−16.85), lack of encouragement from family and friends (OR = 0.11 (0.03−0.42)), and attendance of follow-ups on schedule (OR = 8.49, CI = 3.82−18.85). The success of hypertension therapy is dependent on the healthcare systems and healthcare professionals in supplying enough medication, support of friends/family, and maintaining scheduled follow-ups. A combination of interventions using low-cost mobile technology led by healthcare professionals could be endorsed. To fully practice universal access to medication, public and private hospitals in Namibia should collaborate.

Factors influencing poor medication adherence amongst patients with chronic disease in low-and-middle-income countries: A systematic scoping review.

Background: Poor medication adherence among patients with Chronic Diseases is one of the significant health problems globally. Despite this, evidence on chronic medication adherence in low and middle-income countries is unclear. Objective: This scoping review aimed to identify factors influencing poor medication adherence amongst patients with chronic diseases in low and middle-income countries. Methods: We searched studies exploring factors influencing poor medication adherence amongst patients in low and middle-income countries across the following databases published between 2008 to 2018: Public or publisher Medline, Google scholar, Cumulated Index to Nursing and Allied Health Literature, Health Source, and Medline with full text via Elton B. Stephen's Company host. Methodological quality assessment of the primary studies was done as recommended by Levac, Colquhoun, and O'Brien (2010) review using a Mixed-Method Appraisal Tool 2018. We reported the results following the Preferred Reporting Item for Systematic reviews and Meta-Analyses extension for Scoping Review guidelines. Results: From the initial 154 records screened, we identified six (6) eligible studies that presented evidence on factors influencing poor medication adherence amongst patients in low and middle-income countries. Studies included were from the following countries: Jordan, South Africa, Guatemala, Ethiopia, Indonesia, India, and Palestine. Kappa agreement of the full article screening shows that there was 76.92% agreement versus 58.12% expected by chance which constitutes a considerably good agreement between screeners (Kappa statistic = 0.45 and p-value <0.05). Of the six included studies that underwent methodological quality, five scored 100%, which is regarded as the highest score the remaining one scored between 50-75%, indicating a moderate to low risk bias overall. All included studies presented evidence on medication adherence as being in either knowledge of the diseases, attitudes towards medication taking, beliefs that a patient holds about the treatment or disease, and quality control amongst chronic diseases patients. Conclusions: Our scoping review provides evidence that poor medication adherence in LMICs is influenced by a lack of knowledge, negative attitudes, and negative beliefs, leading to poor quality of life. There is limited research evidence on the effect of patients' beliefs and perceptions on medication adherence in low and middle-income countries. We call upon further research on beliefs, perceptions, and effectiveness of interventions towards chronic medication adherence in low and middle-income countries.