Formative Evaluation and Adaptation of a Hypertension Extension for Community Health Outcomes Program for Healthcare Workers within the Federal Capital Territory, Nigeria.

Background: The Extension for Community Health Outcomes (ECHO) model has been used extensively to link care providers in rural communities with experts with the aim of improving local patient care. Objective: The aim of this qualitative research study was to assess the feasibility, acceptability, perceived needs, and contextual factors to guide implementation of a hypertension focused ECHO program for Community Health Extension Workers (CHEWs) in the Federal Capital Territory, Nigeria. Methods: From September 2020 to December 2020, key informant interviews were performed with seven global organizations (hubs) providing ECHO training focused on cardiovascular disease or nephrology to identify contextual factors and implementation strategies used by each hub. In February 2022, seven focus group discussions were performed with 42 frontline healthcare workers in the Federal Capital Territory to inform local adaptation of a hypertension ECHO program. Directed content analysis identified major themes which were mapped to the Consolidated Framework for Implementation Research. Qualitative analyses were performed using Dedoose, and results were synthesized using the Implementation Research Logic Model. Results: We found both barriers and facilitators across the Consolidated Framework for Implementation Research domains that mapped to a number of constructs in each one. The results of these analyses confirmed that the core components of the ECHO model are a feasible and appropriate intervention for hypertension education of healthcare workers. However, implementing the ECHO program within the Federal Capital Territory may require strategies such as utilizing communications resources effectively, developing incentives to motivate initial participation, and providing rewards or recognition for ongoing engagement. Conclusions: These results provide valuable formative insights to guide implementation of our proposed hypertension ECHO program for CHEWs in the Federal Capital Territory, Nigeria. This information was used for key decisions around: 1) scope and content of training, 2) format and frequency, 3) selection of implementation strategies, and 4) building a community of practice.

Interlimb Coordination During a Combined Gait and Prehension Task.

Reaching and grasping are often completed while walking, yet the interlimb coordination required for such a combined task is not fully understood. Previous studies have produced contradictory evidence regarding preference for support of the lower limb ipsilateral or contralateral to the upper limb when performing a reaching task. This coordinative aspect of the combined task provides insight into whether the two tasks are mutually modified or if the reach is superimposed upon normal arm swinging. Collectively, 18 right-handed young adults walked slower, took shorter steps, and spent more time in double support during the combined task compared with walking alone. The peak grasp aperture was larger in walking reach-to-grasp trials compared with standing trials. There was not a strong trend for lower limb support preferences at the reach initiation or object contact. The participants could begin walking with either foot and demonstrated variability of preferred gait initiation patterns. There was a range of interlimb coordination patterns, none of which could be generalized to all young adults. The variability with which healthy right-handed young adults execute a combined walking reach-to-grasp task suggests that the cyclical (walking) and discrete (prehension) motor tasks may have separate motor control mechanisms, as proposed in the two primitives theory.