Understanding Barriers and Facilitators to Integrated Care for People with HIV and Hypertension in South Africa: Application of the Theoretical Domains Framework Open Access
Khan, Suha (Spring 2023)
Abstract
Background: South Africa faces a dual burden of hypertension and HIV, yet faces significant barriers in the implementation of hypertension care guidelines, especially for people living with HIV (PLWH). This issue persists even after the introduction of the Integrated Chronic Disease Management model in 2011, which aimed to address the growing burden of chronic care needs within the context of existing patient-, clinician-, and health system-level barriers to integrated care.
Objectives: The study aims to inform the development of implementation strategies that promote hypertension screening and treatment practices in HIV care settings by identifying barriers and facilitators to hypertension care among providers, as well as to hypertension self-management among PLWH seeking care at HIV clinics in Johannesburg, South Africa.
Methods: This study uses qualitative data that was collected as part of a formative research phase for an effectiveness-implementation hybrid 2 study that aims to design and test strategies for improving the assessment of cardiovascular risk assessment in PLWH. Data include interviews and focus group discussions that were conducted with key actors across 6 diverse HIV care settings in Johannesburg, South Africa. The data collected was analyzed with MAXQDA22 using a two-stage analytic approach involving 1) deductively applying the Theoretical Domains Framework and 2) inductively coding for themes shared across TDF domains.
Results: Clinical actors identified notable barriers to implementing an integrated hypertension-HIV care model, including limited structural and operational capacity, inadequate training, lack of incentives and organizational readiness of clinicians towards such a model. However, ability to practice task-shifting and clinical managers’ willingness to adopt an integrated model were identified as key enablers. Patients, meanwhile, were motivated to improve their health out of fear of negative consequences, had support from loved ones, and access to reliable information, but expressed dissatisfaction with the clinic’s physical layout and operational protocol.
Conclusion: The promotion of an integrated HIV-hypertension care model will require overcoming both patient- and clinical actor-level barriers to implementation and engagement. The reported findings serve as a blueprint for designing integrated care approaches that are relevant to the local context and thus have the potential to be sustained over time.
Table of Contents
Chapter 1. Literature Review 1
Chapter 2. Methods 5
2.1. Setting 5
2.2. Participants 5
2.3. Eligibility Requirement 6
2.4. Ethics 6
2.5. Data Collection 6
2.6. Data Analysis 7
Chapter 3. Results 9
3.1. Clinic Actor-level IDI and FGD Data 10
3.2. Patient-level IDI Data 22
3.3. Data Triangulation 29
Chapter 4. Discussion and Public Health Implication 31
4.1. Main Findings 31
4.2. Strength and Limitation 39
4.3. Public Health Implication 41
4.4. Conclusion 42
Appendix A. Codebook 45
Reference 48
About this Master's Thesis
| School | |
|---|---|
| Department | |
| Degree | |
| Submission | |
| Language |
|
| Research Field | |
| Keyword | |
| Committee Chair / Thesis Advisor |
Primary PDF
| Thumbnail | Title | Date Uploaded | Actions |
|---|---|---|---|
|
|
Understanding Barriers and Facilitators to Integrated Care for People with HIV and Hypertension in South Africa: Application of the Theoretical Domains Framework () | 2023-04-20 12:47:42 -0400 |
|
Supplemental Files
| Thumbnail | Title | Date Uploaded | Actions |
|---|