Browsing by Author "Tuikong, Nelly"

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    Barriers and Facilitators to Nurse Management of Hypertension: A Qualitative Analysis from Western Kenya
    (International Society on Hypertension in Blacks, 2016-07-21) Vedanthan, Rajesh; Tuikong, Nelly; Kofler, Claire; Blank, Evan; Naanyu, Violet; Kimaiyo, Sylvester; Inui, Thomas S.; Horowitz, Carol R.; Fuster, Valentin; Kimaiyo, Jemima H.; Department of Medicine, IU School of Medicine
    BACKGROUND: Hypertension is the leading global risk for mortality. Poor treatment and control of hypertension in low- and middle-income countries is due to several reasons, including insufficient human resources. Nurse management of hypertension is a novel approach to address the human resource challenge. However, specific barriers and facilitators to this strategy are not known. OBJECTIVE: To evaluate barriers and facilitators to nurse management of hypertensive patients in rural western Kenya, using a qualitative research approach. METHODS: Six key informant interviews (five men, one woman) and seven focus group discussions (24 men, 33 women) were conducted among physicians, clinical officers, nurses, support staff, patients, and community leaders. Content analysis was performed using Atlas.ti 7.0, using deductive and inductive codes that were then grouped into themes representing barriers and facilitators. Ranking of barriers and facilitators was performed using triangulation of density of participant responses from the focus group discussions and key informant interviews, as well as investigator assessments using a two-round Delphi exercise. RESULTS: We identified a total of 23 barriers and nine facilitators to nurse management of hypertension, spanning the following categories of factors: health systems, environmental, nurse-specific, patient-specific, emotional, and community. The Delphi results were generally consistent with the findings from the content analysis. CONCLUSION: Nurse management of hypertension is a potentially feasible strategy to address the human resource challenge of hypertension control in low-resource settings. However, successful implementation will be contingent upon addressing barriers such as access to medications, quality of care, training of nurses, health education, and stigma.
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    Usability of Implementing a Tablet-Based Decision Support and Integrated Record-Keeping (DESIRE) Tool in the Nurse Management of Hypertension in Rural Kenya
    (IOS Press, 2013) Blank, Evan; Tuikong, Nelly; Misoi, Lawrence; Kamano, Jemima; Hutchinson, Claire; Kimaiyo, Sylvester; Fuster, Valentin; Were, Martin; Vedanthan, Rajesh; Medicine, School of Medicine
    In sub-Saharan Africa (SSA), cardiovascular disease (CVD) is the leading cause of death among individuals over the age of 30. Hypertension, a major risk factor for CVD, contributes significantly to the CVD burden in SSA. In order to address the human resource challenge of managing hypertension in low- and middle-income countries (LMICs), task-shifting hypertension care from physicians to nurses has been proposed. To support this task-shifting strategy, the Academic Partnership Providing Access to Healthcare (AMPATH) has developed an Android tablet-based electronic Decision Support and Integrated Record-Keeping (DESIRE) tool to record patient data and assist with clinical decision-making. We investigated the usability of the DESIRE tool in the setting of nurse management of hypertension in rural western Kenya through the use of “mock patient” encounters and “think aloud” exercises. Fiftyseven critical incidents were identified and twenty-three design changes were suggested. Optimization of the tool has the potential to broadly impact treatment of non-communicable diseases in LMICs by providing a model of electronic decision-support in task shifting.