Differences and similarities in explanatory models of hypertension in the United States of america, Tanzania and Jamaica.

BACKGROUND: Misperceptions detract from effective disease management in a number of conditions but the nature of underlying illness beliefs and their relative consistency in patients with chronic hypertension (cHTN) who present to the Emergency Department (ED) with poor blood pressure control is not known. OBJECTIVES: 1) To explore disease knowledge in ED patients with cHTN using explanatory modelling; and 2) to compare gaps in cHTN knowledge across racially similar but geographically divergent ED patients. METHODS: Emergency department patients of African origin with cHTN were recruited from three sites: Detroit Receiving Hospital (DRH - Detroit, MI), the Tanzanian Training Center for International Health (TTCIH - Ifakara, TZ) and the University Hospital of the West Indies (UHWI - Kingston, JA). Demographic and baseline data were collected along with open-ended responses to a series of questions related to cHTN. Qualitative responses were coded into predefined, disease-relevant quantitative domains by two separate, blinded reviewers and multilevel comparisons were performed using Kruskal-Wallis or analysis of variance (ANOVA) tests, where appropriate. RESULTS: One hundred and ninety-seven patients were enrolled; mean age (50.5 years vs 51.6 years vs 50.8 years; p = 0.86) and gender distribution (% male: 49.5 vs 44 vs 40; p = 0.53) were similar across sites but patients at DRH (vs TTCIH vs UHWI) were more hypertensive at presentation (mean systolic BP in mmHg: 166.8 vs 153 vs 152.7; p = 0.003), had a longer mean duration of cHTN (12.1 years vs 4.6 years vs 9.1; p < 0.0001), and were less likely to be on antihypertensive therapy (84.5% vs 92% vs 100%, p = 0.001). Explanatory models revealed limited recognition of cHTN as a "disease" (19.6% vs 28% vs 16%; p = 0.31) and consistency in the belief that cHTN was curable (44.3% vs 36% vs 42%; p = 0.62). Stress (48.4% vs 60% vs 50%; p = 0.31) and, especially at DRH, diet (62.2% vs 22% vs 36%; p < 0.0001) were identified most frequently as causes of cHTN and an association with symptoms was common (83.5% vs 98% vs 78%; p = 0.15). Clear differences existed for perceived benefits of treatment and consequences of poor control by site, but in general, both were under-appreciated. CONCLUSIONS: Misperceptions related to cHTN are common in ED patients. While specific areas of disconnect exist by geographic region, failure to recognize cHTN as a dire and fixed disease state is consistent, suggesting that a uniform educational intervention may be of benefit in this setting.

MicroResearch: finding sustainable local health solutions in East Africa through small local research studies.

BACKGROUND: Sub-Saharan African countries have urged grassroots input to improve research capacity. In East Africa, MicroResearch is fostering local ability to find sustainable solutions for community health problems. At 5years, the following reports its progress. METHODS: The MicroResearch program had three integrated components: (1) 2-week training workshops; (2) small proposal development with international peer review followed by project funding, implementation, knowledge translation; (3) coaching from experienced researchers. Evaluation included standardized questions after completion of the workshops, 2013 online survey of recent workshop participants and discussions at two East Africa MicroResearch Forums in 2013. RESULTS: Between 2008 and 2013, 15 workshops were conducted at 5 East Africa sites with 391 participants. Of the 29 projects funded by MicroResearch, 7 have been completed; of which 6 led to changes in local health policy/practice. MicroResearch training stimulated 13 other funded research projects; of which 8 were external to MicroResearch. Over 90% of participants rated the workshops as excellent with 20% spontaneously noting that MicroResearch changed how they worked. The survey highlighted three local research needs: mentors, skills and funding - each addressed by MicroResearch. On-line MicroResearch and alumni networks, two knowledge translation partnerships and an East Africa Leaders Consortium arose from the MicroResearch Forums. CONCLUSION: MicroResearch helped build local capacity for community-directed interdisciplinary health research.

Innovative medical education: sustainability through partnership with health programs.

INNOVATIVE EDUCATION: The FHS, Moi University has been an active member of Community Based Education and Service (COBES) network. To achieve this, FHS uses innovative educational strategies that encourage active learning and self-directed learning. However, since these educational strategies are very resource intensive, the faculty has been forced to establish links with health programs. SUSTAINABILITY OF INNOVATIONS: Although higher learning institutions have been urged to become more innovative and responsive to a globally competitive knowledge market, support from governments has been declining. This has forced institutions to develop new links with service systems to enable them to sustain innovations. It is undisputable that investments in higher learning generate major community benefits through returns from research, technology application and service provision. Collaboration, which is a mechanism of working together in a harmonious and supportive way with other agencies, is vital for sustaining innovations. POTENTIAL HEALTH PROGRAMS FOR COLLABORATION: In Kenya, where programs such as Health Education and Maternal Child Health that undertake outreach health services exist, Higher Learning Institutions need to collaborate with these programs to enable them make best use of resources and increase efficiency. In this paper, a framework for collaboration in developing countries where resources are meager is suggested.

Continuing education. The experience of Tanzania.

PIP: The continuing education program in Tanzania aims, as part of primary health care (PHC) training, to provide leadership in planning, implementing, and monitoring PHC training; and to implement PHC educational activities. The program was initiated in 1981 under the Ministry of Health with support from the African Medical and Research Foundation. Pilot projects were begun in the Arusha region until funding ceased in 1986. In 1988, the Danish International Development Authority funded the integration and decentralization of continuing education into the existing health system for all 6 zones. Career-based training for health workers was emphasized. Methods involved distance learning and institutional training. The Arusha Center for Educational Development in Health had developed teacher training, research and curriculum development, management training, and production of health learning materials. The Expanded Program on Immunization and Oral Health, as separately funded vertical programs, have been successfully integrated into the health system. Distance learning has been incorporated into the continuing education program, because it permits studying away from the institutions and is affordable for training all types of health workers. The technique has been effectively used after donor support has ended. Distance learning modules were developed for teaching about essential drugs, environmental sanitation and water, food quality control, and diarrheal diseases. Rural medical officers have been trained with distance learning and use of modules on obstructed labor, acute respiratory infections, and epidemiology, which were field tested and evaluated in a pilot project. District Action Research and Evaluation aims to strengthen management capabilities through long and short workshops. The skills emphasized include problem identification, analyzing causes of problems, identifying possible solutions, development of action plans, implementing action plans, and evaluation of activities. Clinical meetings aim to improve hospital-based staff. Lobby meetings inform medical staff and managers of current activities. Lack of funds, lack of qualified staff, inadequate support, and misdirected practices are limitations of continuing education.^ieng