Table 2 Overview of findings by selected RE-AIM and PRISM dimensions
Framework: Selected dimension | Overview of results | |
|---|---|---|
RE-AIM: Reacha | Representativeness of cRCT study participants compared to the general population - Variations in sociodemographic characteristics | |
RE-AIM: Implementationb | Stepped-care hypertension algorithm (EBI) - Implementation delivery: Variations in the availability of HTN medications before and during the COVID-19 pandemic - Adaptations: Mechanisms to supply and provide HTN medications - Adaptations: Varying roles of healthcare workers in the implementation of the HTN protocol Team-based collaborative care (Implementation strategy) - Implementation delivery: Variations in the frequency of team meetings before and during the COVID-19 pandemic - Adaptations: Frequency of team meetings and types of providers who participated | |
PRISM: Organizational perspective on the programc | Facilitators - Perceiving the HTN program as effective or beneficial to community members engaged HCPs in the program delivery. | Barriers - Perceiving the HTN program as additional workload, an imposed activity, or complicated, hindered HCP’s engagement in the program delivery and led to lack of support from health district leadership. |
PRISM: Fit between program and health districtc | Facilitators - Previous experience providing chronic diseases services at the health district - Program champions and strong leadership at the health district- and health area-level - Healthcare team organization, collaboration and communication | Barriers - Competition between HTN program and other MoH primary care programs - Insufficient and overburdened healthcare staff - Temporary suspension of healthcare services due to COVID-19 |
PRISM: Implementation and sustainability infrastructurec | Resources - Essential equipment and supplies to deliver the program (e.g., blood pressure monitors) - Essential human resources to deliver the program together with 22 other primary care programs - Transportation for HCPs to visit patients unable to visit health facilities - Financial resources to cover chronic diseases programs, like hypertension Processes - Effective supply chain of hypertensive medications to ensure consistent access for patients - Supervisory team for chronic diseases programs, including hypertension - Training of HCPs on hypertension management - Effective health information system to capture key indicators of hypertension program | |
Health equity considerationsd | Factors related to reach and equitable implementation - Sociodemographic and community characteristics: males working in agricultural sector, poverty and unemployment, limited literacy, language barriers and ethnicity, rurality, family support, machismo, community leadership - Health district characteristics: implementation and sustainability infrastructure (e.g., program champions) - COVID-19 enhanced health inequities among subgroups (e.g., poverty, language barriers) Program adaptations related to enhanced reach and equitable implementation - Diverse forms to reach all participants (e.g., home visits to reach unemployed participants) - Diverse forms to continue reaching participants during COVID-19 (e.g., phone calls during COVID-19) | |
Sustainability considerationsd | Contextual factors related to program sustainability - Implementation and sustainability infrastructure (e.g., equipment, human resources) - Fit between program and health districts (e.g., experience w/chronic diseases program) - COVID-19 threatened program sustainability (e.g., insufficient staff, supply chain) Program adaptations related to program sustainability - Diverse forms to continue delivering program during COVID-19 (e.g., phone calls among collaborative care team in addition to in-person team meetings) | |