eprintid: 34480 rev_number: 26 eprint_status: archive userid: 7961 dir: disk0/00/03/44/80 datestamp: 2024-02-26 12:12:01 lastmod: 2024-02-27 14:11:43 status_changed: 2024-02-26 12:12:01 type: report metadata_visibility: show creators_name: Singh, Kavita creators_name: Otchi, Elom creators_name: Shah-Rohlfs, Rupal creators_name: Udofia, Emilia creators_name: Louis, Valérie R. creators_name: Adomako, Isaac creators_name: Seneadza, Nana Ayegua Hagan creators_name: Herzhauser, Nikias creators_name: Owusu, Afua Boatemaa creators_name: Tetteh, John creators_name: DeGraft-Amoah, Daniel creators_name: Kallson, Eugene creators_name: Winkler, Volker creators_name: Yawson, Alfred Edwin creators_name: De Allegri, Manuela title: Evaluation of the Ghana Heart Initiative - Design and Rationale of a Pragmatic Mixed-Methods Study from Diverse Perspectives: A Study Protocol subjects: ddc-000 subjects: ddc-300 subjects: ddc-610 divisions: i-912800 divisions: i-999999 cterms_swd: Hypertension cterms_swd: Cardiovascular Disease cterms_swd: Implementation Research cterms_swd: Health Systems Strengthening cterms_swd: Quality of Care cterms_swd: Economic Evaluation cterms_swd: RE-AIM Evaluation Framework cterms_swd: Ghana abstract: Introduction: Rigorous evaluations of health system interventions to strengthen hypertension and cardiovascular disease (CVD) care remain scarce in sub-Saharan Africa (SSA). This study aims to evaluate the reach, effectiveness, adoption / acceptability, implementation fidelity, cost, and sustainability of the Ghana Heart Initiative (GHI), a multicomponent supply-side intervention to improve cardiovascular health in Ghana. Methods: This study adopts a mixed- and multi-methods design comparing the effects of the GHI in 42 intervention health facilities (i.e. primary, secondary and tertiary) in the Greater Accra Region versus 56 control health facilities in the Central and Western Regions. The evaluation design is guided by the RE-AIM framework underpinned by the WHO health systems building blocks framework, integrated by the Institute of Medicine’s six dimensions of health care quality: safe, effective, patient-centered, timely, efficient, equitable. The assessment tools include: (i) a health facility survey, (ii) a healthcare provider survey assessing the knowledge, attitudes, and practices on hypertension and CVD management, (iii) a patient exit survey, (iv) an outpatient and in-patient medical record review and (v) qualitative interviews with patients and various health system stakeholders to understand the barriers and facilitators around the implementation of the GHI. In addition to primary data collection, the study also relies on secondary routine health system data, i.e., the District Health Information Management System to conduct an interrupted time series analysis using monthly counts for relevant hypertension and CVD specific indicators as outcomes. The primary outcome measures are performance of health service delivery indicators, input, process and outcome of care indicators (including screening of hypertension, newly diagnosed hypertension, prescription of guideline directed medical therapy, and satisfaction with service received and acceptability) between the intervention and control facilities. Lastly, an economic evaluation and budget impact analysis is planned. Discussion: This study will generate policy-relevant data on the reach, effectiveness, implementation fidelity, adoption / acceptability, and sustainability of the GHI, and provide insights on the costs and budget-impacts to inform nationwide scale-up to expand the GHI to other regions across Ghana and offer lessons to other countries in SSA as well. RIDIE Registration Number: RIDIE-STUDY-ID-6375e5614fd49 (https://ridie.3ieimpact.org/index.php). University of Heidelberg Repository heiDOK. date: 2024 publisher: Universität id_scheme: DOI id_number: 10.11588/heidok.00034480 ppn_swb: 1881716740 own_urn: urn:nbn:de:bsz:16-heidok-344809 language: eng bibsort: SINGHKAVITEVALUATION20240223 full_text_status: public place_of_pub: Heidelberg citation: Singh, Kavita ; Otchi, Elom ; Shah-Rohlfs, Rupal ; Udofia, Emilia ; Louis, Valérie R. ; Adomako, Isaac ; Seneadza, Nana Ayegua Hagan ; Herzhauser, Nikias ; Owusu, Afua Boatemaa ; Tetteh, John ; DeGraft-Amoah, Daniel ; Kallson, Eugene ; Winkler, Volker ; Yawson, Alfred Edwin ; De Allegri, Manuela (2024) Evaluation of the Ghana Heart Initiative - Design and Rationale of a Pragmatic Mixed-Methods Study from Diverse Perspectives: A Study Protocol. [Other] document_url: https://archiv.ub.uni-heidelberg.de/volltextserver/34480/7/Evaluation_Ghana_Heart_Initiative_Protocol_Paper_2024.pdf