Table 3 Pre-Post Knowledge Differences by Healthcare Provider Cadre (Provider Interviews)
Provider Knowledge Components | Assistant Medical Officer/Medical Officer (N=11) | Assistant clinical officer/clinical officer (N=22) | Total (N=33) | |||
|---|---|---|---|---|---|---|
Pre (n=11) | Post (n=11) | Pre (n=22) | Post (n=22) | Pre (n=33) | Post (n=33) | |
Training | ||||||
Previous in-service training for HT | 3(27.3) | 11(100)*** | 7(31.8) | 22(100)*** | 10(30.3) | 33(100)*** |
Type of training received | ||||||
Risks and complications of HT | 2(66.7) | 10(90.9) | 2(28.6) | 20(90.9)** | 4(40.0) | 30(90.9)** |
Treatment for HT | 1(33.3) | 11(100)* | 5(71.4) | 20(90.9) | 6(60.0) | 31(93.9)* |
Patient preparation prior to BP measurement | 1(33.3) | 11(100)* | 2(28.6) | 22(100)*** | 3(30.0) | 33(100)*** |
Patient monitoring and counselling | 1(33.3) | 10(90.9) | 2(28.6) | 19(86.4)** | 3(30.0) | 29(87.9)** |
Knowledge awareness | ||||||
Have adequate knowledge about HT | 9(81.8) | 11(100) | 17(77.3) | 22(100)* | 26(78.8) | 33(100)** |
Have adequate skills for BP measurement | 10(90.9) | 11(100) | 19(86.4) | 21(95.5) | 29(87.9) | 32(97.0)* |
Correct cut off for HT Diagnosis (140/90) | 9(81.8) | 10(90.9) | 14(63.6) | 22(100) | 23(69.7) | 32(97.0) |
BP threshold for patients with diabetes, cardiac or renal impairment should not exceed 130/80 | 3(27.3) | 11(100)*** | 4(18.2) | 21(95.5)** | 7(21.2) | 32(97.0)*** |
HT management is lifelong | 7(63.6) | 11(100)* | 20(90.9) | 22(100) | 27(81.8) | 33(100)* |
Consequences of HT (heart attack, stroke, death) | 11(100) | 10(90.9) | 22(100) | 22(100) | 33(100) | 32(97.0) |
HT Management goal – Reduce SBP/DBP to 140/90 | 10(90.9) | 9(81.8) | 18(81.8) | 21(95.5) | 28(84.8) | 30(90.9) |
Effective treatment can reduce the risk of heart attack, stroke, and death | 11(100) | 10(90.9) | 21(95.5) | 22(100) | 32(97.0) | 32(97.0) |
Correct definition of HT | 11(100) | 11(100) | 21(95.5) | 21(95.5) | 32(97.0) | 32(97.0) |
HT often shows no symptoms | 7(63.6) | 10(90.9) | 10(45.5) | 18(81.8)* | 17(51.5) | 28(84.8)** |
BP seasonal variations; time of day, season, physical activity | 8(72.7) | 7(63.6) | 9(40.9) | 16(72.7) | 17(51.5) | 23(69.7) |
Heart attack definition | 9(81.8) | 10(90.9) | 15(69.2) | 20(90.9) | 24(72.7) | 30(90.9) |
BP Screening Standards: back and feet supported, feet uncrossed, cuff placement - midpoint upper arm wrap cuff snugly on bare arm/light clothing -ensure 2 fingers can slip at bottom edge, arm rested on flat surface, rest 2-5m before measuring BP | 8(72.7) | 10(90.9) | 15(68.2) | 21(95.5)* | 23(69.7) | 31(93.9)* |
Patient sitting quietly during BP measurement does not cause error in reading | 8(72.7) | 8(72.7) | 7(31.8) | 20(90.9)** | 15(45.5) | 28(84.9)* |
Correct recording for BP | 8(72.7) | 6(54.6) | 13(59.1) | 15(68.2) | 21(63.6) | 21(63.6) |
Correct cuff deflation rate 2mmHG/sec | 7(63.6) | 9(81.8) | 9(40.9) | 17(77.3) | 16(48.9) | 26(78.8)* |
Brachial artery for measuring BP | 8(72.7) | 7(63.6) | 15(68.2) | 17(77.3) | 23(69.7) | 24(72.7) |
Correct cuff application determined by placing 2 fingers under bottom edge of cuff | 8(72.7) | 11(100) | 21(95.5) | 22(100) | 29(87.9) | 33(100) |
Correct placement of BP cuff – bottom of cuff placed above the bend of the elbow | 6(54.6) | 7(63.6) | 11(50.0) | 14(63.6) | 17(53.1) | 21(63.6) |
Recommended time between BP readings 1-2min | 3(27.3) | 8(72.7) | 6(27.3) | 16(72.7)* | 9(28.1) | 24(72.7)** |
Correct patient positioning does not include holding arm up in the air | 8(72.7) | 7(63.6) | 14(63.6) | 22(100)** | 22(66.7) | 29(87.9) |
Importance of ensuring patient did not smoke, exercise, or drink a caffeinated beverage 30 minutes before BP measurement | 8(72.7) | 7(63.6) | 18(81.8) | 19(86.4) | 26(78.8) | 26(78.8) |
HT counseling does not include stopping medication if traditional herbs are used | 3(27.3) | 4(36.4) | 6(27.3) | 3(13.6) | 9(27.3) | 7(21.2) |
Recommended intake of salt/day for patients with HT (5g or 1tsp) | 11(100) | 10(90.9) | 20(90.9) | 21(95.5) | 31(96.9) | 31(96.9) |
Strategies to control HT: Maintain healthy lifestyle, reduce salt intake, regular BP medication, regular follow up with provider | 11(100) | 11(100) | 19(86.4) | 22(100) | 30(90.9) | 33(100) |
Lifestyle changes to control HT; Reduce dietary salt <5g/day, daily consumption of fruit/vegetables, reduce tobacco products, lose weight, regular exercise, avoid/limit alcohol | 3(27.3) | 10(90.9)** | 9(40.9) | 22(100) | 12(36.4) | 32(97.0)*** |
The most that healthy diets can reduce SBP is 2mmHg | 9(81.8) | 8(72.7) | 14(63.6) | 17(77.3) | 23(69.7) | 25(75.8) |
Tanzania Treatment Guidelines for HT | ||||||
Aware of Tanzania Treatment Guidelines | 8(72.7) | 10(90.9) | 17(77.3) | 20(90.9) | 25(75.8) | 30(90.9) |
Ministry guidelines for 3 readings of BP - minimum of 2 days apart of 2 months and >140/90 | 9(81.8) | 9(81.8) | 21(91.5) | 19(86.4) | 30(90.9) | 28(84.8) |
Protocol for HT pt follow up (1-3m, every 6m) | 10(90.9) | 6(54.6) | 17(77.3) | 21(95.5) | 27(84.4) | 27(84.4) |
Minimum of 2 BP readings at 1st visit to confirm HT | 3(27.3) | 7(63.6) | 4(18.2) | 14(63.6)** | 7(21.2) | 21(63.6)** |
Treatment for HT; lifestyle modification and medicines | 11(100) | 11(100) | 22(100) | 22(100) | 33(100) | 33(100) |
Aware of first line antihypertensives based on national protocol | ||||||
Thiazides | 9(81.8) | 9(81.8) | 9(40.9) | 15(68.2) | 18(54.6) | 24(72.7) |
Beta-Blockers | 3(27.3) | 5(45.5) | 13(59.1) | 13(59.1) | 16(48.5) | 18(54.6) |
Calcium Channel Blockers | 5(45.5) | 6(54.6) | 10(45.5) | 12(54.6) | 15(45.5) | 18(54.6) |
ACE Inhibitors | 1(9.1) | 5(45.5) | 8(36.4) | 8(36.4) | 9(27.3) | 13(39.4) |
Blockers (ARBs) | 1(9.1) | 1(9.1) | 2(9.1) | 2(9.1) | 3(9.1) | 3(9.1) |