PhD research shows impact of education program on health outcomes in Kwara, Nigeria

On Tuesday 22nd of December, Aina Olufemi (Femi) Odusola defended his PhD thesis ‘Development and evaluation of a patient-centered cardiovascular health education program among insured primary care patients with hypertension in rural Nigeria – The QUICK-II study’ at the University of Amsterdam.

The QUICK-II program builds on earlier PhD research conducted by Marleen Hendriks among hypertensive patients of the rural population in Kwara State (QUICK-I) It focuses on those patients who had not managed to control their blood pressure and medication intake by the end of QUICK-I, with the aim of developing a patient-centered approach to improving cardiovascular health.

While this group of people had free access to quality care, these patients did not manage to control their blood pressure and adhere to their medication. What might have been missing for those patients to successfully improve their condition, Odusola argues, is educational counselling. In order to develop an attractive and culturally sensitive education program, a number of patients, healthcare professionals and health insurance managers were interviewed. Three interactive group education sessions about the risk factors and consequences of hypertension were given to the patients. Moreover, user-friendly ways of physical activity were introduced, such as food preparation methods, brisk walk sessions, and gardening. An important modifiable risk factor in rural Nigeria for hypertension is salt intake. Therefore, the use of the substitute ‘Iru’ was promoted. Although it tastes like salt, it does not contain sodium. In this way, patients were introduced to easy ways to change their lives in such a way that risk factors to hypertension and cardiovascular diseases decreased.

Patients were interviewed individually before and after the group education sessions. Subsequently, these findings were compared. A decrease of the blood pressure and an increase of medication adherence were observed. While before the education sessions, only 50% reported high adherence to medications and behavioral advice, this number increased to 72% after the education sessions. Participants with controlled blood pressure almost doubled from 24% to 46%. The only factor that had stagnated was body mass index (BMI). However, Odusola explained that he was not surprised that BMI had not improved, because normally a longer time period is required to observe any changes in BMI.

Referring to implementing preventive hypertension and cardiovascular diseases programs in different states in Nigeria or even different countries in sub-Saharan Africa, Odusola said: ‘We have formulated the outline to implement such a program. Others will not have to look as much into details as we did. However, they still need to make the program culturally relevant and put it into context. That is essential for the program to work.’

Although Odusola had to spend many hours travelling from Lagos to Kwara, he has not experienced many other challenges and thanks the great support from his supervisors for that. In the future, he would like to combine clinical practice with research in non-communicable diseases. ‘It’s all about improvement of public health and healthcare delivery in the end.’

Quality Improvement Cardiovascular care Kwara Study

QUICK-I:

QUICK-I assessed the feasibility of CVD prevention care in rural Nigeria, according to international guidelines, in the context of a community based health insurance scheme. The study population consisted of 300 patients at risk for development of CVD (patients with hypertension, diabetes, renal disease or established CVD) who are enrolled in the Kwara State Health Insurance Program. An article on the research of Marleen Hendriks was published in the Journal of the American Medical Association (JAMA).

QUICK-II:

At the end of the QUICK-I study, it was observed that almost 50% of the participants who were included in the study had uncontrolled blood pressure and/or low/medium medication adherence. QUICK-II   aimed to develop a patient-centered and culturally sensitive cardiovascular health education program and to test it for effectiveness.