Tej K. Khalsa|Norm R.C. Campbell|Daniel T. Lackland|Lisheng Liu|Mark L. Niebylski|Xinhua Zhang
A Needs Assessment of National Hypertension Organizations for Hypertension Prevention and Control Programs
University of Calgary|Libin Cardiovascular Institute of Alberta|University of Calgary|Medical University of South Carolina|Fu Wai Hospital|Hypertension Institute|Shanghai Institute of Hypertension
hypertension affects four 10 adults age 25 leading risk factor death disability globally1 2 2010 hypertension estimated cause 94 million deaths 18 total global deaths largely stroke ischemic heart disease13 hypertension prevalence rise 156 billion people expected hypertension 20254 although hypertension largely preventable driving force global epidemic noncommunicable diseases ncds world hypertension league whl international nonprofit organization official relations world health organization international society hypertension ish objectives whl include partnering national member organizations promote prevention control hypertension globally5 whl designed needs assessment guide development programs hypertension prevention control survey objectives 1 determine unifying commonalities perceived needs membership regarding hypertension prevention treatment control 2 understand differences perceived needs member organizations regarding hypertension prevention treatment control 3 formulate results study recommendations whl effectively collaborate member organizations prevention treatment control hypertension needs assessment crosssectional survey national hypertension organizations enrolled full members associate members whl february 2013 december 2013 one full primary membership allocated per country associate memberships available additional societies within given country primary associate membership includes 74 national organizations however members listed verifiable contact information limited 36 societies questionnaire surveyed full member societies interest developing enhancing programs hypertension prevention control opportunities partnership whl opportunities collaboration across member societies needs assessment also identified major barriers developing hypertension control programs data surveillance application national guidelines solicited feedback whls world hypertension day whd appendix 1 analysis data involved quantitative qualitative descriptive methodology statistical analysis included recording number societies affirmative item andor percentage positive responding societies full members whl qualitative methods included interpretive thematic analysis individual surveys descriptive responses coded thematically comparisons subsequent revisions across respondents inclusive full associate members barriers hypertension programs determined method overall ranking barriers determined total number respondents referenced theme qualitative descriptive data undergo theoretical analysis given small sample size whl received 26 responses total 36 societies verifiable contact information march december 2013 declined completing assessment one cited lack time another impending retirement respective organization third due civil unrest country additional society omitted quantitative analysis kept qualitative analysis due status associate member whl represented response rate 64 23 36 although societies answered every question assessment 22 full members included quantitative analysis listed table 1 participants included one society lowincome country two lowmiddleincome countries seven uppermiddleincome countries 12 highincome countries defined world bank6 responding 22 societies interested developing enhancing programs hypertension prevention control country twenty organizations responded questions types interventions wanted enhance develop majority 90 18 20 societies wanted focus national programs lesser interest community 13 20 regional 12 20 workplace programs 9 20 one half interested one two interventions latter half favored implementing three four interventions overall 15 societies exclusively focused national programming 10 interested either community andor workplace interventions interest national hypertension organizations developing enhancing different components hypertension programs surveyed 15 19 choosing prevention 17 19 screening 17 19 control total 68 favored comprehensive approach inclusive prevention screening control 32 interested focused approach involving one two domains interventions considered developed described 16 societies 63 involved public education campaigns 44 educating healthcare providers 36 conducting surveillance 25 developing updating guidelines 13 engaging multisector partnerships high level interest 91 collaborating whl programs hypertension prevention control areas interest partnering whl represented figure 1 whl assistance networking similar programs countries developing educational resources ranked paramount assistance links funding bodies program design prioritized second total 64 societies 14 22 interested collaborating countries willingness share expertise domains outlined figure 2 three highly ranked opportunities collaboration included networking similar programs countries 12 14 development educational resources 10 14 sharing learning experiences 8 14 twenty national hypertension organizations identified current interventions respective countries 14 societies included detailed description majority interventions 15 20 categorized national programs either exclusively focusing hypertension comprehensive approach inclusive cardiovascular disease 8 20 societies community programs 7 20 societies regional programs 6 20 societies stated approach respect identifying barriers optimum activities prevention control blood pressure nationally 91 20 22 societies responded table 2 lack resources predominant barrier included lack funding sources healthcare professionals government support research expertise problematic healthcare systems identified second major barrier included remuneration overlooked prevention favor downstream interventions pharmacotherapy invasive procedures responses category included lack integrated national collaborations ncds including problems surveillance monitoring within clinics eg lack bp measurement devices professional expertise policy level issues governance difficulty evaluating prevention programs low health literacy identified third major barrier optimizing activities prevention control hypertension included social determinants poverty total 91 20 22 societies identified blood pressure surveillance data country regarding prevalence awareness diagnosis treatment control hypertension half respondents utilized unique national guidelines 59 13 22 27 6 22 adopted international guidelines 14 3 22 employed guidelines need guidelines better suited respective country identified 27 6 22 main reasons requiring unique guidelines included economic constraints well differences ethnicity language participants also asked prioritize organizations perspective 10 possible actions whl could undertake using 5point scale 1high priority 5low priority overall ranking determined greatest number societies assigning value 1 2 table 3 developing network funding organizations flagged predominant priority respondents 13 19 societies well conducting training sessions healthcare professionals hypertension control 13 19 training sessions develop strategic plans hypertension prevention control 13 20 training sessions develop sodium reduction programs 11 18 whd ranked useful 28 5 18 societies somewhat useful 28 5 18 societies neutral 22 4 18 useful 22 4 18 needs assessment provides basis national hypertension organizations work together toward reducing burden hypertensionrelated disease majority organizations wanted partner national hypertension organizations whl high priority organizations development national programs multiple dimensions involving prevention screening control encompassing public healthcare professional education many organizations also interested community regional workplace programs expected lack monitory personnel resources major barriers faced organizations followed inadequate healthcare systems low health literacy public notably lack appropriate hypertension guidelines indicated quarter organizations organizations indicated whl could assistance developing network potential funding bodies network national organizations working together toward common goals also indicated need developing training sessions healthcare professionals hypertension assisting development strategic planning hypertension prevention control including assistance developing advocacy programs reducing dietary salt another key issue need engage national governments healthcare system reform needs assessment complementary overlap survey national hypertension organizations ish focused use guidelinesbased care7 needs assessment substantive limitations relatively small number national hypertension organizations responded thus results may generalizable national hypertension organizations particular one respondent lowincome country two lowmiddleincome countries hence survey less likely generalizable organizations lowresource settings responses african organizations survey needs assessment indicates whl must reengage member organizations especially low middleincome countries global burden hypertension highest nevertheless high response rate organizations whl confirmed contact information survey identified national organizations wish collaborate whl sets agenda collaboration also potential limitation surveys filled individuals may may reflect needs organization represent andor responses may represent needs countries populations responses indicate many common themes across organizations suggesting major observations valid whl currently restructuring aligning resources better address global responsibility mandate united nations indicated four critical targets 2025 impact hypertension reduce prevalence hypertension 25 reduce dietary sodium 30 80 coverage essential cardiovascular medications reduce premature mortality ncds 258 targets highly integrated reducing ncds unlikely without significant reduction hypertensionrelated disease reducing dietary salt would substantively achieve target reduce hypertension prevalence whl prioritized partnering national hypertension organizations reestablished contact 50 organizations developing partnerships international health organizations top whl operational priorities designed enhance effort reduce dietary salt increase screening diagnosis hypertension populationwide since conducting needs assessment 2013 whl developed policy statement reducing dietary salt9 call improving quality research dietary salt10 developed overview strategic planning hypertension prevention control5 established journal clinical hypertension official journal11 provided policy guidance selecting automated blood pressure devices12 developed fact sheets blood pressure13 dietary salt14 aid advocacy established recommended nomenclature describing dietary salt intake reduction dietary salt15 developed guidelines analyzing hypertension surveys16 addition working groups issue resource develop screening programs hypertension cardiovascular risk lowresource settings whl launched new web site wwwwhleagueorg resource center featuring aforementioned materials based feedback regarding whd rejuvenated effort made 2014 enhance recognition impact event whd 2014 incorporated global bp screening challenge widely embraced 30 nations achieving three times screening goal summarized report posted new web site whl work member organizations adopt policies resources events well create new resources aid hypertension prevention control globally hypertension prevention control remains major global challenge national hypertension organizations indicate strong desire work together prevent control hypertension although needs assessment substantive limitations helps forge agenda partnership whl national hypertension organizations findings signal need whl develop network potential funding bodies networks national organizations working toward common goals also indicated demand training sessions healthcare professionals need assist strategic planning hypertension prevention developing new hypertension guidelines ranked highly respondents clear need develop expanded multisector network broaden membership include national hypertension organizations establish innovative partnerships corporations largescale provider groups work towards leagues mandate united nations targets whl grateful assistance chellam chellappan administrative secretary whl well following respondents argentina arterial hypertension society national heart foundation australia austrian society hypertension hypertension committee national heart foundation bangladesh belgian hypertension committee brazilian society hypertension bulgarian hypertension league hypertension canada egyptian hypertension society estonian society hypertension iranian heart foundation israel hypertension society italian society hypertension lebanese hypertension league pakistan hypertension league polish society hypertension saudi hypertension management society slovak league hypertension swedish society hypertension stroke vascular medicine thai hypertension society turkish association hypertension control turkish society hypertension renal american society hypertension drs khalsa campbell lackland lisheng zhang report specific funding relation research conflicts interest declare dr niebylski paid contractor whl conflicts declare