Table 1 Summary of the strategies to overcome barriers for risk factors evaluation and treatment
Barrier | General approach | Specific strategy to overcome barrier |
|---|---|---|
1. System/ organizational Level | ||
-Multiple competitive demands on physicians’ time -Inadequate incentives for professionals to promote prevention actions -Community health workers activities mainly focus on maternal and childcare | Task shifting | ●Simplify the physician’s task by assigning the CVD risk stratification and counseling for cardiovascular health care to CHWs |
Difficulties in scheduling medical appointments in PCCs | Organizational change | ● Creation of protected medical appointment slots |
Communication problems in the interface among the primary health care staff | Team-based approach | ● New CVD form that centralizes the clinical registry of physicians, nurses and CHWs |
2. Provider Level | ||
-Low adherence to clinical practice guidelines -Predisposition to accept uncontrolled risk factors | Physician education Aid tools | ● 1 Workshop session in the use of guidelines, treatment algorithms ● 2 Educational outreach visits: prescribing audit and feedback ● Pocket card with drug treatment as decision trees ● New CVD form with a special section to register drug treatment |
3. Individual Level | ||
Lack of CV care knowledge risk perception | Family education | ● Cardiovascular disease care counselling to participant and family in participant’s household |
Poor attendance to the PCC | Appointment reminders, and Family support | ● CHW will provide a card with the medical appointment record ● Family members help to remind each other |
Low health literacy Reluctance to take medication | Patient education | ● Counselling provided by CHWs, who are from the local community, to ensure that health information is culturally and linguistically appropriate ● Distribution of printed educational material |
Lack of time | Organizational change | ● Medical appointment provided in participant’s household |