Barriers to evidence-based acute stroke care in Ghana: A qualitative study on the perspectives of stroke care professionals

Journal article


Baatiema, Leonard, de-Graft Aikins, Ama, Sav, Adem, Mnatzaganian, George, Chan, Carina K. Y. and Somerset, Shawn. (2017) Barriers to evidence-based acute stroke care in Ghana: A qualitative study on the perspectives of stroke care professionals. BMJ Open. 7(4), pp. 1 - 11. https://doi.org/10.1136/bmjopen-2016-015385
AuthorsBaatiema, Leonard, de-Graft Aikins, Ama, Sav, Adem, Mnatzaganian, George, Chan, Carina K. Y. and Somerset, Shawn
Abstract

Objective: Despite major advances in research on acute stroke care interventions, relatively few stroke patients benefit from evidence-based care due to multiple barriers. Yet current evidence of such barriers is predominantly from high-income countries. This study seeks to understand stroke care professionals’ views on the barriers which hinder the provision of optimal acute stroke care in Ghanaian hospital settings. Design: A qualitative approach using semistructured interviews. Both thematic and grounded theory approaches were used to analyse and interpret the data through a synthesis of preidentified and emergent themes. Setting: A multisite study, conducted in six major referral acute hospital settings (three teaching and three non-teaching regional hospitals) in Ghana. Participants: A total of 40 participants comprising neurologists, emergency physician specialists, non-specialist medical doctors, nurses, physiotherapists, clinical psychologists and a dietitian. Results: Four key barriers and 12 subthemes of barriers were identified. These include barriers at the patient (financial constraints, delays, sociocultural or religious practices, discharge against medical advice, denial of stroke), health system (inadequate medical facilities, lack of stroke care protocol, limited staff numbers, inadequate staff development opportunities), health professionals (poor collaboration, limited knowledge of stroke care interventions) and broader national health policy (lack of political will) levels. Perceived barriers varied across health professional disciplines and hospitals. Conclusion: Barriers from low/middle-income countries differ substantially from those in high-income countries. For evidence-based acute stroke care in low/middle-income countries such as Ghana, health policy-makers and hospital managers need to consider the contrasts and uniqueness in these barriers in designing quality improvement interventions to optimise patient outcomes.

Year2017
JournalBMJ Open
Journal citation7 (4), pp. 1 - 11
PublisherBMJ
ISSN2044-6055
Digital Object Identifier (DOI)https://doi.org/10.1136/bmjopen-2016-015385
Scopus EID2-s2.0-85018752704
Open accessOpen access
Page range1 - 11
Research GroupSchool of Allied Health
Publisher's version
License
Place of publicationUnited Kingdom
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Rowe, Fiona, Stewart, Don and Somerset, Shawn. (2010) Nutrition education: towards a whole-school approach. Health Education. 110(3), pp. 197 - 208. https://doi.org/10.1108/09654281011038868
Impact of a school-based food garden on attitudes and identification skills regarding vegetables and fruit: A 12-month intervention trial
Somerset, Shawn and Markwell, Katherine. (2009) Impact of a school-based food garden on attitudes and identification skills regarding vegetables and fruit: A 12-month intervention trial. Public Health Nutrition. 12(2), pp. 214 - 221. https://doi.org/10.1017/S1368980008003327
Variations in prevalence and conduct of school food gardens in tropical and subtropical regions of north-eastern Australia
Somerset, Shawn and Bossard, Antoine. (2009) Variations in prevalence and conduct of school food gardens in tropical and subtropical regions of north-eastern Australia. Public Health Nutrition. 12(9), pp. 1485 - 1493. https://doi.org/10.1017/S1368980008004552
The voices of muslim men: The experiences of Australian muslim men in the workplace
Sav, Adem, Sebar, Bernadette and Harris, Neil. (2009) The voices of muslim men: The experiences of Australian muslim men in the workplace. 8th Industrial and Organisational Psychological Conference. Australia: Griffith University. pp. 1 - 1
Australian muslim men coping with conflict and achieving balance: Positive look at a negative issue
Sav, Adem, Harris, Neil, Sebar, Bernadette, Abdalla, Mohamad and Stewart, Donald. (2009) Australian muslim men coping with conflict and achieving balance: Positive look at a negative issue. Work Stress and Health Conference: Global Concersn and Approaches. United States of America: American Psychological Association. pp. 1 - 1
Work-life conflict among Australian muslim men and women in South-East Queensland
Sav, Adem, Sebar, Bernadette, Abdalla, Mohamad and Stewart, Donald. (2009) Work-life conflict among Australian muslim men and women in South-East Queensland. Work Stress and Health Conference: Global Concerns and Approaches. United States of America: American Psychological Association. pp. 1 - 1
Broadening the scope of work-life balance: Experiences of Australian Muslims
Sav, Adem, Harris, Neil, Sebar, Bernadette, Stewart, Donald and Abdalla, Mohamad. (2009) Broadening the scope of work-life balance: Experiences of Australian Muslims. 8th Industrial and Organisational Psychology Conference: Meeting the future: Promoting sustainable organisational growth. Australia: Australian Psychological Society. pp. 117 - 122
Effect of infections on 30-day mortality among critically ill patients hospitalized in and out of the intensive care unit
Mnatzaganian, George, Sprung, Charles L., Zitser-Gurevich, Yana, Galai, Noya, Goldschmidt, Nethanel, Levi, Leon, Bar-Lavi, Yaron, Zveibil, Fabio, Salz, Inbal Weiss, Ekka-Zohar, Anat and Simchen, Elisheva. (2008) Effect of infections on 30-day mortality among critically ill patients hospitalized in and out of the intensive care unit. Critical Care Medicine. 36(4), pp. 1097 - 1104. https://doi.org/10.1097/CCM.0B013E3181659610
Dietary flavonoid sources in Australian adults
Somerset, Shawn and Johannot, Lidwine. (2008) Dietary flavonoid sources in Australian adults. Nutrition and Cancer: an international journal. 60(4), pp. 442 - 449. https://doi.org/10.1080/01635580802143836