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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Treatment burden among people with chronic illness : What are the consumer health organisations saying?
Sav, Adem, McMillan, Sara, Kelly, Fiona, Kendall, Elizabeth, Whitty, Jennifer, King, Michelle and Wheeler, Amanda. (2012). Treatment burden among people with chronic illness : What are the consumer health organisations saying? Chronic Illness. 9(3), pp. 220 - 232. https://doi.org/10.1177/1742395312463411
Uncovering work-life interference among Australian Muslim Men : Implications for Human Resource Management
Sav, Adem, Harris, Neil and Sebar, Bernadette. (2012). Uncovering work-life interference among Australian Muslim Men : Implications for Human Resource Management. New Zealand Journal of Human Resources Management. 12(2), pp. 69 - 80.
Length of stay in hospital and all-cause readmission following elective total joint replacement in elderly men
Mnatzaganian, George, Ryan, Philip, Norman, Paul, Davidson, David and Hiller, Janet E.. (2012). Length of stay in hospital and all-cause readmission following elective total joint replacement in elderly men. Orthopedic Research and Reviews. 4, pp. 43 - 51. https://doi.org/10.2147/ORR.S31668
Use of routine hospital morbidity data together with weight and height of patients to predict in-hospital complications following total joint replacement
Mnatzaganian, George, Ryan, Philip, Norman, Paul, Davidson, David and Hiller, Janet. (2012). Use of routine hospital morbidity data together with weight and height of patients to predict in-hospital complications following total joint replacement. BMC Health Services Research. 12(1), pp. 1 - 8. https://doi.org/10.1186/1472-6963-12-380
Work-Life interference among working Australian Muslim men: Where religion and culture unite
Sav, Adem, Harris, Neil and Sebar, Bernadette. (2011). Work-Life interference among working Australian Muslim men: Where religion and culture unite. The future of work and organisations: 25th Annual Australian and New Zealand Academy of Management Conference. New Zealand: Australian and New Zealand Academy of Management. pp. 1 - 16
Smoking, body weight, physical exercise, and risk of lower limb total joint replacement in a population-based cohort of men
Mnatzaganian, G., Ryan, P., Norman, P E., Davidson, D. C. and Hiller, Janet E.. (2011). Smoking, body weight, physical exercise, and risk of lower limb total joint replacement in a population-based cohort of men. Arthritis & Rheumatism. 63(8), pp. 2523 - 2530. https://doi.org/10.1002/art.30400
Depression scores predict adherence in a dietary weight loss intervention trial
Somerset, Shawn, Graham, Laura and Markwell, Katherine. (2011). Depression scores predict adherence in a dietary weight loss intervention trial. Clinical Nutrition. 30(5), pp. 593 - 598. https://doi.org/10.1016/j.clnu.2011.04.004
Weaknesses in using quasi-quantitative food-frequency questionnaire data to link habitual intake of flavonoids to hypertension incidence
Somerset, Shawn. (2011). Weaknesses in using quasi-quantitative food-frequency questionnaire data to link habitual intake of flavonoids to hypertension incidence. American Journal of Clinical Nutrition. 93(5), pp. 1153 - 1154. https://doi.org/10.3945/ajcn.111.012856
Food acquisition habits in a group of African refugees recently settled in Australia
Pereira, Carolina, Larder, Nicolette and Somerset, Shawn. (2010). Food acquisition habits in a group of African refugees recently settled in Australia. Health & Place: an international journal. 16(5), pp. 934 - 941. https://doi.org/10.1016/j.healthplace.2010.05.007
Reporting of dietary control frameworks in studies on simvastatin efficacy
Somerset, Shawn. (2010). Reporting of dietary control frameworks in studies on simvastatin efficacy. Clinical Nutrition. 29(3), pp. 352 - 357. https://doi.org/10.1016/j.clnu.2009.10.005
Experiences of Australian Muslim men in the workplace: A field study of employment choices and consequences
Sav, Adem, Sebar, Bernadette and Harris, Neil. (2010). Experiences of Australian Muslim men in the workplace: A field study of employment choices and consequences. Journal of Muslim Minority Affairs. 30(3), pp. 409 - 423. https://doi.org/10.1080/13602004.2010.515825
Nutrition education: towards a whole-school approach
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. 60(4), pp. 442 - 449. https://doi.org/10.1080/01635580802143836