Implementing Community-Based Blood Pressure Groups in Zimbabwe - findings from process evaluation of a pilot intervention

BackgroundHypertension is a significant health challenge in Zimbabwe and uncontrolled blood pressure (BP) highly prevalent. There are multiple barriers to optimal screening and management of BP and accessible and effective management strategies are urgently needed. We present findings from qualitative research on the potential for Community-BP (Com-BP) groups to address this gap. MethodsThe study was conducted in peri-urban (Chitungwiza) and rural (Chiweshe) areas in Zimbabwe. We aimed to assess, over three study phases, the feasibility and acceptability of Com-BP groups to facilitate self/peer measurement of BP, enable peer support and improve BP control. We designed the Com-BP group model with key stakeholders before pilot implementation and evaluation. Focus group discussions, in-depth interviews and observations of group activities were conducted. ResultsFourteen groups were established with a total of 151 community members (10-12 members per group). Digital BP machines were provided, a training manual for Facilitators and a Hypertension guide were produced to increase awareness about hypertension. The intervention was found to be highly acceptable and feasible with the most important enablers identified as the provision of BP machines, joint facilitation by lay CHWs and peer facilitators (as community-champions) from within the community and peer support between members. Participants reported improved knowledge, medication adherence and sense of well- being. ConclusionThe Com-BP group model enabled community members to actively take part in their own health-management and shows promise as an addition to facility-based care for BP control. Further research on sustainability, health system and health economic implications is needed.