Development of a cardiovascular health education program for primary care patients with hypertension in rural Nigeria : a qualitative study

Background: Patient-centered, culturally tailored cardiovascular health education has the potential to improve hypertension self-management. Despite the high prevalence of hypertension in Sub Sahara Africa, this type of health education is hardly available in this region. Objective: To describe how we developed and evaluated a culturally adapted Cardiovascular Health Education Program for insured hypertensive patients in rural Nigeria. Methods: Applying concepts of “cultural adaptation”, we took a hypertension education program from Europe as a starting point for program-development. First, we collected information on socio-cultural perspectives on hypertension care through a literature review and qualitative interviews with 40 hypertensive patients and 15 healthcare professionals/insurance managers in Kwara State Nigeria. Second, we used this information to adapt the content (deep structure) and the form (surface structure) of the European program to the unique patient population and circumstances of a primary care clinic in Kwara. Third, we evaluated the adapted program among 149 hypertensive patients from this clinic. Results: The interviews offered insight into patient perspectives on hypertension, socio-cultural and environmental inhibitors and facilitators for medication/ behavioral self-management (e.g. exercise) and on healthcare professional perspectives on optimal education delivery platforms – group counseling, posters, audiovisuals. These insights were used to adapt elements (e.g., educational tools, content) of the existing educational program. The adapted program has been shown to strengthen medication adherence and consequently blood pressure control among the targeted population. Conclusion: A culturally tailored Cardiovascular Health Education Program, developed by using a qualitative research approach, offered an effective means for educating patients about blood pressure control in a rural primary care setting in Africa. Implications: Our description of the program and the process by which it was developed offers a practical framework for developing cardiovascular health education for other patient populations in Africa.