Open AccessImproving services for chronic non‐communicable diseases in Samoa: an implementation research study using the care cascade framework
Author(s) -
FraserHurt Nicole,
Naseri Leausa Take,
Thomsen Robert,
Matalavea Athena,
IeremiaFaasili Victoria,
Reupena Muagatutia Sefuiva,
Hawley Nicola L.,
Pomer Alysa,
Rivara Anna C.,
Obure Dayo Carol,
Zhang Shuo
Publication year - 2022
Publication title -
australian and new zealand journal of public health
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.946
H-Index - 76
eISSN - 1753-6405
pISSN - 1326-0200
DOI - 10.1111/1753-6405.13113
Subject(s) - referral , non communicable disease , psychological intervention , medicine , health care , communicable disease , nursing , telemedicine , focus group , environmental health , family medicine , medical emergency , business , public health , economic growth , marketing , economics
Objective : Samoa needs to intensify the response to the growing non‐communicable disease burden. This study aimed to assess bottlenecks in the care continuum and identify possible solutions. Methods : The mixed‐methods study used the cascade framework as an analysis tool and hypertension as a tracer condition for chronic non‐communicable diseases. Household survey data were integrated with medical record data of hypertension patients and results from focus group discussions with patients and healthcare providers. Results : Hypertension prevalence was 38.1% but only 4.7% of hypertensive individuals had controlled blood pressure. There were large gaps in the care continuum especially at screening and referral due to multiple socio‐cultural, economic and service delivery constraints. Conclusions : In Samoa, care for chronic non‐communicable diseases is not effectively addressing patient needs. This calls for better health communication, demand creation, treatment support, nutritional interventions and health service redesign, with a focus on primary healthcare and effective patient and community engagement. Implications for public health : The proposed actions can improve the reach, accessibility, quality and effectiveness of Samoa's chronic care services. Health system redesign is necessary to ensure continuity of care and more effective primary prevention. The findings are useful for other countries in the region facing similar challenges.