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Open Access Study protocol

Development and evaluation of a patient centered cardiovascular health education program for insured patients in rural Nigeria (QUICK - II)

Aina Olufemi Odusola12*, Marleen Hendriks13, Constance Schultsz14, Karien Stronks5, Joep Lange1, Akin Osibogun6, Tanimola Akande7, Shade Alli8, Peju Adenusi9, Kayode Agbede10 and Joke Haafkens11

Author Affiliations

1 Dept of Global Health, Academic Medical Center, University of Amsterdam, Pietersbergweg 17, Amsterdam, 1105 BM, The Netherlands

2 PharmAccess Foundation, 1c Raymond Njoku Street, S.W. Ikoyi, Lagos, Nigeria

3 Dept of Neurology, Academic Medical Center, University of Amsterdam, Meibergdreef 9, Amsterdam, 1105 AZ, The Netherlands

4 Oxford University Clinical Research Unit, Hospital for Tropical Diseases, 190 Ben Ham Tu, Ho Chi Min City, District 5, Vietnam

5 Dept of Public Health, Academic Medical Center, University of Amsterdam, Meibergdreef 9, Amsterdam, 1105 AZ, The Netherlands

6 Dept of Community Health, Lagos University Teaching Hospital, P.M.B.12003, Idi-Araba, Surulere, Lagos, Nigeria

7 Dept of Epidemiology and Community Health, University of Ilorin Teaching Hospital, P.M.B. 1459, Ilorin, postal code 240001, Nigeria

8 Dept of Cardiology, Lagoon Hospitals, 8 Marine Road, Apapa, Lagos, Nigeria

9 Hygeia Nigeria Ltd, 13B Idejo Street, Victoria Island, Lagos, Nigeria

10 Ogo Oluwa Hospital, 64/65 Ahmadu Bello Way, Bacita, Kwara State, Nigeria

11 Dept of General Practice, Academic Medical Center, University of Amsterdam, Meibergdreef 9, Amsterdam, 1105 AZ, The Netherlands

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BMC Public Health 2011, 11:171  doi:10.1186/1471-2458-11-171

Published: 21 March 2011



In Sub Saharan Africa, the incidence of hypertension and other modifiable cardiovascular risk factors is growing rapidly. Poor adherence to prescribed prevention and treatment regimens by patients can compromise treatment outcomes. Patient-centered cardiovascular health education is likely to improve shortcomings in adherence. This paper describes a study that aims to develop a cardiovascular health education program for patients participating in a subsidized insurance plan in Nigeria and to evaluate the applicability and effectiveness in patients at increased risk for cardiovascular disease.


Design: The study has two parts. Part 1 will develop a cardiovascular health education program, using qualitative interviews with stakeholders. Part 2 will evaluate the effectiveness of the program in patients, using a prospective (pre-post) observational design.

Setting: A rural primary health center in Kwara State, Nigeria.

Population: For part 1: 40 patients, 10 healthcare professionals, and 5 insurance managers. For part 2: 150 patients with uncontrolled hypertension or other cardiovascular risk factors after one year of treatment.

Intervention: Part 2: patient-centered cardiovascular health education program.

Measurements: Part 1: Semi-structured interviews to identify stakeholder perspectives. Part 2: Pre- and post-intervention assessments including patients' demographic and socioeconomic data, blood pressure, body mass index and self-reporting measures on medication adherence and perception of care. Feasibility of the intervention will be measured using process data.

Outcomes: For program development (part 1): overview of healthcare professionals' perceptions on barriers and facilitators to care, protocol for patient education, and protocol implementation plan.

For program evaluation (part 2): changes in patients' scores on adherence to medication and life style changes, blood pressure, and other physiological and self-reporting measures at six months past baseline.

Analysis: Part 1: content analytic technique utilizing MAXQDA software. Part 2: univariate and multilevel analysis to assess outcomes of intervention.


Diligent implementation of patient-centered education should enhance adherence to cardiovascular disease prevention and management programs in low income countries.

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