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Original Research

Stakeholder Engagement in the Translation of a Hypertension Control Program to Guatemala’s Public Primary Health Care System: Lessons Learned, Challenges, and Opportunities

Authors:

Meredith P. Fort ,

Department of Health Systems, Management and Policy, Centers for American Indian and Alaska Native Health, Colorado School of Public Health, Aurora, CO, US; Institute of Nutrition of Central America and Panama (INCAP) Research Center for the Prevention of Chronic Diseases (CIIPEC), Institute of Nutrition of Central America and Panama, Guatemala City, GT
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Alejandra Paniagua-Avila,

Institute of Nutrition of Central America and Panama (INCAP) Research Center for the Prevention of Chronic Diseases (CIIPEC), Institute of Nutrition of Central America and Panama, Guatemala City, GT
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Andrea Beratarrechea,

Department of Research in Chronic Diseases, Institute for Clinical Effectiveness and Health Policy (IECS), Buenos Aires, AR
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Sayra Cardona,

Institute of Nutrition of Central America and Panama (INCAP) Research Center for the Prevention of Chronic Diseases (CIIPEC), Institute of Nutrition of Central America and Panama, Guatemala City, GT
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Juan Carlos Figueroa,

Institute of Nutrition of Central America and Panama (INCAP) Research Center for the Prevention of Chronic Diseases (CIIPEC), Institute of Nutrition of Central America and Panama, Guatemala City, GT
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Kevin Martinez-Folgar,

Institute of Nutrition of Central America and Panama (INCAP) Research Center for the Prevention of Chronic Diseases (CIIPEC), Institute of Nutrition of Central America and Panama, Guatemala City, GT
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Daniela Moyano,

Department of Research in Chronic Diseases, Institute for Clinical Effectiveness and Health Policy (IECS), Buenos Aires, AR
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Edgar Barrios,

Ministry of Health and Social Welfare, Guatemala City, GT
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Bernardo Eliu Mazariegos,

Ministry of Health and Social Welfare, Guatemala City, GT
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Eduardo Palacios,

Ministry of Health and Social Welfare, Guatemala City, GT
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Vilma Irazola,

Department of Research in Chronic Diseases, Institute for Clinical Effectiveness and Health Policy (IECS), Buenos Aires, AR
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Jiang He,

Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, US
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Manuel Ramirez-Zea

Institute of Nutrition of Central America and Panama (INCAP) Research Center for the Prevention of Chronic Diseases (CIIPEC), Institute of Nutrition of Central America and Panama, Guatemala City, GT
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Abstract

Background: There is an urgent need to define appropriate intervention strategies to control blood pressure in low- and middle-income countries. In 2018, a program proven effective in Argentina was translated to Guatemala’s public primary health care system in rural and primarily indigenous communities.

Objectives: This paper describes the stakeholder engagement process used to adapt the program to the Guatemalan rural context prior to implementing a type II hybrid effectiveness-implementation trial and shares lessons learned.

Methods: We identified key differences in the 2 contexts that are relevant to translating the intervention to the Guatemalan context. Alongside interviews and focus group discussions, we conducted consultation workshops in July and August 2018, applying a participatory translation process involving patients, family members, community members, health care providers, and Ministry of Health officials. The process consisted of multiple meetings in Guatemala City, as well as meetings in each of the 5 departments where the study will be implemented, and 1 district per department. During the workshops, we presented the evidence-based experience from Argentina and then focused on the challenges and recommended solutions that the participants identified for each of the intervention’s 6 components. The process concluded with a meeting in which the research team and Ministry of Health officials defined specific details of the intervention.

Results: The outcome of the process is an adapted approach appropriate to integrate into Guatemala’s public primary health care system in the trial phase. The approach considers the challenges and recommended strategies for each of the 6 intervention components.
Conclusions: We identified lessons learned, challenges, and opportunities during the adaptation process. Findings will inform ongoing stakeholder engagement during the study implementation and future scaleup and efforts to translate evidence-based hypertension control strategies to low- and middle-income countries globally.

Highlights

  • For a geographically disperse and diverse population, local-level meetings are key.
  • Consultation workshops focused on adaptation to the Guatemalan context.
  • Some concerns raised during the engagement process require long-term responses.
  • Ongoing engagement will inform the intervention and generate committed collaboration.
How to Cite: Fort MP, Paniagua-Avila A, Beratarrechea A, Cardona S, Figueroa JC, Martinez-Folgar K, et al.. Stakeholder Engagement in the Translation of a Hypertension Control Program to Guatemala’s Public Primary Health Care System: Lessons Learned, Challenges, and Opportunities. Global Heart. 2019;14(2):155–63. DOI: http://doi.org/10.1016/j.gheart.2019.05.005
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Published on 01 Jun 2019.
Peer Reviewed

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