Improving prevention of cardiovascular diseases: Barriers and facilitators in primary care services in Vietnam

ABSTRACT

Background: The National Hypertention Prevention and Control has been set as the Vietnam national health target program, 2008 to 2020 and functions and responsibilities of commune health centers (CHCs) have been adjusted. The study aimed to identify barriers and facilitators to implementation of government policies about cardiovascular diseases (CVDs) preventions and control in primary health care(PHC) in Vietnam.

Methodology: Ten CHCs in Chi Linh, Hai Duong province were selected. Data were collected through 26 in-depth interviews with heads and specified staffs at CHCs, policymakers at national, regional and local level, about strategy and implementation of the program. A thematic analysis (structural, organizational, professional, social context and attitudinal barriers and facilitators) was used.

Results: The most frequently reported and important barriers were lack of practical guideline and skills on risk factors screening; conflict in referral guideline among PHC facilities; non-financial mechanism to counseling services. The facilitators identified were support from authorities and community. Assistance from Village Health Workers in CVDs preventions and control at PHC was a main finding of this study.

Conclusion: Assessment barriers and facilitators is important to gain a better understanding of health care providers and organizational perspective when enforcement CVD healthcare policies in PHC settings.

KEYWORDS:

• Primary health care
• implementation
• CVDs
• Vietnam

Acknowledgements

We would like to acknowledge the study participants, commune health centers, Chi Linh hospital, Chi Linh medical preventative department, and Hai Duong health department for their support and enthusiasm in the study.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This work was supported by the World Health Organization Asia Pacific Observatory Research Hub. The Asia Pacific Observatory on Health System and Policies.

Notes on contributors

Tran Thi Duc Hanh

Tran Thi Duc Hanh is current working as a researcher and lecturer in Department of Epidemiology, Hanoi University of Public Health. Her research interest focuses on epidemiology, non communicable disease, migrant health, evaluation study design, and implementation research. She is also persuading her PhD in Epidemiology, University of Basel, Switzerland.

Le Bich Ngoc

Le Bich Ngoc have recieved Master Degree at University of North Carolina at Greensboro, USA and bachelor degree at Hanoi University of Public Health, Vietnam. She is currently working as researcher and lecturer in Department of Biostatistics, Hanoi University of Public Health. Her research interest focuses on non-communicable disease, HIV, aging health.

Lam Ngoc Hoa

Lam Ngoc Hoa research interest focuses on non-communicable disease, occupational and environmental health, gastroenterology and implementation research. She received her bachelor degree from Hanoi School of Public Health (now is Hanoi University of Public Health – HUPH) in 2016. Now she is currently working as a researcher assistant in the Institute of Gastroenterology and Hepatology (IGH).

Enying Gong

Enying Gong is a public health researcher with research interests in global health, cardiometabolic disease management and prevention, implementation science and technology-enabled health promotion. Enying received her master degree in global health from Duke University in US and dual bachelor degrees from Peking University in China. She worked as the research analyst at Duke Kunshan University, Kunshan China and currently is a PhD candidate at School of Population and Global Health, The University of Melbourne in Australia.

Xuanchen Tao

Xuanchen Tao received his Master's Degree in Global Health from Duke University and his Bachelor's Degree in Preventive Medicine from Peking University. He is currently working as a research assistant in the diabetes research group in the George Institute for Global Health, China. And he is also a PhD candidate at the George Institute for Global Health, the University of New South Wales in Australia.

Lijing L. Yan

Lijing L. Yan, PhD, MPH, Professor (with tenure) of Global Health, is the Head of Non-communicable Chronic Diseases (NCDs) Research at the Global Health Research Center since July 2014 and Director of Graduate Studies for the Master of Science in Global Health Program at Duke Kunshan University in China, and a Research Professor at the Duke Global Health Institute, Duke University in the USA. Previously, she was the Deputy Director of the George Institute for Global Health at Peking University Health Science Center and Director of the China International Center for Chronic Disease Prevention, a large network of 5 international academic institutions and 7 Chinese institutions dedicated to combat NCDs in China. She is also an Honorary Associate at the Center for Healthy Aging and Development Studies, National School of Development, Peking University, Beijing, China and an Adjunct Professor at the Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA and School of Health, Wuhan University, China. She has a bachelor’s degree in Sociology from Peking University, a Master of Public Health degree in Epidemiology and a doctoral degree in Demography from the University of California, Berkeley. Her main areas of research are primary care and community-based chronic disease prevention and control (hypertension, stroke, heart disease, and diabetes in particular), healthy aging, health innovation and implementation science. She is the Principal Investigator or Co-Investigator on a number of US NIH and UK MRC-funded and China-funded research grants. She has published over 100 peer-reviewed scientific papers some of which in leading medical journals such as JAMA, the Lancet, and Circulation. She is the former secretary general of the China Consortium of Universities for Global Health, the elected member of the Global Health Society and the NCD Prevention and Control Society of the Chinese Preventive Medicine Association. She also provides advices and consultancy to national and international organizations such as the China National Health Commission, World Health Organization, World Heart Federation, and the US NIH Fogarty Global Health Training Programs and the US NIH NHLBI Center for Translation Research and Implementation Science Research Programs.

Hoang Van Minh

Hoang Van Minh, Vice-rector, the Hanoi University of Public Health, Viet Nam. Prof. Hoang Van Minh graduated from Hanoi Medical University in 1994. He got Master and PhD degree from Umeå International School of Public Health, Umeå University, Umeå, Sweden in 2001 and 2006, respectively. Prof. Minh is currently Vice-rector for research of the Hanoi University of Public Health, Viet Nam. He also serves as Editor-in-chief of the Vietnam Journal of Health and Development Studies. Prof. Minh specializes in health research methods and health economics. He has particular interests in doing research on issues of health system, especially about capacities health system for prevention and control of the rising burden of non-communicable diseases in Vietnam. He has more than 110 scientific articles published in international peer- reviewed journals. Prof. Minh is also a steering member of the Health Space Asia, of the Vietnam Health Economics Association. He is a member the Editorial Board of Global Health Action Journal, International Journal of Healthcare-Sciedu Press, Vietnam Journal of Public Health, Vietnam Journal of Communicable Diseases. (Email: [email protected]).