Table 1. Emergent themes and illustrative quotes on cardiovascular disease (CVD) prevention programmes within health-based organizations, extracted from interviews and focus groups conducted with church leaders and health committee members, Accra, Ghana, 2010.
| Domain, underlying dimension and theme | Quote |
|---|---|
| I. Capacity of faith-based organizations in health programme delivery | |
| A. Church leaders’ views on the church’s role in health | |
| 1.1. Provide education and increase awareness | a. “… I think the role of the church is to educate church members on the steps that they should take to prevent these diseases.” (Male leader, Church 2) |
| b. “Continuous education and awareness should be done all the time. A specialist should be invited to the church. By getting in touch with 200 people at a time they can increase awareness… We will be aware that if I do this or that, this will happen.” (Male health committee member, Church 5) | |
| 1.2. Provide screening | a. “The church will continue to do screening and education at the same time. These are the two areas that I think we can do and educate the members with disease that may affect them and when they are ready, to help them get out of it.” (Male leader, Church 4) |
| b. “… to raise awareness, because most of these people do not have symptoms, even though they have high blood pressure. They just live with it until something happens. But at that point it’s too late. So we think that the screening allows you to quickly identify them and then to do something about it.” (Male leader, Church 3) | |
| 1.3. Organize activities to help others achieve better health | a. “The church has a role in increasing sensitization, exercise classes, and helping organize health walks, maybe games.” (Female leader, Church 4) |
| b. “and exercises, yes ... after this programme was started they formed a keep-fit exercise ...” (Male health committee member, Church 5) | |
| B. Churches’ experiences and operation in health programme delivery | |
| 1.4. Programme accessibility | a. “…the programme is meant for the church members, but the door is open to anyone.” (Male leader, Church 2) |
| b. “…but it's not just for our members but for the full community (both members and non-members). We reach out to them, medical outreach.” (Male leader, Church 3) | |
| c. “Sometimes we have people from the neighbouring areas…some from Madina. People came from all over. The ones who were doing the screening, we overtaxed them because we did not expect such huge numbers…” (Male leader, Church 4) | |
| 1.5. Partnerships with external organizations and non-members | a. “We have help like the Lion’s…Sometimes the pharmaceutical companies also provided drugs. We call on other professionals to help also…we call them friends of the church.” (Female leader, Church 4) |
| b. “We have doctors. From Korle-Bu. They are not members. I think those who are members of this congregation are just about two.” (Male health committee member, Church 3) | |
| 1.6. Multiple influences on health programme content | a. “Depending on the kind of disease that is popping out. It’s basically what we hear…” (Male leader, Church 5) |
| b. “So the health committees can come up with the proposals on issues or topics that they will be treating this year.” (Male health committee member, Church 5) | |
| c. “…the programme is given to us from The Church of Ghana. They have their health programmes. They give us a topic, based on that we talk a lot about it.” (Female leader, Church 4) | |
| II. Feasibility of having CHWs deliver a CVD prevention programme in a faith-based organization | |
| 2.1. Role of lay person in church health programmes | a. “We train some of the youth to take blood pressure and they are able to do it satisfactorily…most of them are going back to school.” (Male leader, Church 4) |
| b. “their work is more on data entry and trying to organize the people, positioning them in the right place, and getting the right information…so we have people who are not really health professionals, but who are more interested in helping organize people, entering data for us.” (Male health committee member, Church 3) | |
| 2.2. Existence of a semi-CHW model | a. “…we have a special nurse and health personnel on that committee who give guidance to the rest of the membership.” (Male leader, Church 2) |
| b. “The medical outreach team is made up of doctors and nurses…the medical personnel don’t take money from us.” (Male health committee member, Church 3) | |
| c. “We have resource personnel…nurses, doctors and other health personnel…and we have students also in the church…we use them most of the time.” (Female health committee member, Church 4) | |
| d. “We have a three-person health committee…3 nurses…members of the congregation who are volunteers.” (Male leader, Church 1) | |
| III. Potential barriers to implementing or sustaining a CVD health programme in a faith-based organization | |
| 3.1. Limited resources | a. “We provide our own funds – the local churches. So we are local and if we want to do anything we provide the funds ourselves.” (Female leader, Church 4) |
| b. “…because we don’t have the resources and since we fall under the mother church, we talk to the big men over there and they come to assist.” (Male leader, Church 5) | |
| c. “We are always cutting our quota according to our sizes.” (Male leader, Church 2) | |
| d. “I think they need more…more programmes...like the mammograms…” (Male leader, Church 3) | |
| 3.2. Absence of formal monitoring and evaluation | a. “It depends on the response that comes from the church members…Yes at the end of the year we ask the various committees to come out or write their reports. OK…they don't ask the church members but you can see from the attendance … that … they are ok with the programme…” (Male leader, Church 2) |
| b. “if they were told to see a doctor, we make a follow-up phone call after 1 month to see if the recommendation was followed and if the person’s health improved.” (Male leader, Church 1) | |
| c. “…judging from the contributions…we can see that the programme helps. We realize that we don’t get more people complaining about the same sickness.” (Male leader, Church 5) | |
| 3.3. Poverty | a. “Maybe poverty is also part of it because you know the right diet but you cannot afford it. So you still go to the starches of the past…” (Female leader, Church 4) |
| b. “These economic hardships…people get stressed out.” (Male health committee member, Church 3) | |
| 3.4. Limited access to health care | a. “The issue is that they are not getting treatment because for someone who works….or seeks that service, you need … to miss a day … and get to a doctor. You may end up not even seeing a doctor … you get frustrated.” (Male leader, Church 3) |
| IV. Knowledge of CVD | |
| 4.1. CVD is major problem in Ghana. | a. “I think it is a major problem….cardiovascular challenge is a serious issue….We have people as young as 22 to 25 years who are diagnosed with high blood pressure and diabetes… It’s a serious issue…” (Male health committee member, Church 3) |
| b. “Yes it is a problem in Ghana; my church is also in Ghana. I think everybody is at risk.” (Male leader, Church 1) | |
| c. “…when talking about cardiovascular diseases it is more dangerous, anybody can go at any time.” (Male leader, Church 2) | |
| 4.2. Stress is a risk factor for CVD. | a. “People get stressed out because they go all the way to church…like the pastor, who lives so far away. He has to drive in the night, he’s praying for this one, there is not even time for them to rest. So rest is a factor. Rest is a major factor…” (Female leader, Church 4) |
| b. “There is not enough for them to eat. They are always worried whether their next meal will come where they are living so all those things are factors.” (Female health committee member, Church 4) | |
| c. “Marriage today is so stressful, so so so stressful.” (Female health committee member, Church 5) | |
| d. “I consider females (overlap of gender and stress) to be the dominant group because of the way they assume things from their emotions.” (Male health committee member, Church 2) | |
| 4.3. Diet is a risk factor for CVD. | a. “We are going back to eat o broni (“white man”) food. We are eating what has been imported – fish which was canned ten years ago (laughter) and then brought here.” (Female leader, Church 4) |
| b. “I feel also that there is too much chemicals in the planting – the fertilizer for the crops. One time I decided to live on vegetable. ...so one day I buy carrots to use for three weeks. The third day the whole thing got rotten and so I became afraid and stopped…if the chemical is too much what effects will it have on my body?” (Female leader, Church 4) | |
| c. “We are so much eating starchy food, and because of that it is causing so many cardiovascular challenges to the body.” (Male health committee member, Church 3) | |
| d. “Early to work, straight and eat very late…” (Male health committee member, Church 5) | |
| e. “Fasting during the day and eating at night.” | |
| 4.4. Age is a risk factor for CVD. | a. “especially people who are 40. We have people very young, as young as 22 to 25 years, who are diagnosed with hypertension, diabetic, you know.” (Male health committee member, Church 3) |
| b. “Once we took blood pressure for the old people like me, but now at 20, 23, or 25, they have that condition.” (Male leader, Church 1) | |
| 4.5. Lack of physical activity is a risk factor for CVD. | a. “One thing I want to say is… we don’t do a lot of exercises – and that’s one major problem with the Ghanaians. If we adopt that attitude of exercise…” (Male leader, Church 5) |
| b. “People in the city cannot walk 15 to 30 metres…they take the tro tro (public transportation).” (Male health committee member, Church 3) |
CHW, community health worker.
Note: Church 1, Charismatic; Church 2, Presbyterian; Church 3, Baptist; Church 4, Presbyterian; Church 5, Pentecostal.