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Background: Metabolic syndrome (MetS), a cluster of metabolic dysregulations indicative of increased cardiometabolic risk is on the rise in Sub-Saharan Africa. The study aimed to determine the prevalence of MetS and its components, among corporate employees in Kampala, Uganda., Methods: A cross-sectional survey was undertaken among 408 adults who were employees from seven corporate companies in Kampala, using the WHO STEPwise NCD screening approach. Metabolic syndrome was measured using the National Cholesterol Education Program Adult Treatment Panel (ATPIII) and the International Diabetes Federation (IDF) criteria with the waist circumference (WC) cut-off points adapted for Sub-Saharan African populations., Results: The mean population age (standard deviation [SD]) of the respondents was 34years (± 8.87) years and 52% of them were females. The prevalence of MetS was 22.8% (NCEP ATPIII) and 28.4% (IDF). Of the respondents who did not have MetS, 75% had at least one metabolic dysregulation. Of those respondents with MetS, only 31% perceived that they were at risk of this cluster of metabolic dysregulations. In this analysis, we observed that the systolic blood pressure (BP) and the body mass index (BMI) correlated strongly (r = 0.81 and r = 0.71) with the diastolic BP and waist circumference (WC), respectively. Age on the other hand correlated fairly with the WC and BMI (both r values = 0.46). Principal component analysis showed that the greatest loadings in principle factors one, two and three were from central obesity, with low HDL-C explaining 60.8% variance in the population. Age, BMI, family history of having cardiometabolic disorders, and perceived cardiometabolic disease risk (CMR) were associated with an increased risk of MetS by 5, 8.86, 1.55, and 2.73 (all P values were < 0.05) respectively in this group of respondents. These risks remained for age, BMI and perceived CMR after removing the confounding effects of education status, marital status and family history of cardiometabolic disease. Being single on the other hand, was associated with a reduced risk of MetS (0.23, p < 0.009)., Conclusion: While the primary contributors to the high prevalence of MetS among corporate employees in Kampala, Uganda were the high BP, high WC and high fasting blood sugar (FBS); age, BMI and perceived CMR were the key determinants of MetS. Future MetS interventions should aim to control and monitor obesity indicators in this population. Additionally, the findings inform targeted screening parameters for cardiometabolic risk assessment and suggest the need for further research into a weighted algorithm for MetS in this population., Competing Interests: Competing Interests: The authors declare no competing interest.

Background: Unveiling the understanding of older persons with non-communicable diseases (NCDs) regarding health well-being is paramount and can translate to increased self-efficiency, independence, and enhanced well-being. However, little is known about older persons' understanding of the concept of health-related quality of life (HRQoL) in Uganda. The study explored perceptions of older persons with NCDs on HRQoL in central Uganda., Methods: This exploratory qualitative study design involved 23 participants recruited from selected Primary healthcare facilities in Central Uganda. Thematic analysis using an inductive approach generated themes that informed the study's qualitative findings., Results: The key themes that emerged from the study include holistic well-being, lifestyle modification, and financial stability. The key component of HRQoL that came out clearly from the study was the physical domain. There is a need to embrace a person-centered approach based on the perceptions of older persons on HRQoL, which has the potential to improve well-being and enhance a healthy aging journey., Competing Interests: Declaration of Conflicting Interest The author (s) declare no potential conflict of interest concerning the research, authorship, and publication of the article.

Prostate cancer accounts for 20.3% of all cancers in men in sub-Saharan Africa. Early screening among at-risk groups is challenging in Uganda, with limited data on prostate cancer screening uptake in most districts, including newly established ones. The purpose of this study was to determine factors influencing the uptake of prostate cancer screening among men aged ≥ 40 in Kazo Town Council, Kazo District, a newly created district. We used a descriptive cross-sectional study design that employed both quantitative and qualitative data collection methods. Participants were recruited through simple random sampling between November 2020 and January 2021. Structured questionnaires were used for quantitative data ( n = 300). Statistical analyses to determine associations were carried out using inferential and chi-square tests followed by logistic regression. In-depth interviews were conducted with 10 key informants and analyzed thematically to explore a range of perceptions related to prostate cancer screening. Only 10 (3.33%; 95% CI: 0.018-0.60) respondents had ever screened for prostate cancer. Lack of privacy ( p < 0.033), access to prostate cancer information ( p < 0.014), and distance to health facilities ( p < 0.001) were significantly associated with the uptake of prostate cancer screening. Marital status (OR = 7.93; 95% CI: 1.85-33.99; p = 0.005), positive health worker attitudes (OR = 0.002; 95% CI: 0.000-0.023, p < 0.001), and perceived affordability (OR = 0.001; 95% CI: 0.000-0.011, p < 0.001) were independently associated with uptake of prostate cancer screening. Key barriers included lack of information, access to screening centres, and fear of screening. The level of uptake of prostate cancer screening was considerably low among men aged 40 and above in the Kazo District. Targeted community interventions to improve access to prostate cancer information, screening, sensitization, and addressing perceived and actual barriers are needed in newly created districts to bolster the uptake of prostate cancer screening. This has implications for prioritizing research evaluating district resource allocation to support optimized and integrated evidence-based service delivery in primary healthcare centres, especially for specialized services in newly created districts., Competing Interests: The authors declare no conflict of interest., (Copyright © 2023 Smart Mwebembezi et al.)

Background: Family carers face challenges that could significantly affect their health and the health of those they care for. However, these challenges are not well documented in low-income settings, including Uganda. We explored the challenges of caring for someone with chronic non-communicable disease (NCD) in Uganda., Methods: We conducted a qualitative exploratory study at Hospice Africa, Uganda (an urban setting) and Hampton Health Center (a rural setting) in Uganda in February and March 2021. Family carers (n = 44) were recruited using snowball and purposive sampling techniques. Data were collected using focus group discussions and in-depth interviews, gathering family carer perspectives of (a) their caring role (b) their support needs, and (c) attitudes of the wider community. In total, four focus group discussions and 10 individual interviews were completed., Results: The average age of carers was 46 years old. The majority of family care was provided by female relatives, who also experienced intersectional disadvantages relating to economic opportunities and employment. Family carers carried a huge burden of care, experiencing significant challenges that affected their physical health, and material and emotional well-being. These challenges also affected the quality of care of the patients for whom they cared. Carers struggled to provide for the basic needs of the patient including the provision of medication and transport to health facilities. Carers received no formal training and limited support to carry out the caring role. They reported that they had little understanding of the patient's illness, or how best to provide care., Conclusions: As NCDs continue to rise globally, the role of family caregivers is becoming more prominent. The need to support carers is an urgent concern. Family carer needs should be prioritised in policy and resource allocation. The need for a carer's toolkit of resources, and the enhancement of community support, have been identified., (© 2023. The Author(s).)

Aims: To describe nurses' perceptions of family nursing practice and to explore the influence of their perceptions of the benefits, barriers and activities of family engagement in care on family nursing practice., Design: A cross-sectional correlational study., Methods: In total, 460 nurses from two tertiary hospitals in the central region of Uganda participated. Quantitative and qualitative data were collected between August 2020 and January 2021 using the Family Nursing Practice Scale. Analyses included descriptive statistics, t-test, Pearson correlation, analysis of variance and ordinal logistics regression. Quantitative content analysis was carried out on the textual data., Results: Nurses who perceived that family engagement in care improves patient and family outcomes were more likely to rate family nursing practice highly. Perceived barriers to family engagement in care particularly time constraints, work overload and family-related conflicts have a negative and significant influence on family nursing practice. Nurse characteristics such as education, usual shift pattern and personal experience of having a family member in hospital are significantly associated with family nursing practice; nurses who work morning shifts were likely to report higher family nursing practice., Conclusion: The study reveals that several parameters (perceived barriers, perceived benefits and nurse characteristics) influence nursing practice with families. Thus, bearing in mind the diversity of healthcare contexts, the findings show that multiple interacting factors are important for advancing family nursing interventions and practice., Impact: Probabilistic factor-specific predictions of nursing practice with families are provided in this study - this addresses a gap in the evidence regarding the elements that should be optimized when designing well-informed policies and interventions to advance family nursing practice. A comparison of results in the literature with the present study's findings suggests a need to broaden the scope and context perspective in future research and broaden the understanding of how nurses´ perceptions influence family engagement in care., Reporting Method: The study adheres to the STROBE reporting guidelines., Patient or Public Contribution: Family members/caregivers were involved in the design of the study particularly in assessment of validation of the tools used in the study., (© 2023 The Authors. Journal of Advanced Nursing published by John Wiley & Sons Ltd.)

Background: Globally, school-going children spend most of their days at school, sitting in lessons and unable to achieve the daily WHO recommendations for Physical Activity (PA) of at least 60 minutes per day. Limited studies have assessed the opportunities schools provide for PA to help the children achieve their daily recommended PA. We determined the level of and the factors associated with PA offered in primary schools in Makindye Division in Kampala during the school term., Methods: This cross-sectional study was conducted in 36 selected government and private primary schools in Makindye Division, Kampala. PA was defined as the amount of time in minutes available for PA as per WHO recommendations - sufficient (60 minutes or more of PA) or insufficient (less than 60 minutes of PA) and assessed for any factors associated with provision of time for PA in schools. Data were collected by interview administered questionnaires and analysed descriptively. Factors associated with PA were assessed using a logistic regression model., Results: Of the 36 schools, 3 were government and 33 were private schools. The proportion of schools offering sufficient time for PA among Primary schools in the Makindye Division was (8/36) 22%. The average time for PA for all schools per week was 197 minutes (SD 70.7). Sufficient PA was associated with the provision of PE lessons after a break or after lunch (p-value 0.038). Sufficient PA was more likely in schools that offered volleyball (OR 8.69), had space in the school for PA (OR 13.27), provided athletics (OR 2.26) and whose fees were Ushs 700,000 (USD 187) or more (OR 1.30)., Conclusions: Only 22% of sampled schools offered sufficient time for PA among Primary schools in Kampala per WHO guidelines. Provision of sufficient time for PA was associated with PE scheduled either after break or lunch. Sufficient PA was more likely with schools that had space for PA, schools which offered volleyball and athletics, and whose fees were 700,000/= or more. Schools should consider scheduling PE lessons after break or after lunch to increase the likelihood of meeting the targeted time for PA. Primary schools need to be supported to establish facilities and to increase diversity in available activities to ensure children achieve their recommended PA., (© 2023. The Author(s).)

Aim: To describe the mentoring process between the ICN Advanced Practice Nurse Network practice subgroup and the University of Pécs to support the emerging advanced practice role in Hungary, and explore the creation of a mentoring algorithm for faculty and other key stakeholders worldwide who wish to develop advanced practice nursing programs., Background: Advanced practice nurses provide comprehensive clinical care and expand access to care in more than 70 countries. In March of 2017, a representative of the Faculty of Health Sciences of the University of Pécs requested assistance in curricula development for the inaugural advanced practice nursing program in Hungary., Methods: A mixed-methods single case study was undertaken. The sources of evidence include interviews, e-mails, review of the literature, and related documents. Qualitative data were analyzed for content, and frequencies were calculated for quantitative indicators., Findings and Discussion: The findings highlight the importance of clear communication, development of shared goals, and determination to see the project through. Enriching information was provided by colleagues from diverse global settings. Credibility was gained in Hungary from the support of national and international experts., Conclusion: The mentoring foundation and process facilitated the role development in Hungary and contributed to an increased understanding of advanced practice nurses' scope of practice. The intentional approach and the careful ongoing reflection may lead to future successful endeavors. Multinational engagement and collaborations will promote advanced practice nursing contributions globally., Implications for Nursing Policy: Mentoring can effectively empower nurses and advanced practice nurses to work to their full capacity. The shared experiences of international mentoring colleagues can contribute to and support the development and acceptance of national policies for the advanced practice nursing roles., (© 2022 International Council of Nurses.)

Background: Measures in nursing research frequently use Likert scales that yield ordinal data. Confirmatory factor analysis using Pearson correlations commonly applies to such data, although this violates ordinal scale assumptions., Objectives: The aim of this study was to illustrate the application of polychoric correlations and polychoric confirmatory factor analysis as a valid alternative statistical approach using data on family members' perceived support from nurses as an exemplar., Methods: A primary analysis of cross-sectional data from a sample of 800 participants using data collected with the Iceland-Family Perceived Support Questionnaire was conducted using polychoric versus Pearson correlations, analysis of variance, and confirmatory factor analysis., Results: A two-factor measurement model was compatible with data from family members in the Ugandan care settings. Two contextual factors (cognitive and emotional support) constituted the family support measurement model. A factor correlation indicated that the two factors reflected distinct but closely related aspects of family support. Polychoric correlation revealed 13.8% (range: 5.5%-25.2%) higher correlations compared to Pearson correlations. Moreover, the polychoric agreed with the data, whereas the Pearson confirmatory factor analysis did not fit based on multiple statistical criteria. Analyses indicated a difference in emotional and cognitive support perception across two family characteristics: education and relationship to the patient., Discussion: A polychoric correlation suggests stronger associations, and consequently, the approach can be more credible with an ordinal Likert scale than Pearson correlations. Hence, polychoric confirmatory factor analysis can address a larger proportion of variance. In nursing research, polychoric confirmatory factor analysis can confidently be utilized when conducting confirmatory factor analysis of ordinal variables in Likert scales. Furthermore, when a Pearson confirmatory factor analysis is used for ordinal Likert scales, the researcher should carefully evaluate the difference between the two approaches and justify their methodological choice. Even though we do not suggest dispensing with Pearson correlations entirely, we recommend using polychoric correlation for ordinal Likert scales., Competing Interests: The authors have no conflicts of interest to report., (Copyright © 2022 The Authors. Published by Wolters Kluwer Health, Inc.)

Background: During the recent Coronavirus pandemic, many universities realized that the traditional delivery of educational content was not adequate in the context of imposed restrictions. Adoption of e-learning was one obvious way to foster continuity of learning. Despite its rapid implementation during the lockdown in Uganda, it was not known whether health professional students were willing to adopt e-learning as a way to foster continuity of learning. We, therefore, adopted a Technology Acceptance Model to determine the predictors for the adoption of e-learning using learner and information technology variables., Methods: A cross-sectional study among 109 health professional students ≥18 years of age at Clarke International University was conducted. Adoption of e-learning was measured as a self-report. Data were obtained using a smart survey and descriptively summarized. The differences in the study outcome were compared using the chi-square test. The factors that independently influenced the adoption of e-learning were determined using binary logistic regression and reported as adjusted odds ratios (aORs) with a 95% confidence interval (CI)., Results: Of the 109 respondents, 71 (65.1%) adopted e-learning. Our data showed low odds of adoption of e-learning among participants in first year (aOR, 0.34: 95%CI, 0.14-0.79), low e-learning expectations (aOR, 0.01: 95%CI, 0.01-0.34), no confidence in using IT devices (aOR, 0.16: 95%CI, 0.00-0.77), no prior experience in e-learning (aOR, 0.11: 95%CI, 0.02-0.68), not considering e-learning flexible (aOR, 0.25:95%CI, 0.08-0.86) and high cost of internet (aOR, 0.13: 95%CI, 0.02-0.84)., Conclusion: We identified predictors of e-learning adoption which include having completed at least 1 year of study, high e-learning expectations, confidence in using IT devices, prior experience in e-learning, considering e-learning to be flexible and internet access. This information can be used by universities to enhance infrastructure and prepare potential e-learners., (© 2022. The Author(s).)

Purpose: Hypertension is prevalent in Uganda and achieving treatment goals remains a challenge. Our aim was to assess the impact of a bundled nurse-led intervention on hypertension physiologic measures and lifestyle modification, and to explore perceptions of the interventions to enhance sustainability., Design and Setting: We employed a sequential explanatory mixed-method design. The study was conducted at a large urban private hospital in Uganda from September 2018 to May 2019., Sample: Participants were clinic patients with hypertension currently under care. A total of 54 participants were enrolled in two study groups. Two focus groups with 16 participants and 2 nurse-educator interviews were conducted., Methods: Blood pressure and weight were measured at baseline, three, six, and nine months. The Self-Care of Hypertension Inventory was used to assess lifestyle modification. Monthly education and group-support with text-message follow-up were implemented. Two focus-groups and nurse-educator interviews were conducted to assess perceptions post-implementation. The analysis included descriptive statistic, multivariate analysis and qualitative analysis for themes and subthemes., Findings: Overall, participants had a mean weight loss of 7.7 kg (p = 0.001) and a mean reduction in systolic blood pressure (SBP) of 9.5 mm Hg (p = 0.001). Improvement in biometric outcomes was associated with lifestyle modification such as taking medicine as prescribed (p = 0.008), eat lots of fruit and vegetables (p = 0.043), and control your body weight (p = 0.015). Thematic analysis yielded the following themes: Knowledge and understanding, Attitude change, Adherence-a real struggle, and Adapting to what suits us. Participants found group support, shared learning, and knowledge reinforcement enhanced their knowledge and self-efficacy. Nurse educators were motivated by the patients' favorable responses to the Bundled Education and Support with Text (BEST) intervention., Conclusion: Findings support the use of nurse-led interventions to enhance the achievement of hypertension treatment goals. To sustain the achieved lifestyle modification and blood pressure outcomes, participants expressed a desire for continued support, information access, and inclusion of patients as champions for knowledge dissemination. Future studies need to explore the provision of enabling structures to support nurse-led interventions in routine non-Communicable disease (NCD) care., Clinical Relevance: Hypertension knowledge-gaps exist among patients and may reflect missed opportunities for patient engagement and education for behavior change. Bundled nurse-led hypertension interventions can significantly improve lifestyle modification and enhance hypertension outcomes. Persons supported and empowered with knowledge can act as conduits to wider communities in championing knowledge dissemination., (© 2021 Sigma Theta Tau International.)

Background: Hypertension is the most common non-communicable disease in Uganda and its prevalence is predicted to grow substantially over the next several years. Rates of hypertension control remain suboptimal, however, due in part to poor medication adherence. There is a significant need to better understand the drivers of poor medication adherence for patients with non-communicable diseases and to implement appropriate interventions to improve adherence., Objective: The purpose of this study was two-fold. First, this study sought to understand what factors support or undermine patients' efforts to adhere to their hypertensive medications at baseline. Second, this study sought to explore the acceptability and feasibility of adherence interventions to both providers and patients., Methods: This study was conducted at a large, urban private hospital in Kampala, Uganda. We conducted key informant interviews with both providers and patients. We explored their beliefs about the causes of medication non-adherence while examining the acceptability of support strategies validated in similar contexts, such as: daily text reminders, educational materials on hypertension, monthly group meetings (i.e. "adherence clubs") led by patients or providers, one-on-one appointments with providers, and modified drug dispensing at the hospital pharmacy., Study Design and Participants: Fifteen healthcare providers and forty-two patients were interviewed. All interviews were transcribed, and these transcripts were analyzed using the NVIVO software. We utilized a conventional content analysis approach informed by the Health Belief Model., Results: Of the proposed interventions, participants expressed particularly strong interest in adherence clubs and educational materials. Participants drew connections between these interventions and previously underexplored drivers of non-adherence, which included the lack of symptoms from untreated hypertension, fear of medication side effects, interest in traditional herbal medicine, and the importance of family and community support., Conclusions: Both providers and patients at the facility recognized medication non-adherence as a major barrier to hypertension control and expressed interest in improving adherence through interventions that addressed context-specific barriers., Competing Interests: Declaration of Competing Interest Dr. Heller reports grant support from Teva Pharmaceutical Industries. However, this funding did not support any aspect of his time or effort in contributing to this manuscript. We have no other potential conflicts of interest to report. The manuscript and its associated research was supported entirely by the Arnhold Institute for Global Health and Clarke International University (the home institutions of several co-authors), and received no external funding., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

Background: The COVID-19 pandemic has exacerbated the consequences of a patient's admission to critical care settings, causing families to face more psychosocial issues than in previous years. Thus, nurses and other clinicians need to keep abreast of interventions that support the families of critical care patients., Objective: To provide evidence of nurse-led family interventions and their family outcomes in adult critical care settings., Design: A mixed method systematic review in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis checklist., Data Sources: The search included both a screen of relevant databases (PubMed, Scopus, Cumulative Index of Nursing and Allied Health Literature, and the Cochrane Library) and the screening of citations in relevant articles. Studies published in the English language between January 2010 and October 2020 were considered. The final database searches were performed on 20 October 2020., Methods: Screening and eligibility assessment were conducted using the Rayyan software. Studies describing the family outcomes of nurse-led interventions in adult critical care settings through either qualitative or quantitative methods were included, i.e., the mixed method synthesis permitted the inclusion of either qualitative or quantitative findings. Article quality was evaluated by three authors using the Joanna Briggs Institute's critical appraisal tools., Findings: A total of 15 studies - two trials, eight quasi-experimental studies, four qualitative, and one mixed method met the inclusion criteria. The described interventions were organized into five categories: educational/informational; family involvement in care; diary; communication; and bundled interventions. These categories varied in terms of elements, delivery, and family outcomes. Nurse-led interventions that resulted in small to medium improvements in family outcomes included educational interventions with digital storytelling, a bundled approach, informational nursing interventions, and nurse-driven emotional support. The included studies (n = 2) that investigated family rounds in the ICU reported that this approach did not noticeably influence family outcomes., Conclusion: The differences in the intervention elements, tools, and outcomes evaluated in this review reflect the diversity of family needs, and that numerous interventions have already been developed to promote family health in critical care settings. The evidence suggests that interdisciplinary nurse-led family interventions can improve family outcomes. Tweetable abstract: Interprofessional nurse-led family interventions draw on diverse approaches and improve family outcomes in adult critical care settings., Competing Interests: Declaration of Competing Interest The authors declare no conflict of interest., (Copyright © 2021 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Aim: To examine the impact of nursing leadership styles on intensive care unit quality measures., Background: Evidence on the impact of leadership styles has direct implications for building and strengthening leadership behaviours that foster quality nursing care in intensive care units., Evaluation: An integrative review approach was adopted. Databases including the Cumulative Index of Nursing and Allied Health Literature, PubMed, Scopus, ProQuest, Google Scholar and the Cochrane Library were searched., Key Issues(s): Out of 253 identified studies, seven were included in the review. Leadership styles in intensive care units include transformational, considerate, exemplary, trusted and absentee leadership. Active nurse leaders who share a common vision, and advocate for their staff are perceived as more effective than those who exhibit absentee characteristics. Structural measures influenced by leadership styles include productivity and morale of nursing staff. Outcome measures such as staff outcomes (intent to stay, job satisfaction), medication errors and periventricular/intraventricular haemorrhage in neonatal intensive care units have a positive relational effect with nursing leadership style., Conclusions: The findings highlight the link between nursing leadership styles on structural and outcome measures in intensive care units. The current literature lacks studies highlighting the impact of nursing leadership styles on process measures in intensive care units., Implications for Nursing Management: Transformational, considerate, exemplary leadership practices, and trusted leadership styles when used by nurse leaders guarantee higher quality of nursing care in intensive care units. Therefore, modern leadership styles need to be supported by health care organisations and education., (© 2020 John Wiley & Sons Ltd.)

Background: NCDs are the greatest global contributors to morbidity and mortality and are a major health challenge in the 21st century. The global burden of NCDs remains unacceptably high. Access to care remains a challenge for the majority of persons living with NCDs in sub-Saharan Africa. In Uganda, 55% of refugee households, including those with chronic illnesses, lack access to health services. Of these, 56% are in the West-Nile region where the Bidibidi settlement is located, with 61% of its refugee households in need of health services especially for NCDs (UNHCR, 2019). Data on NCDs in Bidibidi are scarce. Unpublished health facilities' (HFs) data indicate that cardiovascular diseases (CVDs) (54.3%) and metabolic disorders (20.6%) were the leading causes of consultation for major NCDs (IRC, 2019). No readiness assessment has ever been conducted to inform strategies for the efficient management of NCDs to avert more morbidity, mortality, and the economic burden associated with NCD management or complications among refugees. This study sought to determine the readiness of HFs in managing hypertension (HTN) and diabetes cases at primary health facilities in the Bidibidi refugee settlement, Yumbe district, Uganda., Methods: The study used facility-based, cross-sectional design and quantitative approach to assess readiness for the management of HTN and diabetes. All the 16 HFs at the Health Centre III (HCIII) level in Bidibidi were studied, and a sample size of 148 healthcare workers (HCWs) was determined using Yamane's formula (1967). Proportionate sample sizes were determined at each HF and the simple random sampling technique was used. HF data were collected using the Service Availability and Readiness Assessment (SARA) checklist and a structured questionnaire used among HCWs. Data were analyzed using SPSS version 20. Univariate analysis involved descriptive statistics; bivariate analysis used chi-square, Fisher's exact test, and multivariable regression analysis for readiness of HCWs., Results: 16 HCIIIs were studied in five zones and involved 148 HCWs with a mean age of 28 (std ±4) years. The majority 71.6% (106) were aged 20-29 years, 52.7% were females, and 37.8% (56/148) were nurses. Among the 16 HFs, readiness average score was 71.7%. The highest readiness score was 89.5% while the lowest was 52.6%. The 16 HFs had 100% diagnostic equipment, 96% had diagnostics, and 58.8% had essential drugs (low for nifedipine, 37.5%, and metformin, 31.2%). Availability of guidelines for the management of HTN and diabetes was 94%, but only low scores were observed for job aid (12.5%), trained staff (50%), and supervision visits (19%). Only 6.25% of the HFs had all the clinical readiness parameters. On the other hand, only 24% (36) of the HCWs were found to be ready to manage HTN and diabetes cases. Chi-square tests on sex ( p < 0.001), education level ( p =0.002), and Fisher's tests on profession ( p < 0.001) established that HCWs with bachelor's degree (AOR = 3.15, 95% CI: 0.569-17.480) and diploma (AOR = 2.93, 95% CI: 1.22-7.032) were more likely to be ready compared to the reference group (certificate holders). Medical officers (AOR = 4.85, 95% CI: 0.108-217.142) and clinical officers (AOR = 3.79, 95 CI: 0.673-21.336) were more likely to be ready compared to the reference group, and midwives (AOR = 0.12, 95% CI: 0.013-1.097) were less likely to be ready compared to the reference group. In addition, female HCWs were significantly less likely to be ready compared to male HCWs (AOR = 0.19, 95% CI: 0.073-474)., Conclusion: HFs readiness was high, but readiness among HCWs was low. HFs had high scores in equipment, diagnostics, and guidelines, but essential drugs, trained staff, and supervision visits as well HCWs had low scores in trainings and supervisions received. Being male, bachelor's degree holders, diploma holders, medical officers, and clinical officers increased the readiness of the HCWs., Competing Interests: The authors declare that they have no conflicts of interest in this study and its outcomes., (Copyright © 2021 Vuchiri Ray Isadru et al.)

Evidence regarding the role of nurses-in-leadership and how to engage nurses in policy decisions is minimal in sub-Saharan Africa. The purpose of this study was: (1) to assess the leadership practices of nurses-in-leadership in Uganda (by self-report) and from the perspective of 'followers' (direct-report, peers, co-workers, other); and (2) to determine factors (positively) associated with leadership practices. We surveyed 480 nurses, 120 in leadership roles (Response Rate 57%) and 360 'followers' (Response Rate 60%), who were recruited from five hospitals in Kampala, Uganda. We used the Leadership Practice Inventory (Self and Observer), a project-specific demographic questionnaire and Denison's Organizational Culture Survey (DOCS). Sixty-three per cent of the respondents held a registered nursing certificate; 79% had received formal leadership training; 47% were based in private for-profit (PFP) hospitals, 28% in private not-for-profit (PNFP) and 25% in public hospitals. Among the five leadership practices, nurses-in-leadership used the practice of Model the Way (M = 8.27, SD = 1.30), Challenge the Process (M = 8.12, SD = 1.30) and Encourage the Heart (M = 8.04, SD = 1.51) more frequently (on a 10-point Likert Scale). Inspire a Shared Vision (M = 7.82, SD = 1.57) and Enable Others to Act (M = 7.62, SD = 1.66) practices were used less frequently. The same rank order was true for leadership scores from the perception of followers. However, leadership scores by followers were significantly lower (P < 0.01) than the nurse leader self-reported scores across all sub-scales. Leadership practice scores were higher in public than private hospitals (P < 0.0001). Organizational culture (OC) was associated (P < 0.001) with leadership practices. Although overall leadership practice scores were generally high, the less frequent use of Inspire and Enable practices suggests opportunities for targeted improvement. Moreover, differences between self-reported and leadership scores by followers suggest perception gaps between leaders and their followers. The positive relationship between public hospital settings and self-reported leadership practices among nurses-in-leadership suggests that important nursing leadership practices are possible even in a low-resource clinical setting., (© The Author(s) 2020. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine.)

Background: Hypertension is increasingly prevalent in Uganda and its clinical management remains suboptimal across the country. Prior research has elucidated some of the factors contributing to poor control, but little is known about providers' approaches to hypertension management and perceptions of barriers to care. This is particularly true in private health care settings - despite the fact that the private sector provides a substantial and growing portion of health care in Uganda., Objective: Our exploratory, pragmatic qualitative study aimed to examine the factors affecting the quality of hypertension care from the perspective of providers working in an urban, private hospital in Uganda. We focused on the organizational and system-level factors influencing providers' approaches to management in the outpatient setting., Methods: We conducted interviews with 19 health care providers working in the outpatient setting of a 110-bed, private urban hospital in Kampala, Uganda. We then coded the interviews for thematic analysis, using an inductive approach to generate the study's findings., Findings: Several themes emerged around perceived barriers and facilitators to care. Providers cited patient beliefs and behaviors, driven in part by cultural norms, as a key challenge to hypertension control; however, most felt their own approach to hypertension treatment aligned with international guidelines. Providers struggled to collaborate with colleagues in coordinating the joint management of patients. Furthermore, they cited the high cost and limited availability of medication as barriers., Conclusions: These findings offer important strategic direction for intervention development specific to this Ugandan context: for example, regarding culturally-adapted patient education initiatives, or programs to improve access to essential medications. Other settings facing similar challenges scaling up management of hypertension may find the results useful for informing intervention development as well., Competing Interests: Allison Squires receives payments for editorial work through Elsevier, and also has her own consulting company. However, it does not overlap in this space. David J. Heller reports grant support from Teva Pharmaceuticals. However, this entity was not involved in any aspect of the design, conduct, or analysis of this study; the content of this manuscript; nor the decision to publish., (Copyright: © 2020 The Author(s).)

Aim: The aim of the study was to test a nurse-led intervention to enhance lifestyle modification and improve hypertension outcomes., Background: Hypertension is the leading modifiable contributor to non-communicable disease morbidity and mortality affecting more than 25% of adults in Uganda., Methods: A mixed-method study was conducted to evaluate nurse-led interventions for hypertension. Group education and support with text message follow-up was the bundled interventions implemented in an outpatient clinical setting., Conclusion and Implications: The statistically favourable outcomes of the nurse-led interventions support a cost-effective approach to, with policy support, sustainably improve practice outcomes., (© 2019 International Council of Nurses.)