Barriers to and facilitators of linkage to care following hypertension and diabetes screening among health workers in Zimbabwe: A mixed method study.

Abstract

The benefits of screening for any condition are only realised if individuals who screen positive link to care services. We investigated linkage to hypertension and diabetes care by healthcare workers accessing a comprehensive health check service. We also explored facilitators and barriers to linkage to care. Between July 2020 and June 2022, a health check with referral and follow-up was offered to healthcare workers (clients) in Zimbabwe. We aimed to understand the proportion that linked to care after referral for an elevated blood pressure and/or HbA1c, assessed by follow-up phone calls. Linkage to care was defined as self-report of having seen a health professional within 30-60 days of the positive screening test result. In-depth interviews were conducted with 15 clients to understand associated facilitators and barriers. Overall, 3,143 clients accessed screening services. The majority were women (75.7%), and median age was 37 (IQR: 28-46) years. 785 (25.0%) clients screened positive for hypertension and 279 (8.9%) screened positive for diabetes. Clients referred for diabetes were more likely to accept referral (n=212, 72.0%) than those referred for hypertension (n=323, 41.1%). Among those referred and successfully contacted for follow-up, 131/182 (72.0%) reported having linked to care for diabetes and 218/269 (81.0%) for hypertension. Distance, accessibility, and travel costs to the facility they were referred to, influenced the decision and ability to link to care. While linkage to care for hypertension and diabetes was high among those who accepted referral, many healthcare workers did not accept referral. Greater awareness among healthcare providers regarding the importance of NCD care to improve acceptance of referral is required and every step of the care cascade must be affordable, accessible, and patient-centred.