Browsing by Author "Shrestha, Archana"
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Publication Antihypertensive Medication Adherence and Associated Factors among Hypertensive Patients(Nepal Health Research Council, 2025) Baral, Phanindra; Poudel, Lisasha; Bista, Bihunghum; Mali, Sushmita; Baral, Niraj; Shrestha, ArchanaBackground: Hypertension is a significant public health concern in Nepal, particularly in rural areas with limited healthcare access. Adherence to antihypertensive medication is critical for adequate blood pressure control and reducing cardiovascular complications. This study aims to assess medication adherence among hypertensive patients and identify associated factors. Methods: A descriptive cross-sectional study was conducted in Namobuddha Municipality, Nepal. A total of 2,024 individuals aged 30 years and older were screened, of which 1,008 were identified as hypertensive. After applying the eligibility criteria, 478 participants were included in the final analysis. Medication adherence was assessed using the Hill-Bone Compliance to High Blood Pressure Therapy (HBCHBPT) Scale. Data were collected through face-to-face interviews using standardized questionnaires and analyzed using STATA version 17. Multivariate linear regression was performed to determine factors influencing adherence. Results: Among 478 participants, the mean age was 62.12 years, with 55.86% being female. Most participants (91.63%) were on a single antihypertensive medication, and 57.11% had uncontrolled hypertension. The mean medication adherence score was 34.57 ± 1.90. In multivariate analysis, higher hypertension knowledge scores were significantly associated with better medication adherence (? = 0.07, 95% CI: 0.01, 0.13, p = 0.03). Other factors, including age, gender, education, ethnicity, marital status, smoking, alcohol use, physical activity, and social support, were not significantly associated with adherence. Conclusions: The study found that medication adherence among hypertensive patients was suboptimal, with a significant proportion having uncontrolled blood pressure. Higher hypertension knowledge was associated with better adherence, highlighting the importance of patient education. Strengthening educational interventions and counseling strategies may improve adherence and, consequently, hypertension control. Keywords: Antihypertensive drugs; blood pressure control; hypertension; medication adherence; rural Nepal.Publication Evaluation of Self-vision Assessment Charts in Schools of Eastern Nepal: A Multi Method Study(Nepal Medical Association, 2024) Shrestha, Archana; Thakur, Sudhir Kumar; Roshan, Abhishek; Singh, Sanjay Kumar; Pokhrel, Archana; Bohara, Apekshya; Poudel, Lisasha; Thakur, Chanda; Adhikari, Asmita; Timsina, Priyanka; Acharya, Yunika; Karn, Rajiv RanjanAbstract Introduction: Globally, over two billion people suffer from vision impairment, almost half preventable. In Nepal, the Eastern Regional Eye Care Program introduced self-vision assessment charts in 137 schools for early eye issue detection. This study assessed the charts' use and perceived impact. Methods: A multi-method study was conducted to evaluate the use of self-vision assessment charts in schools in Eastern Nepal. Ethical approval was obtained from Institutional Review Board (Refrence number: 72-079-040). Quantitative data were collected through a questionnaire survey. Quantitative data were analyzed using descriptive statistics, while qualitative data were analyzed using framework analysis. Both methods were integrated to enhance understanding of participants' experiences. Results: In this study, 400 students participated in questionnaire survey, 180 in self vision assessment, and 16 teachers in in-depth interviews. Among the participants, 198 (49.50%) of students used the chart, 125 (65.78%) expressed satisfaction, 241 (60.25%) found it useful, 276 (69%) as beneficial, and 253 (63.25%) stated improved health. There were 93 (23.25%) students who felt knowledgeable about its use, with 18 (10%) using it correctly. In 162 (90%) of schools there were adequate chart placement, 23 (12.77%) provided clear signage for viewing points. Teachers recognized the chart's benefits and encouraged its use, but students lacked awareness. Regular use was viewed as beneficial for early detection of eye issues, though challenges included a need for more awareness among students and teachers and reliance on home remedies. Conclusions: Most students and teachers acknowledged self-vision assessment charts’ benefits but had low utilization and accuracy rates. Strategic interventions such as regular informational sessions, teacher motivation, and engagement with eye health experts are essential.Publication Reinforcement of Peer-Coaching and Clinical Audit to improve Implementation of the Package of Essential Non-Communicable Diseases (PEN) in Nepal: A Pilot Implementation Study Method(Nepal Medical Association, 2025) Prajapati, Dipanker; Sapkota, Sujata; Suwal, Punya Shori; Aryal, Anu; Maharjan, Rashmi; Magar, Sudip Ale; Magar, Kamala Rana; Poudel, Kabita; Pyakurel, Prajjwal; Vaidya, Abhinav; Shrestha, ArchanaAbstract Introduction: Nepal endorsed and implemented the WHO Package of Essential Non-communicable Disease Intervention. However, its implementation is far from satisfactory. We designed and implemented an intervention to reinforce peer coaching and clinical audit mechanisms in primary- level health facilities, and tested its feasibility and preliminary effectiveness. This paper details the methodology used in designing, implementing and assessing the intervention. Methods: The study adoptes a hybrid type II implementation trial design. The intervention assignment followed a non-blinded, two-arm, parallel randomized controlled trial design with a 1:1 allocation ratio. Seventeen primary-level public health facilities with at least one trained staff were randomized. The clinical staff at the intervention health facilities received peer-coaching and clinical audit reinforcement, while the control group followed their usual practice. The study was conducted over a 12-month duration. A mixed-method approach, applying pre-post assessment and thematic analysis, to inform the intervention development and assess implementation outcomes and its effectiveness was. The study was guided by the Proctor framework. Ethical clearance was obtained from the Nepal Health Research Council (Registraion number: 30212021). Discussion: The tools and methods that guide intervention implementation and assessment have the potential to be replicated in various settings to design strategies to improve Package of Essential Non-communicable Disease Intervention adoption and sustainment.