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Background: Many of the 28 million deaths from noncommunicable diseases (NCDs) in low- and middle-income countries each year could be prevented through early detection and intervention. The introduction of screening for NCDs in community pharmacies (CPs) in Ghana could enhance access to early detection. Methods: We surveyed clients in three districts in suburban Ghana to assess perceived need for screening, willingness to be screened in CPs, and willingness to receive NCD health promotion information through text messages (NCD m-Health). We performed regression analysis to identify predictors of NCD m-Health acceptability. Results: We interviewed 330 clients in six CPs, 134 (42.3%) of whom were females. The median age was 34 years (interquartile range, 27-43). Fifty-four (16.4%) had no formal education. Although most respondents knew obesity (74.9%), smoking (81.9%), and excessive dietary salt (91.7%) were risk factors for NCDs, only 27.0% knew family history carried similar risk. Most respondents, 61.6% and 70.6%, respectively, had not had their weight and blood pressure (BP) checked for more than 12 months. These included about a third of respondents who were known hypertensives. Similarly, 71.3% of 80 participants with a family history of hypertension had not had their BPs checked. Screening for NCDs in CPs and the sending of NCD m-Health messages was deemed acceptable to 98.5% and 83.1% of the participants, respectively. Formal education beyond junior high school (Grade 9) was the strongest independent predictor of NCD m-Health acceptance (OR = 4.77; 95% CI, 1.72-13.18; P value < 0.01). One hundred and twenty-five (39.4%) participants indicated they would consider unsolicited NCD m-Health messages an invasion of their privacy. Conclusion: An urgent need exists to promote access to NCD screening in these communities. Its introduction into CPs is acceptable to nearly all the clients surveyed. The introduction of NCD m-Health as an accompaniment requires consideration for the privacy of clients.
The study was conducted in CPs in the Asuogyaman, Lower Manya Krobo, and Yilo Krobo districts of the Eastern region of Ghana. The three districts have a combined population of about 400 000. Most inhabitants live in rural settlements. The main occupations are subsistence farming and fishing. The most common ethnic groups are the Ga‐Adangbes and Akwamus. The respective district capitals, Akosombo, Odumase, and Somanya, are all suburban. Each district has at least either a district hospital (Asuogyaman, Lower Manya Krobo) or a polyclinic (Yilo Krobo) that are staffed by a medical officer and where comprehensive services, including special clinics and surgeries, are performed. The public health services in the three districts are managed by the District (and Municipal) Health Management Teams. The approach to the delivery of public health services is based on the PHC concept, with emphasis on the control of communicable diseases and provision of maternal and child health services. The delivery of adult health services including NCD screening remain largely at the level of health centers and hospitals at subdistrict and district levels, respectively. The most decentralized form of health service provision are privately owned CPs and over‐the‐counter–medicine shops. There is a total of nine CPs in the three districts. Over a 6‐week period, adult (aged ≥18 y) clients at six selected CPs in the three districts were interviewed using a questionnaire that inquired into sociodemographic background, personal and family history of hypertension and diabetes, access to screening for hypertension and diabetes, and willingness to avail oneself of CP‐based screening services and to receive NCD‐related health promotion messages via text messaging (m‐Health). The input of the owners of CPs, experienced local public health practitioners, and program officers of community‐based health programs were sought to finalize the questionnaire. The most highly patronized CPs in the three districts were selected, and the owners were approached for permission to interview clients. At the time of the study, none of the selected CPs was offering NCD screening services. All adult clients reporting to the CPs during the day were targeted to be interviewed. The interviews were conducted by trained research assistants and in dialects that clients were comfortable to speak in. Most of the questions on the questionnaire were close ended. The data were entered into a computer using a platform created in Microsoft Access 2013. Double data entry was used to ensure accuracy. Data were then exported into Stata (version 12, College Station, Texas) for analysis. Sociodemographic variables were analyzed descriptively using chi‐square and means. Proportions and percentages were computed based on the number of respondents who agreed to respond that specific question. Willingness to be screened and to receive m‐Health messaging via text were analyzed using logistic regression. We included in the multivariate logistic regression model variables that were significant in bivariate analysis at a P value of less than 0.05. The final model was obtained using backward elimination procedures. The results of regression analysis are presented here as odds ratios (OR) with 95% confidence intervals (CI). All P values are derived from chi‐square analysis except in instances when contingency tables contain numbers that are less than five. In such instances, Fisher's exact estimates are reported. We planned to enroll 401 respondents on the basis that it will afford an estimation of the proportion of clients willing to be screened for NCD within a margin of error of 3.8% at 95% confidence level, assuming 80% of clients will consider it acceptable. The predicted level of acceptability was based on the finding of an acceptance level of 70% in a study in Ghana where actual testing was performed.27 The six selected CPs see about 12 000 clients in a year. The target sample size was not achieved due to logistical constraints (see below). The protocol for the study was reviewed and approved by the Institutional Review Board of the Ensign College of Public Health, Kpong, Ghana. Individual informed consent was obtained from each participant prior to the start of interview. The request to participate in the survey was made only after clients had been served at the CPs and were about to exit. No information that identified individual clients was obtained.
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