Recruitment of participants was supported by the management of these institutions who assisted in identifying suitable participants. Those who were willing to participate were then asked to sign consent forms (one consent form per participant). Interviews lasted between 35 and 65 minutes.
Focus group discussions
To understand patients’ perspectives on Ghana’s response to diabetes and hypertension, two separate focus group discussions were conducted. In the Greater Accra Region, diabetes/hypertension clinics involving doctors, nurses and patients are held to educate patients on these diseases. The research team were invited to interact with patients during the weekly-held diabetes/hypertension clinics after making contact with health staff. The team used the opportunity to introduce the study to patients and invited them to voluntarily participate in the study. In the Central Region, because there were no hypertension/diabetes clinics, health staff contacted patients using hospital records and invited them specifically for the focus group discussion. In both cases, patients who agreed to be part of the study signed consent forms and were recruited into the study using a recruitment script that was designed. Each focus group included patients – one focus group included patients who were diagnosed with, and were undergoing treatment for diabetes; and the other group included patients who were diagnosed with and were undergoing treatments for hypertension. Some patients had both diabetes and hypertension and were included in both groups. Each group consisted of nine patients.
Documents
Data from the following documents were combined with interview and focus group data:
- Ministry of Health policy documents
- Ghana Health Service documents
- Annual reports detailing yearly activities in response to hypertension/diabetes
- Program of work documents
- Municipal reports and documents
- WHO protocols and other documents
Data collection
Approvals for the study were obtained from the University of Canterbury’s Human Ethics Committee and the Ghana Health Service Ethics Review Committee. Data collection began on 25th June, 2017 and ended on 7th October, 2017. A semi-structured interview guide was prepared ahead of data collection for interviewing participants who fitted into different stakeholder categories, or who perform different roles even within the same stakeholder group. Thus, a single format interview guide was not used in this study. Interview guides consisted of open-ended questions based on the study objectives. Focus group discussions lasted for about 90 minutes per session. Patients were invited to share their experiences on how their conditions were being managed.
Data analysis
Raw data from the participants were obtained in the form of audio recordings (interviews and focus groups) which were then transcribed verbatim as hand-written pages. Hand-written documents and soft copies of other documents for the study were entered into NVivo 11 software. Data were then coded using NVivo 11 software with nodes being guided by the objectives of the study in the identification of categories and themes. Findings of the study are presented in the form of themes and sub-themes in line with the objectives of the study. Verbatim statements of participants are presented to support key themes and sub-themes that reflect study findings.