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Barriers to evidence-based acute stroke care in Ghana: a qualitative study on the perspectives of stroke care professionals
  1. Leonard Baatiema1,2,
  2. Ama de-Graft Aikins1,
  3. Adem Sav3,
  4. George Mnatzaganian4,
  5. Carina K Y Chan5,
  6. Shawn Somerset3
  1. 1 Regional Institute for Population Studies, University of Ghana, Accra, Legon, Ghana
  2. 2 School of Allied Health, Faculty of Health Sciences, Australian Catholic University, Sydney, Australia
  3. 3 School of Allied Health, Faculty of Health Sciences, Australian Catholic University, Brisbane, Australia
  4. 4 College of Science, Health and Engineering, La Trobe Rural Health School, La Trobe University, Melbourne, Australia
  5. 5 School of Psychology, Faculty of Health Sciences, Australian Catholic University, Brisbane, Australia
  1. Correspondence to Leonard Baatiema; baatiemaleonard{at}


Objective Despite major advances in research on acute stroke care interventions, relatively few stroke patients benefit from evidence-based care due to multiple barriers. Yet current evidence of such barriers is predominantly from high-income countries. This study seeks to understand stroke care professionals’ views on the barriers which hinder the provision of optimal acute stroke care in Ghanaian hospital settings.

Design A qualitative approach using semistructured interviews. Both thematic and grounded theory approaches were used to analyse and interpret the data through a synthesis of preidentified and emergent themes.

Setting A multisite study, conducted in six major referral acute hospital settings (three teaching and three non-teaching regional hospitals) in Ghana.

Participants A total of 40 participants comprising neurologists, emergency physician specialists, non-specialist medical doctors, nurses, physiotherapists, clinical psychologists and a dietitian.

Results Four key barriers and 12 subthemes of barriers were identified. These include barriers at the patient (financial constraints, delays, sociocultural or religious practices, discharge against medical advice, denial of stroke), health system (inadequate medical facilities, lack of stroke care protocol, limited staff numbers, inadequate staff development opportunities), health professionals (poor collaboration, limited knowledge of stroke care interventions) and broader national health policy (lack of political will) levels. Perceived barriers varied across health professional disciplines and hospitals.

Conclusion Barriers from low/middle-income countries differ substantially from those in high-income countries. For evidence-based acute stroke care in low/middle-income countries such as Ghana, health policy-makers and hospital managers need to consider the contrasts and uniqueness in these barriers in designing quality improvement interventions to optimise patient outcomes.

  • Stroke care
  • barriers
  • evidence-based practice
  • implementation
  • stroke service
  • developing countries
  • Africa

This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) license, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is properly cited. See:

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  • Contributors Study design and instrumentation process: LB, Ad-GA, GM, SS. Participants recruitment: LB, Ad-GA. Data collection, analysis, interpretation and writing of first manuscript: LB. Contribution to study interpretation and critical review of the manuscript: LB, Ad-GA, AS, GM, CKYC and SS. All authors have made substantial contribution to the writing of this manuscript for critical intellectual content. All authors have reviewed and approved the final version for submission.

  • Funding LB is a PhD candidate funded under the University International Students Scholarship programme. LB also received funding support from the University Faculty of Health Science Higher Degree Research (HDR) Student Support Scheme during his candidature. However, these funding bodies did not play a role in the study design, data collection and analysis, results interpretation, writing of the entire manuscript and the decision to submit the manuscript to this journal.

  • Competing interests None declared.

  • Ethics approval Australian Catholic University Human Research Ethics Committee (2015-154H), the Ghana Health Service Ethical Review Committee on Research Involving Human Subjects (GHS-ERC: 11/07/15), the Committee on Human Research Publications and Ethics of the School of Medical Sciences of the Kwame Nkrumah University of Science and Technology and the Komfo Anokye Teaching Hospital (CHRPE/AP/141/16) and lastly the institutional Review Board of the 37 Military Hospital (37MH-IRB IPN 035/2015).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement No additional data are available.

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