PERCEPTION OF HEALTH STAKEHOLDERS ON BARRIERS AND FACILITATORS OF CARDIOVASCULAR RISK MANAGEMENT IN SANTANDER, COLOMBIA: A QUALITATIVE STUDY OF REHOPE PROJECT

Objective: To identify the perceptions and narratives of institutional actors in the departmental health system in Santander Colombia, on facilitators and barriers in the management of cardiovascular risk in people with hypertension participating in the REHOPE study. Design and method: Qualitative phenomenological study, based on the study of the implementation of a community-based strategy, REHOPE, for the management of cardiovascular risk and the control of arterial hypertension. The study was endorsed by the Bioethics Committee of the University of Santander. Focus groups were conducted with health stakeholders, such as local authorities, insurers, and providers of health services, between December 2022 and February 2023. The meetings were recorded and transcribed using the NVivo Transcription add-on and analysed with the same software Version Release 1.6.1. An interpretative analysis was made through open and axial coding, identifying categories and subcategories and then quality criteria were evaluated. Results: A total of 25 representatives of the three types of stakeholders included, distributed in five focus groups, participated. The majority were women, and all were health professionals in different areas. Seven categories were identified: strategies, resources, access, risk measurement, intersectorality, articulation and stewardship. The main barriers to risk management were the lack of access to health services, the absence of multistakeholderness. and the scarcity of data and information. These were mainly outlined by insurers and providers of services. As facilitators, mainly from the territorial entity, leaderdship, and governance to advance the implementation of public policy emerged. All of them recognised the importance of having a clear purpose and the need to improve, as well as the importance of educating and providing continuity of care for people. Conclusions: Perceptions and narratives varied according to the type of actor, showing gaps in articulation and intersectorality. One of the main opportunities for improvement and facilitators identified was the implementation of initiatives that encourage community and leaders involvement, as well as greater literacy for people.