Advancing Physiotherapy-led health promotion to decrease cardiovascular disease in Cameroon

Background

Cardiovascular diseases (CVDs) and their associated risk factors are among the leading causes of illness and death globally, with particularly high impact in low- and middle-income countries such as Cameroon. Most individuals utilising physiotherapy services in Cameroon have CVDs, complications related to these conditions or present with cardiovascular risk factors. Physiotherapists play a major role in preventing and managing these health issues, with physiotherapist-led health promotion (PLHP) interventions shown to effectively enhance health outcomes for people at risk of or living with CVD (pwCVDs). However, the extent of Cameroonian physiotherapists’ engagement in health promotion (HP) activities remains uncertain. Understanding patients' perspectives is essential for developing effective, contextually relevant PLHP interventions. This study aimed to explore PLHP from the viewpoints of both physiotherapists and pwCVDs to inform recommendations that can enhance HP practices in Cameroon.

Methods

This research was guided by a pragmatic philosophical approach and comprised four studies. Study one was a systematic scoping review which evaluated existing global evidence on PLHP. Study two was a national, cross-sectional survey of Cameroonian physiotherapists to examine their involvement in HP. Study three was a qualitative study conducted with Cameroonian physiotherapists to explore their perspectives on HP for pwCVD. Thematic content analysis was employed for data analysis using NVIVO 12. Study four was a sequential mixed methods study conducted with a sample of pwCVD in Cameroon to explore their perspectives upon and experiences of PLHP. The quantitative data was analysed descriptively, and a two-stage reflective thematic analysis was employed for qualitative data.

Results

Study 1: The systematic scoping review included 20 studies with varied populations, including those with stroke, coronary artery disease, peripheral artery disease, hypertension, diabetes and multiple risk factors. Identified HP strategies range from exercise and physical activity programmes, dietary interventions, education, and counselling sessions with various supplementary approaches. Study 2: the survey findings from physiotherapists revealed that of 181 respondents, 95% (n=172) reported delivering HP to pwCVDs, addressing various health behaviours. However, HP practices were generally unsystematic and influenced by intra and interpersonal, institutional factors. Study 3: qualitative data from 16 Cameroonian physiotherapists highlighted gaps in awareness and understanding of key health behaviour theories and concepts relevant to HP interventions and assessments. Study 4: the mixed-methods study indicated that pwCVDs expressed strong confidence in physiotherapists. In person treatment and dietary advice were deemed highly useful and acceptable.

Conclusion

Physiotherapists in Cameroon hold great potential to reduce the CVD burden. Despite evident interest and current participation in PLHP, the current approaches towards HP identified within this research programme were inconsistent and unsystematic. The variation in practices and lack of evidence-based approaches indicate a need for investment in capacity-building and comprehensive physiotherapy approaches that support long-term health and well-being. Recommendations are provided to enhance physiotherapy practice, public health messaging, and training, aligned with a healthcare model that shifts from “diagnose and treat” to “predict and prevent.”