**5. Collaborations with family and communities**

Collaboration is about working together to achieve a particular purpose; in this context working together to achieve improved health outcomes using cost-effective interventions. The components of collaborations include openness, focus, accountability, and knowledge sharing [23]. Collaboration in health care is defined as professionals assuming complementary roles and cooperatively working together, sharing responsibility for problem-solving and making decisions to formulate and carry out plans for patient care [23]. Collaboration is about teamwork, which when applied in health care implies interdisciplinary approach. Unlike a multidisciplinary approach, in which each team member is responsible only for the improved healthcare collaboration has been cited as a key strategy for healthcare reform [24]. So far, collaboration in health care improved patient outcomes such as reducing preventable adverse drug reactions, decreasing morbidity and mortality rates, and optimizing medication dosages [23]. In addition, teamwork is beneficial to healthcare providers by reducing extra work and increasing job satisfaction [23]. Most of the care of outpatients takes place where they reside; therefore, there is a need for health care to collaborate with family members and communities for improved outcomes using cost-effective strategies.

**Figure 1** shows the collaboration of communities and families of patients in providing an appropriate care.

### **5.1 Collaboration with families**

Family is regarded as the most important source of social support and is tightly related with self-care activities and improved health outcomes [25]. Since most of the patients with heart failure live with other family members at home, participation and support of family members can play a key role in self-care behaviors and efficiency of disease control, as shown in **Figure 1**. Therefore, family can influence a patient's

**Figure 1.** *Collaborating in the care of patient.*

#### *Cost-Effective Interventions to Curb Cardiovascular Diseases in Africa DOI: http://dx.doi.org/10.5772/intechopen.105464*

success and stability of their behavior change in self-care programs. Several studies revealed the association between family support and heart failure patients' self-care [26, 27]. Earlier studies showed that patients with more support had better compliance of self-care health behaviors. Adherence to self-care behaviors such as restricting fluid intake, regular medication, and exercise are associated with patients with social or family support [28]. It has been found that the level of family support was directly associated with adherence to dietary modification and other dimensions of self-care in heart failure patients [29].

Family members, who provide support at home, were found to have inadequate knowledge regarding management of disease, its signs and treatment [29]. In addition, they were found not to have knowledge on how best to support and encourage patients to follow self-care behaviors [29]. Therefore, the support from families with inadequate knowledge may be harmful and lead to poor health outcomes [30]. Hence, collaboration of primary healthcare providers with family in the care of patients is significant [31] and can close identified knowledge gap. In addition, the primary healthcare providers could play a significant role in support, education, counseling, and taking care of patients diagnosed with cardiovascular diseases and their caregivers or family members [32]. The collaboration can help in familiarizing family members of patients' necessary behavioral changes to equip them to act as a knowledgeable and capable source of family-focused nursing at home where most care happen [32]. It has been reported that effective behavioral changes require baseline line analysis to gain insight into family dynamics and mutual interdependence of the family system [33]. Interventions which target family members, caregivers, and children, encourage communication among family unit, and address the structural and environmental conditions in which families live and operate, are likely to be the most effective approach to promote cardiovascular health [33]. Therefore, there is a need for the adoption of the family-centered care approach.

Family-centered care (FCC) is considered as an approach of responding to the needs, values, and cultural needs of the patient and their families [32] and begins from consultation at the healthcare facility involving healthcare professionals, patients, and family members, being involved in decision-making and shared leadership [31]. Family members are often asked to share responsibility in support of the person living with diabetes; this responsibility includes driving patients to appointments, and social and emotional support, among others. The FCC has so far produced better outcomes in younger children who are usually cared for by their parents or families, since younger children are unable to perform certain tasks related to selfcare [34]. The aim of the FCC is to maintain and strengthen family bond and roles so as to provide healthy family functioning, and at the same time improving the quality of life (QoL) of patients, as well as minimizing new cases involving family members who are already at risk due to family history [35].

#### **5.2 Collaboration with communities**

Collaboration with communities was found to be essential and cornerstones of efforts to improve public health [36]. A community can be regarded as the social and political networks that link individuals, community organizations, and leaders [37]. Therefore, it is critical to understand these networks in planning engagements with communities. The purpose of community engagement is to build trust, enlist new resources and allies, create better communication, and improve overall health outcomes [37, 38]. The importance of collaboration with communities derives from

acknowledgment that lifestyle, behaviors, and the incidence of illness are all shaped by social and physical environments [38]. Community engagement and mobilization have been critical in addressing smoking cessation, obesity, cancer, heart disease, and other health concerns [37, 38]. Community awareness campaigns or intervention which involves communities during planning were essential in identification of most pertinent health issues as well as to design the most effective and appropriate strategies to solve them [39]. **Figure 1** indicates that working together with all stakeholders within communities is required to effectively change environmental and organizational conditions that promote rather that inhibit healthy lifestyles [36].

A community collaboration that considers the behavioral risks of associated with increased chances of development of CVD has the potential to improve access to health checks [37]. These could be an effective strategy for improved implementation and uptake of health checks leading to early detection and management of CVDs. Community engagement is defined as the process of working collaboratively with and through groups of people affiliated by geographic proximity, special interest, or similar situations, to address issues affecting the well-being of those people [37]. A review on community engagement interventions was conducted and the findings showed that it is effective in improving health behaviors, health consequences, and psychological outcomes [40].

It has been found that a healthy community has well-connected, interdependent sectors that share responsibility for recognizing and resolving problems, including enhancing its well-being [40]. Effective and successful community interventions are based on integration, collaboration, and coordination of resources from all parts [40]. Health can be impacted by social factors; therefore, it is significant to engage stakeholders within the communities who can bring their own perspectives and understandings of community life and health issues to help in developing an intervention [38].
