Training of primary care nurses in addressing noncommunicable diseases prevention, surveillance, and management: Endline evaluation of an implementation research project conducted in Hwange District, Zimbabwe

Abstract

Background: Noncommunicable diseases (NCDs) cause over 70% of global deaths, with 33% of deaths in Zimbabwe attributed to NCDs. Rural districts face severe workforce and resource shortages. We evaluated an effective end–line training program for primary care nurses (PCNs) in Hwange District to strengthen NCD prevention, surveillance, and management. Materials and Methods: In March 2025, 14 nurses from seven primary clinics completed a posttraining survey. A validated questionnaire (Cronbach’s α= 0.89) assessed self-rated competency (1–4) across six prevention, six surveillance, and five management domains, and perceptions of module usefulness and healthsystem readiness on a 5-point Likert scale. We calculated descriptive statistics, reliability, normality (Shapiro–Wilk), and U-tests for gender comparisons. Ethical approval was obtained and consent provided. Results: Participants were 71.4% female, mean age 44.1±6.1 years with 14.0±4.1 years of experience. High self-rated competency in prevention was highest for alcohol use and diet (71.4% each) and lowest for tobacco use and mental health (57.1% each). Surveillance knowledge peaked for diet (78.6%) and was lowest for alcohol (50.0%). Management competency was highest for hypertension (71.4%) and lowest for cancer (21.4%) and heart disease (35.7%). Despite high module usefulness ratings (78.6%–92.9%), 71.4% reported insufficient resources and 85.7% reported medication stockouts. No gender differences emerged (U= 27.0, P= 0.346). Conclusion: These findings provide actionable evidence to support the scale-up of nurse-led NCD services in line with national strategies and global goals. Task-shifting NCD care to PCNs is feasible and enhances self-reported competencies. To sustain rural services, targeted mentorship, supply-chain strengthening, and focused training on tobacco control, mental health, and complex disease management are essential using implementation research.