Barriers, Enablers and Strategies for the Treatment and Control of Hypertension in Nepal: A Systematic Review

Abstract

Background: Understanding country-specific factors influencing hypertension care is critical to address the gaps in the management of hypertension. However, no systematic investigation of factors influencing hypertension treatment and control in Nepal is available. This study aimed to systematically review the published literature and synthesise the findings on barriers, enablers, and strategies for hypertension treatment and control in Nepal.Methods: Embase, PubMed, Web of Science, CINAHL, ProQuest and WorldCat, and Nepali journals and government websites were searched for qualitative, quantitative, and mixed-methods studies on factors or strategies related to hypertension treatment and control in Nepal. Information from qualitative studies was analysed using template analysis, while results from quantitative studies were narratively synthesised. Summary findings were framed under “health system”, “provider”, and “patient” domains. The protocol was registered in PROSPERO (registration number: CRD42020145823).Results: We identified 15 studies; ten related to barriers and enablers and five to strategies. The identified barriers associated with the health system were: lack of affordable services and lack of resources. The barriers at the provider's level were: communication gaps, inadequate counselling, long waiting hours for appointments, lack of national guidelines for hypertension treatment, and provider's unsupportive behaviours. Non-adherence to medication, irregular follow-up visits, lack of awareness on blood pressure target, poor help-seeking behaviours, reluctance to change behaviours, perceived side-effects of anti-hypertensive medication, self-medication, lack of family support, financial hardship, lack of awareness on blood pressure complications, and comorbidity were barriers identified at patient level. The following enablers were identified: free essential health care services, family support, positive illness perception, and drug reminders. Strategies implemented at the health system, provider and patient levels were: establishing digital health records at health centres, health worker's capacity development, and health education.Conclusion: There is a range of barriers for hypertension treatment and control in Nepal pertaining to the health system, health providers, and patients. Comprehensive interventions are needed at all three levels to further improve management and control of hypertension in Nepal.

Blood pressure and the hypertension care cascade in The Gambia: Findings from a nationwide survey

“…There should be more localized data to understand determinants of and barriers to treatment uptake to adapt public health interventions to the local context. As reported elsewhere, these factors include patients being worried about the need to take medication for life, perceived side effects of drugs, loss to follow‐up, and inadequate counselling from physician at the time of diagnosis 38–41 . Our study also highlights the need to identify factors leading to non‐treatment of patients with hypertension.…”

“…As reported elsewhere, these factors include patients being worried about the need to take medication for life, perceived side effects of drugs, loss to follow‐up, and inadequate counselling from physician at the time of diagnosis. 38 , 39 , 40 , 41 Our study also highlights the need to identify factors leading to non‐treatment of patients with hypertension. A lot of patients rely on traditional treatment methods whose effect has not been evaluated.…”

Quality of Care for Patients with Hypertension in selected Health Centres in Rwamagana District, Rwanda

“…[13] This lack of access to resources constituted a big barrier to hypertension care, like other chronic NCDs. [16,17] Rwanda has started the integration of NCDs and their risk factors into the primary health care level. [18,19] The main objective of integration is to improve access to chronic care and care outcomes for patients with NCDs like hypertension.…”