Barriers to and facilitators of hypertension management in Asmara, Eritrea: patients’ perspectives

Abstract

BackgroundPersonal hypertension management is a cornerstone in the prevention of hypertension complications. In Eritrea, the increase in the national life expectancy rate has been accompanied by an increase in hypertension complications such as stroke. Hence, this study was designed to identify barriers and facilitates to hypertension management from the perspective of the patients.MethodsThis was a qualitative study of a total of 48 individual in-depth interviews and two focus group discussions. It was conducted among hypertensive patients who were attending outpatient services at two hospitals in Asmara, Eritrea.ResultsThis study identified barriers and facilitators of hypertension management related to the individual patient, family and community, and healthcare system. With respect to individual factors, economic barriers, stress, non-adherence to medications due to the use of traditional remedies, and difficulties and misconceptions about following physical activity guidelines were mentioned as barriers to hypertension management. Related to the community and healthcare system, low community awareness, community stigma, and inadequate health promotion materials were stated as barriers. Individual knowledge, family, and government support were reported as very important factors to the patient’s success in the personal hypertension management.ConclusionsCounseling patients about adherence to medication, strengthening family and government support, and empowering families and the community with appropriate knowledge of hypertension management could potentially help in an individual’s adherence.

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“…Although drug treatment has precise indications, the adoption of a healthy lifestyle is strongly suggested as a coadjuvant for the control of hypertension, with emphasis on the regular practice of physical activity, healthy eating, smoking cessation, and reduced alcohol consumption 28 , 29 . This indication is based on evidence that these behaviors may reduce blood pressure levels, improve the effect of antihypertensive medication, and decrease cardiovascular risk, and this effect is intensified when two or more practices are combined 30 .…”

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“…Special attention should be given to the control of hypertension attributed to background, indicating that among both women (33.7%) and men (63.7%), hypertension control is attributed to other factors, such as schooling, socioeconomic status, obesity, and others, which are widely described in the literature as associated with hypertension control 2,10,20,28 , but which were not the focus of the current study. In addition, the drug treatment variable used in ELSI-Brasil was based on the participant's self-report and does not mean that the reported treatment was followed according to the medical prescription.…”

“…Next to moderate alcohol consumption, regular physical activity was the health behavior that most contributed to hypertension control, both in the total sample and in men and women. Various studies have evidenced the positive association between physical activity and blood pressure control 10,18,19,33 . The current study corroborates these results, quantifying the contribution of physical activity to hypertension control and highlighting the importance of maintaining physical activity at recommended levels among hypertensive individuals, as an important adjuvant to medication.…”

“…Prevalence of hypertension is high in the general population (about 30%) and increases sharply with age, reaching some 65% of the elderly 1,4,5,6,7 . The importance of hypertension control (systolic pressure < 140mmHg and diastolic pressure < 90mmHg) 8,9 to reduce cardiovascular morbidity and mortality has been highlighted in various studies 10,11 . In recent decades, even with the development of modern pharmaceutical technologies, blood pressure control is still low, posing a major global public health challenge 2,3,10 .…”