Facilitators and barriers to hypertension management in urban Nepal: findings from a qualitative study

Abstract

IntroductionIn Nepal, one-fourth of the adult population has hypertension. Despite provision of comprehensive hypertension services through the primary healthcare system, huge gaps in treatment and control of hypertension exist. Our study explored the individual, interpersonal, health system and community-level barriers and facilitators affecting hypertension management in urban Nepal.MethodsWe used a qualitative methodology informed by Kaufman’s socioecological model, conducting focus group discussions with hypertension patients and their family members. In-depth interviews with hypertension patients, healthcare providers and municipal officials were also conducted.ResultsWe found that inadequate knowledge about hypertension and harmful cultural beliefs hindered effective treatment of hypertension. Interrupted medical supply and distrust in primary healthcare providers affected the poor’s access to hypertension services. Poor communication between family members and gender norms affected adaptation of treatment measures. This study emphasised the role of family members in supporting patients in adhering to treatment measures and rebuilding community trust in primary healthcare providers for better access to hypertension services. The findings guided the development of a manual to be used by community health workers during home visits to support patients to control high blood pressure.ConclusionThe study highlights the importance of integrating various aspects of care to overcome the multiple barriers to hypertension management in urban settings in low-resource countries. Participatory home visits have the potential to empower individuals and families to develop and implement feasible and acceptable actions for home management of hypertension through improved adherence to antihypertensive medication, and behaviour change.

A Qualitative Analysis of the Association of Treatment Outcomes, Psychosocial Factors, and Multimorbidity in Severe Hypertensive Patients Attending Health Institutions in Southeast Nigeria

“…Furthermore, the development of HTN is associated with several demographic, lifestyle, and psychosocial variables [14] Risk factors, such as psychosocial ones and mental disorders, have also been investigated by several authors, nevertheless the relation with HTN results less clear and, sometimes, controversial [15][16][17] While research shows that HTN management is improving, we still lack a comprehensive understanding of the factors that contribute to the disease onset, trajectory of progression and patient outcomes. Despite evidence on the effectiveness of lifestyle measures and antihypertensive medication, hypertension management remains challenging [10] Understanding of the complexity in managing hypertension demands an integrated approach considering the individual, and structural factors and how their interaction affects patients. [11] This study sought to evaluate the association between psychosocial factors and multi-morbidities and how it affects the treatment outcomes in severe hypertensive patients.…”

Understanding the Influence of Psychosocial Factors and Multimorbidity on Patient Outcomes in Severe Hypertensive Patients Attending Health Institutions in Southeastern Nigeria

“…Despite evidence on the effectiveness of lifestyle measures and antihypertensive medication, hypertension management remains challenging [10] Understanding of the complexity in managing hypertension demands a comprehensive approach considering the individual, and structural factors and how their interaction affects patients. [11] This study sought to evaluate the association between psychosocial factors and multi-morbidities and how it affects the treatment outcomes in severe hypertensive patients.…”

Role of Perceived Social Support in Adherence to Antihypertensives and Controlled Hypertension: Findings of a Community Survey from Urban Nepal

“…A possible explanation might be that those receiving higher support spend longer time with friends and are thereby more exposed to peer pressure for unhealthy behaviour which was indicated as a barrier for effective control of blood pressure in our formative study in the same population. 52 Reverse causation can also not be ruled out, as those with poorly controlled blood pressure may be receiving higher support from friends.…”