Patient and Healthcare Provider Barriers to Hypertension Awareness, Treatment and Follow Up: A Systematic Review and Meta-Analysis of Qualitative and Quantitative Studies

Abstract

BackgroundAlthough the importance of detecting, treating, and controlling hypertension has been recognized for decades, the majority of patients with hypertension remain uncontrolled. The path from evidence to practice contains many potential barriers, but their role has not been reviewed systematically. This review aimed to synthesize and identify important barriers to hypertension control as reported by patients and healthcare providers.MethodsElectronic databases MEDLINE, EMBASE and Global Health were searched systematically up to February 2013. Two reviewers independently selected eligible studies. Two reviewers categorized barriers based on a theoretical framework of behavior change. The theoretical framework suggests that a change in behavior requires a strong commitment to change [intention], the necessary skills and abilities to adopt the behavior [capability], and an absence of health system and support constraints.FindingsTwenty-five qualitative studies and 44 quantitative studies met the inclusion criteria. In qualitative studies, health system barriers were most commonly discussed in studies of patients and health care providers. Quantitative studies identified disagreement with clinical recommendations as the most common barrier among health care providers. Quantitative studies of patients yielded different results: lack of knowledge was the most common barrier to hypertension awareness. Stress, anxiety and depression were most commonly reported as barriers that hindered or delayed adoption of a healthier lifestyle. In terms of hypertension treatment adherence, patients mostly reported forgetting to take their medication. Finally, priority setting barriers were most commonly reported by patients in terms of following up with their health care providers.ConclusionsThis review identified a wide range of barriers facing patients and health care providers pursuing hypertension control, indicating the need for targeted multi-faceted interventions. More methodologically rigorous studies that encompass the range of barriers and that include low- and middle-income countries are required in order to inform policies to improve hypertension control.

Patient-related beliefs and adherence toward their medications among the adult hypertensive outpatients in Tanzania

“…High blood pressure (BP) is a leading cause of adult mortality across the world, estimated to cause more than 13% of deaths annually [1,2]. Overall, high BP is associated with at least 7.6 million to 9.4 deaths annually [3][4][5], and envisaged to cost globally nearly US$1trillion over the next decade unless adequately addressed [4].…”

“…Pharmacological methods include antihypertensive medications daily [9][10][11]. This is increasingly coupled with measures to enhance adherence to the medicines prescribed given current concerns, coupled with other measures to reduce morbidity and mortality [1,12,13]. Non-pharmacological methods include restricting sodium intake to 80-100 mmol/day, weight loss, exercise and dietary changes [8,14] as well as stress reduction through relaxation methods such as yoga [15,16].…”

Development of cardiovascular health education program for primary care patients with hypertension in rural Nigeria: a qualitative study

“…These perceptions can be rooted in individual experiences but also in the broader social, cultural, economic or environmental context of patients' lives. This was also highlighted in recent reviews of studies of patient perspectives on hypertension [21,22]. It is well recognized that "patient-centred" health education can play an important role in promoting adequate hypertension self-management, and particularly education that addresses patient perceptions on hypertension (e.g., its causes, symptoms, duration, severity, and consequences), the recommended treatment and their own ability to use medication and implement the recommended behavioural changes [10,23].…”

High prevalence of prehypertension in mothers of young children in peri-urban Nepal

“…Health-care providers as well as the general population often have the misconception that blood pressure in the prehypertension range does not require intervention, and that people can continue with their lifestyle including dietary and physical activity behaviours [36][37][38][39] . Failure to adapt proper health behaviour if having prehypertension maylead to full-fl edged hypertension and a greater diffi culty to implement necessary lifestyle changes [39][40][41] .…”

“…Failure to adapt proper health behaviour if having prehypertension maylead to full-fl edged hypertension and a greater diffi culty to implement necessary lifestyle changes [39][40][41] . In fact, we reported earlier that there is a tendency among mothers in our peri-urban study setting to act, particularly in relation to diet and physical activity, only when they have been diagnosed as having a disease, including high blood pressure 24 .…”