Barriers and Facilitators to Treatment among Newly Diagnosed Hypertensive Patients in Nepal: a Qualitative Study

Thesis (Master's)--University of Washington, 2016-06Background: Hypertension, a leading risk factor for cardiovascular disease, is a significant and rising burden in Nepal. The disease remains undetected and inadequately managed. However, no studies have been conducted to understand the inhibiting and facilitating factors to hypertension treatment among newly diagnosed cases. Objective: This qualitative study aimed to explore barriers and facilitators to treatment among newly diagnosed hypertensive patients aged ≥18years from patients’ and providers’ perspectives. Method: We conducted seven focus group discussions with newly diagnosed hypertensive patients and eight in-depth interviews with health care providers. Audio-taped discussion and interviews were transcribed, inductively coded and analyzed by thematic framework method using Atlas ti.7. Results: Hypertension was viewed as a rising problem in the community. The barriers to treatment included: absence of symptoms, reluctance to take medicine, low perceived seriousness of hypertension and its outcome, negligence (lack of self-care), lack of family support, uncontrolled diet during feast and festivals, social drinking, lack of communication and trust of provider, and lack of resources in health care institutions. Factors facilitating treatment included: fear of consequences, self-awareness and self-care, self-reminding strategies, family support, counseling by health care providers, and availability of adequate health care resources. The participants suggested solutions to include the need for greater awareness, screening and routine monitoring of blood pressure, making resources available in health institutions, and training of health workers. Conclusion: A number of factors emerged as barriers and facilitators to hypertension management from patients’ and the providers’ perspectives. This information is useful to design individual, social and health system levels of interventions to improve hypertension management