Journal Article

Patients’ experiences on accessing health care services for management of hypertension in rural Bangladesh, Pakistan and Sri Lanka: A qualitative study

Siddiqui, Sahar, Haldane, Victoria, Cobb, Benjamin, Jafar, Tazeen H., Naheed, Aliya, Tavajoh, Saeideh, Kasturiratne, Anuradhani, de Silva, H. Asita, Jehan, Imtiaz, Chakma, Nantu, Legido-Quigley, Helena

2019

Overview

Hypertension is the leading risk factor for cardiovascular disease and leading cause of premature death globally. In 2008, approximately 40% of adults were diagnosed with hypertension, with more than 1.5 billion people estimated to be affected globally by 2025. Hypertension disproportionally affects low- and middle-income countries, where the prevalence is higher and where the health systems are more fragile. This qualitative study explored patients' experiences on the management and control of hypertension in rural Bangladesh, Sri Lanka and Pakistan. We conducted sixty semi-structured interviews, with 20 participants in each country. Hypertensive individuals were recruited based on age, gender and hypertensive status. Overall, patients' reported symptoms across the three countries were quite similar, although perceptions of hypertension were mixed. The majority of patients reported low knowledge on how to prevent or treat hypertension. The main barriers to accessing health services, as reported by participants, were inadequate services and poor quality of existing facilities, shortage of medicine supplies, busyness of doctors due to high patient load, long travel distance to facilities, and long waiting times once facilities were reached. Patients also mentioned that cost was a barrier to accessing services and adhering to medication. Many patients, when asked for areas of improvement, reported on the importance of the provider-patient relationship and mentioned valuing doctors who spent time with them, provided advice, and could be trusted. However, most patients reported that, especially at primary health care level and in government hospitals, the experience with their doctor did not meet their expectations. Patients in the three countries reported desire for good quality local medical services, the need for access to doctors, medicine and diagnostics and decreased cost for medication and medical services. Patients also described welcoming health care outreach activities near their homes. Areas of improvement could focus on reorienting community health workers' activities; involving family members in comprehensive counseling for medication adherence; providing appropriate training for health care staff to deliver effective information and services for controlling hypertension to patients; enhancing primary health care and specialist services; improving supplies of hypertensive medication in public facilities; taking into account patients' cultural and social background when providing services; and facilitating access and treatment to those who are most vulnerable.

• Publisher: Public Library of Science,Public Library of Science (PLoS)
• Subject: Adult / Adults / Aged / Antihypertensive Agents - administration & dosage / Ayurvedic medicine / Bangladesh - epidemiology / Blood pressure / Cardiovascular diseases / Care and treatment / Clinical trials / Disease prevention / Drugs / Economic aspects / Education / Female / Global health / Health aspects / Health care / Health care services accessibility / Health facilities / Health risks / Health sciences / Health services / Health Services Accessibility / Humans / Hypertension / Hypertension - drug therapy / Hypertension - epidemiology / Male / Medical personnel / Medically underserved areas / Medication Adherence / Medicine / Medicine and Health Sciences / Middle Aged / Pakistan - epidemiology / Patients / People and Places / Physicians / Population / Primary care / Public health / Qualitative Research / Research and Analysis Methods / Risk analysis / Risk factors / Rural areas / Rural Health Services / Rural Population / Signs and symptoms / Social aspects / Sri Lanka - epidemiology / Workers