Article Text
Abstract
Introduction Uncontrolled hypertension is the leading risk factor for mortality globally, including low-income and middle-income countries (LMICs). However, pathways for seeking hypertension care and patients’ experience with the utilisation of health services for hypertension in LMICs are not well understood.
Objectives This study aimed to explore patients’ perspectives on different dimensions of accessibility and availability of healthcare for the management of uncontrolled hypertension in Sri Lanka.
Setting Primary care in rural areas in Sri Lanka.
Participants 20 patients with hypertension were purposively sampled from an ongoing study of Control of Blood Pressure and Risk Attenuation in rural Bangladesh, Pakistan, Sri Lanka.
Method We conducted in-depth interviews with patients. Interviews were audio-recorded and transcribed into local language (Sinhala) and translated to English. Thematic analysis was used and patient pathways on their experiences accessing care from government and private clinics are mapped out.
Results Overall, most patients alluded to the fact that their hypertension was diagnosed accidentally in an unrelated visit to a healthcare provider and revealed lack of adherence and consuming alternatives as barriers to control hypertension. Referring to the theme ‘Accessibility and availability of hypertension care’, patients complained of distance to the hospitals, long waiting time and shortage of medicine supplies at government clinics as the main barriers to accessing health services. They often resorted to private physicians and paid out of pocket when they experienced acute symptoms attributable to hypertension. Considering the theme ‘Approachability and ability to perceive’, the majority of patients mentioned increasing public awareness, training healthcare professionals for effective communication as areas of improvement. Under the theme ‘Appropriateness and ability to engage’, few patients were aware of the names or purpose of their medications and reportedly missed doses frequently. Reminders from family members were considered a major facilitator to adherence to antihypertensive medications. Patients welcomed the idea of outreach services for hypertension and health education closer to home in the theme ‘Things the patients reported to improve the system’.
Conclusion Patients identified several barriers to accessing hypertension care in Sri Lanka. Measures recommended improving hypertension management in Sri Lanka including public education on hypertension, better communication between healthcare professionals and patients, and efforts to improve access and understanding of antihypertensive medications.
Trial registration number NCT02657746.
- hypertension
- health services administration & management
- qualitative research
This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.
Statistics from Altmetric.com
Footnotes
CKdS and ST are joint first authors.
Contributors THJ conceived the conceptual design of COBRA-BPS study. ST, MNP and HLQ performed the thematic analysis. DSE, NL and CDR performed the data validation. MNP, CKdS and ST wrote the first draft in consultation with THJ, HAdS and AK. All authors reviewed and provided comments on the paper and approved the final version. THJ is the guarantor.
Funding COBRA-BPS is funded by the UK Department for International Development, the Medical Research Council and the Wellcome Trust.
Competing interests None declared.
Patient consent for publication Not required.
Ethics approval Ethical clearance for the study was obtained from the Ethics Review Committee of Faculty of Medicine, University of Kelaniya. COBRA-BPS study was registered in the Sri Lanka Clinical Trials Registry (SLCTR/2016/005) and Duke-NUS Medical School, in Singapore, and London School of Hygiene and Tropical Medicine, London, UK.
Provenance and peer review Not commissioned; externally peer reviewed.
Data availability statement All data relevant to the study are included in the article or uploaded as supplementary information.