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Barriers and facilitators to treatment among patients with newly diagnosed hypertension in Nepal
  1. Sachita Shrestha1,2,
  2. Archana Shrestha3,
  3. Rajendra P Koju1,4,5,
  4. James P LoGerfo1,6,
  5. Biraj Man Karmacharya5,7,
  6. Nona Sotoodehnia8,
  7. Annette L Fitzpatrick1,9,10
  1. 1 Department of Global Health, University of Washington, Seattle, Washington, USA
  2. 2 Department of Health Outcomes and Biomedical Informatics, University of Florida, Gainesville, Florida, USA
  3. 3 Department of Epidemiology, Harvard T H Chan School of Public Health, Boston, Massachusetts, USA
  4. 4 Department of Cardiology, Dhulikhel Hospital-Kathmandu University Hospital, Dhulikhel, Nepal
  5. 5 Department of Community Medicine, Kathmandu University School of Medical Sciences, Dhulikhel, Nepal
  6. 6 Department of Medicine, University of Washington, Seattle, Washington, USA
  7. 7 Department of Community Programs, Dhulikhel Hospital-Kathmandu University Hospital, Dhulikhel, Nepal
  8. 8 Division of Cardiology, University of Washington, Seattle, Washington, USA
  9. 9 Department of Epidemiology, University of Washington, Seattle, Washington, USA
  10. 10 Department of Family Medicine, University of Washington, Seattle, Washington, USA
  1. Correspondence to Sachita Shrestha, Department of Health Outcomes and Biomedical Informatics, University of Florida, Gainesville, Florida 32608, USA; sachizshrestha{at}gmail.com

Abstract

Objective Hypertension 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. This qualitative study aimed to explore barriers and facilitators to treatment among patients with newly diagnosed hypertension aged ≥18 years in Dhulikhel, Nepal.

Methods We conducted seven focus group discussions with 35 patients with newly diagnosed hypertension identified through community surveillance of the Dhulikhel Heart Study, an observational cohort of Dhulikhel Hospital, Kathmandu University. Audiotaped discussions were transcribed, inductively coded and analysed by the thematic framework method using Atlas.ti V.7.

Results Hypertension was viewed as a rising problem in the community. Participants had limited knowledge and many misbeliefs regarding hypertension and its treatment. The major barriers included absence of symptoms, reluctance to take medicine, low perceived seriousness of the disease, challenges in behaviour change (diet and exercise), lack of family support, and lack of communication and trust with the provider. The major reported facilitating factors were fear of consequences of the disease, and family support in controlling diet and adhering to treatment.

Conclusions A number of factors emerged as barriers and facilitators to hypertension treatment. This information can be useful in designing appropriate health interventions to improve hypertension management.

  • Hypertension
  • public health
  • education
  • primary care
  • delivery of care

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Footnotes

  • Contributors SS conceptualised the study, collected, transcribed and analysed the data, and drafted and reviewed the manuscript. AS contributed to designing the research study, analysing the data and reviewing the manuscript. BMK contributed to research design. ALF contributed significantly to manuscript writing. All authors contributed to refinement and approved the final manuscript.

  • Funding SS and NS were supported by the Laughlin family.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Ethics approval The study was approved by the Kathmandu University School of Medical Sciences Institutional Review Committee and the University of Washington Division of Human Subjects.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement The data are not available to share.

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