Why hypertensive patients do not comply with the treatment: results from a qualitative study

Medical non-compliance has been identified as a major public health problem in the treatment of hypertension. There is a large research record focusing on the understanding of this phenomenon. However, to date, the majority of studies in this field have been focused from the medical care perspective, but few studies have focused on the patients' point of view.

Our aim was to identify factors related to non-compliance with the treatment of patients with hypertension.

We use a qualitative study in which data were gathered from seven focus group discussions conducted in March-May 2001. Patients were identified as non-compliant, using the Morisky-Green test, at two primary health care centres of the Spanish National Health Service.

A complex web of factors was identified that influenced non-compliance. Patients had fears and negative images of antihypertensive drugs. The data also revealed a lack of basic background knowledge about hypertension. The clinical encounter was viewed as unsatisfactory because of its length, few explanations given by the physician and low physician-patient interaction.

Most of the factors related to poor compliance have implications for patient management. Knowing patients' priorities regarding the most important aspects of care that have high potential for low compliance may be helpful in improvement of the quality of hypertensive patient care.