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Patient perspectives on hypertension management in health system of Sri Lanka: a qualitative study
Manuja Perera1, Chamini Kanatiwela de Silva2, Saeideh Tavajoh3
1Department of Public Health, University of Kelaniya Faculty of Medicine, Ragama, Sri Lanka.
Insights
Patients in Sri Lanka face barriers accessing hypertension care, including distance and medication shortages. Improving public awareness and healthcare communication are key to better hypertension management.
Area of Science:
- Public Health
- Health Services Research
- Cardiovascular Disease Management
Background:
- Uncontrolled hypertension is a leading global mortality risk factor, particularly in low- and middle-income countries (LMICs).
- Understanding patient experiences and care-seeking pathways for hypertension in LMICs is crucial but often limited.
- This study focuses on the specific context of primary care in rural Sri Lanka.
Purpose of the Study:
- To explore patient perspectives on healthcare accessibility and availability for uncontrolled hypertension management in Sri Lanka.
- To identify barriers and facilitators influencing patient engagement with hypertension care services.
- To gather patient-recommended improvements for hypertension management systems.
Main Methods:
- Purposive sampling of 20 patients with hypertension from a larger study in rural South Asia.
- Conducting in-depth, audio-recorded interviews, transcribed and translated.
- Utilizing thematic analysis to map patient pathways and experiences with government and private healthcare.
Main Results:
- Hypertension often diagnosed incidentally; adherence issues and alternative treatments cited as control barriers.
- Barriers to care include distance, long waits, and medicine shortages at public clinics, leading to out-of-pocket private care.
- Patients desire increased public awareness, improved healthcare provider communication, and better medication understanding; outreach services are welcomed.
Conclusions:
- Patients in Sri Lanka encounter significant barriers in accessing hypertension care.
- Recommendations include enhancing public education, improving patient-provider communication, and ensuring medication access and understanding.
- Systemic improvements are needed to facilitate better hypertension management and control.
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.
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