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Assessing Providers' Approach to Hypertension Management at a Large, Private Hospital in Kampala, Uganda
Aliza S Green1, Hayley M Lynch1, Rose Clarke Nanyonga2
1Department of Health System Design and Global Health, Icahn School of Medicine at Mount Sinai, New York, US.
Insights
Healthcare providers in Uganda face challenges in managing hypertension due to patient beliefs, cultural norms, and medication access. Improving hypertension care requires context-specific interventions and better collaboration.
Area of Science:
- Public Health
- Healthcare Management
- Clinical Practice
Background:
- Hypertension prevalence is rising in Uganda, with suboptimal clinical management.
- Limited understanding of provider perspectives on hypertension management barriers in private healthcare settings.
Purpose of the Study:
- Examine factors influencing hypertension care quality from provider viewpoints in an urban Ugandan private hospital.
- Focus on organizational and system-level influences on outpatient hypertension management.
Main Methods:
- Qualitative, exploratory, pragmatic study design.
- Conducted interviews with 19 healthcare providers in Kampala, Uganda.
- Thematic analysis using an inductive approach.
Main Results:
- Patient beliefs and cultural norms present challenges to hypertension control.
- Providers perceive their treatment approaches align with international guidelines.
- Barriers include poor inter-provider collaboration and high medication costs/limited availability.
Conclusions:
- Findings inform culturally-adapted patient education and medication access interventions in Uganda.
- Results offer insights for similar hypertension management challenges in other settings.
Background:
Hypertension is increasingly prevalent in Uganda and its clinical management remains suboptimal across the country. Prior research has elucidated some of the factors contributing to poor control, but little is known about providers' approaches to hypertension management and perceptions of barriers to care. This is particularly true in private health care settings - despite the fact that the private sector provides a substantial and growing portion of health care in Uganda.
Objective:
Our exploratory, pragmatic qualitative study aimed to examine the factors affecting the quality of hypertension care from the perspective of providers working in an urban, private hospital in Uganda. We focused on the organizational and system-level factors influencing providers' approaches to management in the outpatient setting.
Methods:
We conducted interviews with 19 health care providers working in the outpatient setting of a 110-bed, private urban hospital in Kampala, Uganda. We then coded the interviews for thematic analysis, using an inductive approach to generate the study's findings.
Findings:
Several themes emerged around perceived barriers and facilitators to care. Providers cited patient beliefs and behaviors, driven in part by cultural norms, as a key challenge to hypertension control; however, most felt their own approach to hypertension treatment aligned with international guidelines. Providers struggled to collaborate with colleagues in coordinating the joint management of patients. Furthermore, they cited the high cost and limited availability of medication as barriers.
Conclusions:
These findings offer important strategic direction for intervention development specific to this Ugandan context: for example, regarding culturally-adapted patient education initiatives, or programs to improve access to essential medications. Other settings facing similar challenges scaling up management of hypertension may find the results useful for informing intervention development as well.
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