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Perceived Barriers and Facilitators in Cardiovascular Risk Management in Colombia: A Qualitative Analysis of the
Jose P Lopez-Lopez1, Yesica Giraldo-Castrillon1, Johanna Otero1,2
1Masira Research Institute, Universidad de Santander (UDES), Bloque G, piso 6, Bucaramanga 680003, Colombia.
Insights
Improving hypertension control in low- and middle-income countries requires addressing systemic issues. Enhanced stewardship and intersectoral collaboration are key to overcoming barriers in hypertension management.
Area of Science:
- Public Health
- Health Systems Research
- Cardiovascular Disease Management
Background:
- Low medication adherence and hypertension control pose significant public health challenges, especially in low- and middle-income countries (LMICs).
- Healthcare system and patient-related barriers impede effective hypertension management.
Purpose of the Study:
- To identify perceived barriers and facilitators to hypertension management among health system stakeholders in Santander, Colombia.
- To explore stakeholder perspectives on improving hypertension control strategies within the Colombian healthcare system.
Main Methods:
- Qualitative, phenomenological, and interpretative study utilizing five focus groups with health system stakeholders.
- Data collected between December 2022 and February 2023, recorded, transcribed, and analyzed using NVivo software.
Main Results:
- Seven categories of barriers and facilitators were identified: strategies, resources, access, risk assessment, cross-sector collaboration, articulation, and stewardship.
- Articulation and stewardship emerged as primary barriers, indicating deficiencies in practices, unclear objectives, and misalignment with public policy.
Conclusions:
- Multisectoral actions beyond healthcare providers are crucial for improving hypertension control in LMICs.
- Strengthening primary healthcare, addressing social determinants, and enhancing stewardship and access are critical priorities for effective hypertension management.
Abstract:
Introduction: Low medication adherence and low hypertension control are a public health challenge, particularly in low- and middle-income countries (LMICs). Healthcare system- and patient-related barriers hinder the successful management of hypertension. This study aimed to identify the perceptions of barriers and facilitators to hypertension management among health system stakeholders in Santander, Colombia. Materials and Methods: We conducted a qualitative, phenomenological, and interpretative study, comprising five focus groups, to explore the barriers and facilitators to managing people with hypertension. Each focus group was formed by stakeholders from territorial entities, healthcare insurers, or healthcare providers. Meetings were held between December 2022 and February 2023. The sessions were recorded and transcribed using NVivo Transcription and analyzed using NVivo version 1.6.1. Results: Seven categories of barriers and facilitators were identified: strategies, resources, access, risk assessment, cross-sector collaboration, articulation, and stewardship. Of these categories, articulation and stewardship emerged as the main barriers, as revealed through axial coding and cluster analysis, which highlighted deficiencies in stewardship practices, a lack of clear objectives, and misalignment with public policy frameworks. Conclusions: Multisectoral actions extending beyond healthcare providers and aimed at improving coordination and intersectoral collaboration are essential for enhancing hypertension control in LMICs, such as Colombia. Addressing social determinants and strengthening primary healthcare through community-based strategies are critical, making stewardship and improved access key priorities.
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