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Barriers to Blood Pressure Control in Treated Patients Attending Public Primary Healthcare Clinics in Gaborone,
Setlhare V1, Bogatsu Y1, Youssouf N2
1Department of Family Medicine and Public Health Medicine University of Botswana Gaborone Botswana.
Insights
Barriers to controlling high blood pressure (BP) in Botswana are multifaceted, stemming from health system issues, healthcare worker factors, patient non-adherence, and socioeconomic challenges. Addressing these requires a comprehensive strategy involving improved funding, management, and education for both staff and patients.
Area of Science:
- Public Health
- Health Services Research
- Qualitative Research
Background:
- High blood pressure (BP) is a significant public health concern in low- and middle-income countries (LMICs), leading to severe cardiovascular and kidney diseases.
- Uncontrolled BP results in substantial morbidity, mortality, and economic burden on families and governments.
- Understanding barriers to BP control is crucial for developing effective interventions in resource-limited settings.
Purpose of the Study:
- To explore the barriers to effective blood pressure control among patients undergoing treatment for hypertension.
- To identify challenges within the healthcare system, from healthcare workers, patients, and socioeconomic factors influencing BP management in Gaborone, Botswana.
Main Methods:
- A descriptive qualitative study was conducted in public primary healthcare clinics in Gaborone, Botswana.
- Data were gathered through structured interviews with 18 participants, including patients, nurses, doctors, and district health managers.
- Interview transcripts were analyzed for thematic content using NVivo software.
Main Results:
- Identified barriers included health system deficiencies (drug/equipment shortages, poor administration), healthcare worker-related issues (attitude, knowledge gaps), patient-related factors (non-adherence, lifestyle), and socioeconomic determinants.
- Specific examples cited include shortages of essential medications and equipment, negative patient-provider interactions, and challenges with patient adherence to treatment regimens and healthy lifestyles.
Conclusions:
- Blood pressure control is hindered by a complex interplay of health system, healthcare worker, patient, and socioeconomic factors.
- A holistic approach is necessary, focusing on enhanced central government funding and planning, improved district-level health management, better clinic resourcing, and targeted education for healthcare workers and patients.
Background:
High blood pressure (BP) is prevalent and uncontrolled in many low- and middle-income countries (LMICs). Uncontrolled BP causes cardiovascular diseases (CVDs) and kidney disease. The high morbidity and mortality caused by uncontrolled BP results in high health expenditures for families and governments. Knowledge of the barriers to BP control may help in crafting suitable interventions. The aim of this study was to explore the barriers to BP control among patients who were on treatment for high BP in public clinics in Gaborone, Botswana.
Methods:
This was a descriptive qualitative study to explore the barriers to BP control among patients already on BP treatment in public primary healthcare (PHC) clinics in Gaborone, Botswana. Data were collected from patients, nurses, doctors and district health managers, through structured interviews. The interviews were conducted using an interview guide, and they were audio recorded. The interviews were translated into English transcripts, and the transcripts were analysed for themes using NVivo, a software that is used in qualitative data analysis.
Results:
Eighteen participants were interviewed (six patients, four nurses, four doctors and four district health managers). The barriers to BP control were health system-related (e.g., drug and equipment shortages and poor clinic administration), healthcare worker (HCW)-related (e.g., poor attitudes and lack of knowledge), patient-related (e.g., non-adherence to treatment and negative lifestyle habits) and other socioeconomic factors.
Conclusions:
Barriers to BP control among patients receiving BP treatment were multifactorial and included health system, HCW, patient, and socioeconomic factors. There needs to be a holistic approach to overcome these barriers, and interventions should be aimed at central government funding and planning of health services, district-level management of health services, proper management and resourcing of clinics, as well as HCW and patient education.
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