Access to hypertension services and health-seeking experiences in rural Coastal Kenya: A qualitative study

Globally, hypertension causes 10.8 million deaths annually. However, in Kenya, like in other low-and middle-income countries, access to hypertension care remains limited and inequitable. Understanding patients' journeys in accessing care along the care cascade is critical to inform patient-centred care and policy improvements. This study aimed to explore patient experiences in accessing primary care services for hypertension along the care cascade in rural Coastal Kenya-a setting with a high hypertension burden. We conducted a qualitative cross-sectional study and collected data using in-depth interviews (n = 24) and five focus group discussions (n = 30) with hypertension patients and their adult family caregivers in two purposively selected sub-counties in Kilifi County. We conducted and transcribed the interviews in Kiswahili and Giriama (local languages) and translated them into English. We used QSR NVivo 12 for data management. We analysed the data using a framework approach and interpreted our findings using Levesque's access framework. Access to hypertension screening and diagnosis services was undermined by information barriers which led to inadequate awareness and lack of knowledge about hypertension and its causes. There were perceptions of inadequate health facility capacity to offer hypertension screening services, particularly to 'healthy' individuals thus presenting as a barrier to demand for screening services. Acceptability of care was undermined by inadequate patient counselling at diagnosis and perceived disrespectful treatment of patients. Access to treatment and diagnostic tests was undermined by unaffordable care, limited availability of medicines and equipment, long waiting times, and inaccessible health facilities. Having health insurance enabled access to care; however, most participants were uninsured. Participants adapted to these access barriers by reducing/skipping daily medication doses, resorting to alternative forms of care (e.g., herbal treatments and faith healing), and changing health facilities for routine clinic appointments. Access to care for older patients (i.e., ≥70 years) and those with complications was enabled by family caregivers who coordinated and navigated the health system on their behalf. Our findings show that people living with hypertension experience a combination of interacting individual, community, and health system-related barriers to accessing care. There is a need to systematically address identified barriers and ensure patient-centred responses that meet patients' needs. Strengthening the health system's capacity to ensure availability and affordability of treatment and diagnosis services, creation of community hypertension awareness, adequate patient counselling at screening and diagnosis, and involvement of family caregivers for older patients are examples of urgent interventions to improve access to hypertension care.