Health-seeking challenges among older adults with hypertension in Nepal: a phenomenological study

Hypertension is a leading non-communicable disease in Nepal, with a rising burden among older adults and persistently low rates of blood pressure control. While several studies have explored healthcare-seeking behavior in the general population, little is known about the specific challenges faced by older adults with hypertension. In particular, the perspectives of older adults with hypertension, family caregivers and healthcare providers-key actors in the care process are rarely explored. Therefore, this study aims to explore challenges to healthcare-seeking among older adults with hypertension in Nepal from the perspective of older adults, family caregivers, and healthcare providers.

We adopted a qualitative study design to collect the required information. Trained researchers conducted 24 In Depth Interviews (IDIs) with older adults, healthcare providers, and facilitated 2 Focus Group Discussions (FGDs) with 18 caregivers. Interviews and FGDs were held in private settings using a semi-structured guideline based on the socio-ecological model. The interviews and FGDs were conducted in the Nepali language. The audio-recorded sessions were then transcribed verbatim and subsequently translated into English before analysis, to then apply both inductive and deductive coding. We then analyzed the data using thematic analysis with Taguette software.

Applying the Socio-Ecological Model, we explored multi-level challenges to seeking care as perceived by older adults with hypertension, family care givers and healthcare providers in Central Nepal. At the individual level, perceived physical and cognitive decline, low health autonomy, and competing priorities as limiting their ability to seek care, while healthcare providers viewed these same factors as major challenges to timely service utilization. Interpersonal challenges were perceived in terms of limited family support and poor communication between older adults with hypertension and health care providers. At the community level, inadequate infrastructure and transportation difficulties restrict access. Organizational challenges were perceived as insufficient geriatric services, fragmented care pathways, and shortages of health staff, with providers particularly emphasizing these system constraints. Finally, at the policy level, perceived exclusion from health insurance, lack of structured programs, and inefficiencies in medication supply and enforcement as significant challenges.

To improve hypertension management, a coordinated response is needed by investing in geriatric-friendly services, empowering older adults with hypertension, strengthening family and community support, and closing the policy-to-practice gap. As Nepal's population ages, addressing these issues is vital to achieving equitable, age-inclusive healthcare.