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Facilitators of Blood Pressure Control Among Treated Patients in Public Clinics in Botswana
Vincent Setlhare1, Yaone Bogatsu1, Nabila Youssouf2
1Department of Family Medicine and Primary Healthcare University of Botswana Gaborone Botswana.
Insights
Facilitators of blood pressure (BP) control in Botswana include health system, healthcare worker, patient, and socio-economic factors. Understanding these elements is key to improving hypertension management in primary healthcare settings.
Area of Science:
- Public Health
- Health Services Research
- Hypertension Management
Background:
- Rising high blood pressure (BP) prevalence in low- and middle-income countries increases morbidity and mortality, impacting Sustainable Development Goal 3.
- Most patients with high BP do not achieve normal BP levels despite treatment, leading to severe health consequences like cardiovascular and kidney diseases.
- Identifying facilitators of BP control among treated patients is crucial for effective hypertension management.
Purpose of the Study:
- To explore the facilitators of BP control among patients undergoing BP treatment in public primary healthcare (PHC) clinics in Gaborone, Botswana.
- To identify factors contributing to successful hypertension management from the perspectives of patients, healthcare workers, and health managers.
Main Methods:
- Purposive sampling of patients with over 1 year of BP treatment, healthcare workers (HCWs) with over 3 years of experience, and district health managers.
- Semi-structured interviews were conducted with 18 participants (6 patients, 4 nurses, 4 doctors, 4 district health managers) until data saturation.
- Data analysis involved audio recording, transcription, coding, thematic analysis using NVivo, and iterative theme development.
Main Results:
- Key themes emerged related to health system, HCW, patient, and socio-economic factors influencing BP control.
- Facilitators identified include factors at the central government, local government, and public PHC clinic levels.
- Patient-related and HCW-related components were also perceived as significant facilitators of BP control.
Conclusions:
- The study identified multi-level facilitators of BP control in Botswana's primary healthcare system.
- Findings provide a foundation for further qualitative and quantitative research to assess generalizability across Botswana's public PHC clinics.
- Understanding these facilitators can inform strategies to improve hypertension management and patient outcomes.
Background:
High blood pressure (BP) prevalence is increasing in low- and middle-income countries, leading to increased morbidity and mortality. This compromises Sustainable Development Goal number 3-to ensure healthy lives for all people. Most BP patients do not attain normal BP despite treatment. Uncontrolled BP causes cardiovascular diseases, kidney disease and early death. It is therefore prudent to know the facilitators of BP control among treated patients.
Methods:
The aim of this study was to explore the facilitators of BP control among treated patients in two public primary healthcare (PHC) clinics in Gaborone, Botswana. Participants were purposively selected to ensure the selection of participants with good knowledge of high BP. These were patients with more than 1 year experience of BP treatment, healthcare workers (HCWs) with more than 3 years' experience of treating BP patients, and district health managers. Semi-structured interviews were used to collect data until saturation, from BP patients, nurses, doctors and district health managers. Interviews were audio recorded, transcribed and then coded by three authors. The codes were iteratively grouped and regrouped into themes several times to produce a codebook. The codebook and transcripts were uploaded into NVivo for analysing all the transcripts.
Results:
Eighteen participants (six patients, four nurses, four doctors and four district health managers) were interviewed. The themes that were extracted from the data included health system, HCW, patient and socio-economic related factors.
Conclusion:
The perceived facilitators of BP control among patients receiving BP treatment included central government, local government and public PHC clinic level factors. Perceived facilitating factors also included patient, and HCW components. The study findings present a firm base from which more extensive qualitative and quantitative studies can be made to confirm or disprove the generalisability of these findings to all the public PHC clinics in Botswana.
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