Adherence to Pharmacological Therapy for Hypertension in Portugal: Insights from Patients' Focus Groups

Medication adherence is crucial for blood pressure control. Knowledge of medication adherence and its influencing factors, particularly within cultural and healthcare contexts, is essential for developing effective strategies to enhance medication adherence. Qualitative studies have explored patients' perspectives globally. Few have focused on strategies to improve adherence, and such research is lacking in Portugal. This study aimed to gather the perspectives of Portuguese patients with Arterial Hypertension (HTN) concerning the most effective strategies to enhance adherence to antihypertensive medication and to understand its contributing factors.

We conducted qualitative research through online focus groups of four to ten participants each. Participants were adult patients with HTN taking at least one antihypertensive drug from the primary care setting. The number of focus groups was achieved through theoretical saturation. Purposive sampling was used, with patients recruited through their family doctors. Participants were recruited from all seven Portuguese regions, representing both sexes, controlled and uncontrolled HTN, and a diverse range of educational levels, employment statuses, living arrangements, and socioeconomic statuses. Meetings were audio-recorded and transcribed. Two researchers conducted content analyses using MAXQDA 2023 through comparative analyses and consensus. Results are presented narratively.

Four focus groups were conducted. Findings reported patients' strategies to improve adherence to pharmacological therapy for HTN. These included changes to medication and blister packs, such as a color-coded system. Other strategies involved reducing medication costs and making specific suggestions for primary healthcare. Patients additionally proposed psychological support and technological aids. Barriers such as difficulties in accepting medication and facilitators, such as fears of complications associated with HTN, were also identified.

These results highlight the multifaceted perspectives of Portuguese patients with HTN and emphasise the role of technology, family support, and primary health services in promoting adherence. Such insights should be incorporated when addressing medication adherence in HTN.