Why don't patients return for antihypertensive treatment in Soweto?

Out of an inception cohort of 91 newly treated hypertensive patients at a Soweto polyclinic only 16 (18%) attended regularly during the year after their first visit. Visits were made to the homes of the 75 non-compliant patients between 18 and 21 months after the patient's first visit to establish the reasons for non-attendance. Five of the 75 (7%) had died, 16 (21%) were not available for an interview and 54 (72%) were interviewed. These 54 patients gave many different reasons for not returning regularly. The most common reasons were: (i) they did not remember being told that they had hypertension and that they needed to return for more treatment--14 patients; (ii) they had been away from Soweto--7 patients; (iii) they had been unable to take time off work--6 patients; (iv) they considered themselves to be regular attenders--5 patients; (v) they had not felt ill--5 patients; and (vi) they experienced unwanted side-effects--4 patients. Only 2 patients said that they had received regular treatment elsewhere. In the light of these results different approaches designed to improve both attendance and medication compliance are being developed and evaluated.