Perceptions of inhibitors and facilitators for adhering to hypertension treatment among insured patients in rural Nigeria: a qualitative study

Autor: Tanimola M. Akande, Oladimeji Akeem Bolarinwa, Constance Schultsz, Akin Osibogun, Peju Adenusi, Karien Stronks, Gbenga Ogedegbe, Kayode Agbede, Joke A. Haafkens, Marleen E. Hendriks, Aina Olufemi Odusola, Joep M. A. Lange, Charles Agyemang, Henk van Weert
Přispěvatelé: Anthropology of Health, Care and the Body (AISSR, FMG), Faculteit der Geneeskunde, AIAS (FdR), Public and occupational health, AII - Amsterdam institute for Infection and Immunity, Global Health, ACS - Amsterdam Cardiovascular Sciences, APH - Amsterdam Public Health, CCA -Cancer Center Amsterdam, General practice, AGEM - Amsterdam Gastroenterology Endocrinology Metabolism, Other Research
Jazyk: angličtina
Rok vydání: 2014
Předmět:
Zdroj: BMC Health Services Research
BMC Health Services Research, 14:624. BioMed Central
BMC health services research, 14(1). BioMed Central
ISSN: 1472-6963
DOI: 10.1186/s12913-014-0624-z
Popis: Background Universal health care coverage has been identified as a promising strategy for improving hypertension treatment and control rates in sub Saharan Africa (SSA). Yet, even when quality care is accessible, poor adherence can compromise treatment outcomes. To provide information for adherence support interventions, this study explored what low income patients who received hypertension care in the context of a community based health insurance program in Nigeria perceive as inhibitors and facilitators for adhering to pharmacotherapy and healthy behaviors. Methods We conducted a qualitative interview study with 40 insured hypertensive patients who had received hypertension care for > 1 year in a rural primary care hospital in Kwara state, Nigeria. Supported by MAXQDA software, interview transcripts were inductively coded. Codes were then grouped into concepts and thematic categories, leading to matrices for inhibitors and facilitators of treatment adherence. Results Important patient-identified facilitators of medication adherence included: affordability of care (through health insurance); trust in orthodox “western” medicines; trust in Doctor; dreaded dangers of hypertension; and use of prayer to support efficacy of pills. Inhibitors of medication adherence included: inconvenient clinic operating hours; long waiting times; under-dispensing of prescriptions; side-effects of pills; faith motivated changes of medication regimen; herbal supplementation/substitution of pills; and ignorance that regular use is needed. Local practices and norms were identified as important inhibitors to the uptake of healthier behaviors (e.g. use of salt for food preservation; negative cultural images associated with decreased body size and physical activity). Important factors facilitating such behaviors were the awareness that salt substitutes and products for composing healthier meals were cheaply available at local markets and that exercise could be integrated in people’s daily activities (e.g. farming, yam pounding, and household chores). Conclusions With a better understanding of patient perceived inhibitors and facilitators of adherence to hypertension treatment, this study provides information for patient education and health system level interventions that can be designed to improve compliance. Trial registration ISRCTN47894401. Electronic supplementary material The online version of this article (doi:10.1186/s12913-014-0624-z) contains supplementary material, which is available to authorized users.
Databáze: OpenAIRE
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