Experiences and Perspectives of Patients With Hypertension in Mbarara, Uganda

Abstract

Purpose: Hypertension is a common cardiovascular risk factor that accounts for a majority of cardiovascular disease burden. We aimed to describe how patients with hypertension in Mbarara, Uganda, experience and perceive hypertension in order to understand the factors that drive patient-centered care of hypertension and contribute to how care is delivered in this setting. Methods: We purposively enrolled patients with a physician-made diagnosis of hypertension and taking antihypertensive medication for at least 1 month. A trained assistant performed in-depth interviews of 30 participants in outpatient clinics at Mbarara Regional Referral Hospital focusing on the perceptions and experiences with the diagnosis, management, care at the clinic and at home with hypertension. We sampled for equal representation of gender and comorbid conditions (diabetes and HIV) to capture varied experiences. We used a content analysis approach to develop a codebook and identify themes. Results: Our participants initiated care at various stages of disease, and that variance impacted the understanding of disease, as several expressed a concern of hypertension as a chronic disease that can lead to future complications if not controlled while others attributed other symptoms to the disease. The major barriers to care for patients include inconsistent access to regular medications and difficulty with transport to the clinic, both in time needed and expense. Facilitators to care included family support and accessible clinics, which were consistently identified by participants as major factors for initiating and maintaining treatment. Many participants identified an understanding of the important lifestyle and dietary changes required to control hypertension, especially when endorsing difficulty purchasing medications. Conclusions: Considering patient factors, including understanding of disease and lifestyle adjustments to prevent complications, in healthcare delivery can help ensure adequate management of hypertension and other NCDs by aligning the clinic structure and resources with patient values and beliefs, such as by counseling family members alongside patients or strengthening outreach and educational resources.