Barriers to hypertension management in a developing country: a qualitative study among patients with hypertension at the National Hospital of Sri Lanka

A rapidly rising prevalence of hypertension (HTN) is observed in low-and-middle-income countries but few studies explore factors such as attitudes and beliefs, experiences and social and cultural conditions which affect its overall management. This study addresses this deficit through a qualitative assessment in adults with HTN from Sri Lanka. A phenomenological approach was used to explore patient experiences and perceptions regarding HTN management. Thirty-five adults were purposively sampled from outpatient clinics at the National Hospital of Sri Lanka, Colombo, Sri Lanka. Seven focus group discussions were conducted using a semi-structured guide until information saturation. Discussions were transcribed verbatim, audio-recorded, and translated to English. Thematic analysis based on Braun and Clarke’s approach was conducted using a hybrid inductive–deductive approach with independent coding and collaborative resolution of discrepancies. A total of 35 people, the majority of whom were male (n = 20, 57.1%), with a mean age of 62.0 ± 11.2 years, took part in this study. The themes were interpreted under four domains; health literacy, medication adherence, blood pressure (BP) monitoring and lifestyle modifications with a total of 22 subthemes. ‘Health literacy’: Participants showcased poor knowledge in the natural course of HTN, medication identification, BP values and awareness of health-education resource centres. Common misconceptions revolved around medication adverse effects and misattribution of symptoms of other diseases. Apart from health education by health professionals and media, patients relied on ideas passed on from friends/relatives/family. ‘Medication Adherence’ was determined by behavioural strategies, occupational factors, family support, previous negative experiences, health literacy, health education interventions, conflicting medical advice and communication barriers with health-care providers. BP monitoring’ was largely symptom-driven rather than routine. Home BP monitoring was hindered by financial and technical barriers. ‘Lifestyle modifications’: Most individuals possessed inadequate knowledge, not knowing the recommended daily salt intake or role of physical exercise. Many incorporated medicinal herbs in their diet as complementary therapies. Sub-optimal management of HTN in Sri Lankan adults results from barriers related to the patient, the health care providers and the health care systems. Improving HTN control requires patient-centred, culturally-sensitive care that strengthens health literacy, enhances communication, expands access to home BP monitoring, and leverages family and community support.