Exploring patient perspectives on barriers contributing to lost to follow-up in hypertension care: A qualitative study in a tertiary-care hospital in Coastal Karnataka, India

BACKGROUND: Hypertension requires lifelong treatment and regular follow-up to prevent complications; however, lost to follow-up (LTFU) remains a major challenge in long-term hypertension care, particularly in resource-constrained settings. OBJECTIVE: This study explored patient perspectives on barriers contributing to LTFU in hypertension management. METHODS: A qualitative study was conducted among 32 hypertensive patients who were LTFU at a tertiary care hospital in Coastal Karnataka, India. Participants were aged 31-69years, with 21 (65.6%) men and 11 (34.4%) women. Participants were identified through hospital records and interviewed using a semi-structured interview guide. Interviews were conducted from February to April 2026 Interviews were audio-recorded, transcribed verbatim, and analysed thematically following COREQ guidelines. RESULTS: Six major themes emerged.: (1) illness perception and self-management practices, (2) care-seeking and follow-up behaviour, (3) structural and socioeconomic barriers, (4) health system and continuity gaps, (5) patient-perceived strategies to improve continuity of care, and (6) health information continuity and interoperability needs. Participants described symptom-driven healthcare seeking, medication non-adherence, occupational responsibilities, and competing family priorities contributing to irregular follow-up. Financial burden, including treatment costs, transportation expenses, and wage loss, substantially affected continuity of care. Long travel distances, dependence on family members, overcrowding, rushed consultations, and inadequate follow-up mechanisms further influenced disengagement from care. Participants also reported fragmented healthcare utilisation, repeated investigations, dependence on paper-based records, and poor continuity of medical information across healthcare facilities. Several participants perceived that integrated digital health information systems, decentralised services, appointment reminders, and improved counselling could strengthen long-term hypertension follow-up. CONCLUSIONS: LTFU in hypertension care is influenced by interconnected individual, socioeconomic, and health system-related barriers. A notable finding was the fragmented nature of continuity of care and poor health information continuity across healthcare facilities. Strengthening patient-centred follow-up systems, decentralised chronic disease services, financial protection mechanisms, and interoperable health information systems may improve continuity of hypertension care and reduce long-term disengagement from chronic disease management.