Patient pathways and perceptions of hypertension treatment, management, and control in rural Bangladesh: a qualitative study

Abstract

Purpose: Hypertension is an increasing threat to global public health, a leading cause of premature death, and an important modifiable risk factor for cardiovascular and cerebrovascular disease. Despite evidence on the efficacy of antihypertensive medication for blood-pressure control and mortality prevention, a large proportion of individuals are undiagnosed and untreated, especially in resource-constrained settings. This qualitative study explored patient pathways to care, as well as knowledge of and adherence to hypertension care.

Methods: We conducted in-depth interviews with 20 hypertensive patients in two rural districts in Bangladesh. Interviews were conducted and transcribed in Bangla and translated to English. QSR NVivo 10 software was used for analyses. We mapped patient pathways and report here on patient experiences accessing care from local pharmacies, the government, and private clinics.

Results: Overall, most patients reported hypertension awareness prior to diagnosis and were conscious about consequences of hypertension. However, patients had little knowledge about prevention and treatment strategies. Most patients considered hypertension an important disease, albeit reporting taking medication only when symptomatic. Patients were aware of dietary advice; however, they were largely sedentary. Qualified doctors in both private and government settings diagnosed hypertension in the majority of the patients, and some were diagnosed by an informal provider and a few reported self-care at home. Patients followed three pathways: specialized hospitals for acute care, private hospitals/local pharmacy for nonacute symptoms, and incidental hypertension identification while being treated for another condition.

Conclusion: We identify barriers to access to hypertension prevention and care that prevented patients from seeking and receiving treatment from government facilities. Challenges included a lack of support to enable community screening by government health workers, long waiting times, and inadequate supplies for hypertension treatment. Expanding community-health workers' scope in the dissemination of chronic-disease information may improve patient pathways to hypertension care in rural communities in Bangladesh.

Keywords: Bangladesh; awareness; barrier; diagnosis; hypertension; medication; qualitative.

Conflict of interest statement

Disclosure A Naheed is the country principal investigator from icddr, Bangladesh and TH Jafar is the overall chief principal investigator at Duke National University of Singapore Medical School, Singapore. The authors report no other conflicts of interest in this work.

Figures

Figure 1

Overview of patient pathways. Abbreviations: BP, blood pressure; HTN, hypertension.

Figure 2

Patient pathway: nonacute symptoms. Abbreviations: BP, blood pressure; HTN, hypertension.

Figure 3

Patient pathway: acute episode. Abbreviations: BP, blood pressure; HTN, hypertension; TB, tuberculosis.

Figure 4

Patient pathway: comorbidity symptoms. Abbreviations: HTN, hypertension; T2DM, type 2 diabetes mellitus.