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

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...

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Autores principales: Odusola, Aina O, Hendriks, Marleen, Schultsz, Constance, Bolarinwa, Oladimeji A, Akande, Tanimola, Osibogun, Akin, Agyemang, Charles, Ogedegbe, Gbenga, Agbede, Kayode, Adenusi, Peju, Lange, Joep, van Weert, Henk, Stronks, Karien, Haafkens, Joke A
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2014
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4267751/
https://www.ncbi.nlm.nih.gov/pubmed/25491509
http://dx.doi.org/10.1186/s12913-014-0624-z
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author Odusola, Aina O
Hendriks, Marleen
Schultsz, Constance
Bolarinwa, Oladimeji A
Akande, Tanimola
Osibogun, Akin
Agyemang, Charles
Ogedegbe, Gbenga
Agbede, Kayode
Adenusi, Peju
Lange, Joep
van Weert, Henk
Stronks, Karien
Haafkens, Joke A
author_facet Odusola, Aina O
Hendriks, Marleen
Schultsz, Constance
Bolarinwa, Oladimeji A
Akande, Tanimola
Osibogun, Akin
Agyemang, Charles
Ogedegbe, Gbenga
Agbede, Kayode
Adenusi, Peju
Lange, Joep
van Weert, Henk
Stronks, Karien
Haafkens, Joke A
author_sort Odusola, Aina O
collection PubMed
description 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.
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spelling pubmed-42677512014-12-17 Perceptions of inhibitors and facilitators for adhering to hypertension treatment among insured patients in rural Nigeria: a qualitative study Odusola, Aina O Hendriks, Marleen Schultsz, Constance Bolarinwa, Oladimeji A Akande, Tanimola Osibogun, Akin Agyemang, Charles Ogedegbe, Gbenga Agbede, Kayode Adenusi, Peju Lange, Joep van Weert, Henk Stronks, Karien Haafkens, Joke A BMC Health Serv Res Research Article 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. BioMed Central 2014-12-10 /pmc/articles/PMC4267751/ /pubmed/25491509 http://dx.doi.org/10.1186/s12913-014-0624-z Text en © Odusola et al.; licensee BioMed Central Ltd. 2014 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Research Article
Odusola, Aina O
Hendriks, Marleen
Schultsz, Constance
Bolarinwa, Oladimeji A
Akande, Tanimola
Osibogun, Akin
Agyemang, Charles
Ogedegbe, Gbenga
Agbede, Kayode
Adenusi, Peju
Lange, Joep
van Weert, Henk
Stronks, Karien
Haafkens, Joke A
Perceptions of inhibitors and facilitators for adhering to hypertension treatment among insured patients in rural Nigeria: a qualitative study
title Perceptions of inhibitors and facilitators for adhering to hypertension treatment among insured patients in rural Nigeria: a qualitative study
title_full Perceptions of inhibitors and facilitators for adhering to hypertension treatment among insured patients in rural Nigeria: a qualitative study
title_fullStr Perceptions of inhibitors and facilitators for adhering to hypertension treatment among insured patients in rural Nigeria: a qualitative study
title_full_unstemmed Perceptions of inhibitors and facilitators for adhering to hypertension treatment among insured patients in rural Nigeria: a qualitative study
title_short Perceptions of inhibitors and facilitators for adhering to hypertension treatment among insured patients in rural Nigeria: a qualitative study
title_sort perceptions of inhibitors and facilitators for adhering to hypertension treatment among insured patients in rural nigeria: a qualitative study
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4267751/
https://www.ncbi.nlm.nih.gov/pubmed/25491509
http://dx.doi.org/10.1186/s12913-014-0624-z
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