The Long and Winding Road: A Systematic Literature Review Conceptualising Pathways for Hypertension Care and Control in Low- and Middle-Income Countries

Document Type : Review Article

Authors

1 Brown School, Washington University in St Louis, St Louis, MO, USA

2 Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK

3 Department of Health Services Research and Policy, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK

Abstract

Background
Hypertension control is poor everywhere, especially in low- and middle-income countries (LMICs). An effective response requires understanding factors acting at each stage on the patients’ pathway through the health system from entry or first contact with the health system, through to treatment initiation and follow up. This systematic review aimed to identify barriers to and facilitators of hypertension control along this pathway and, respectively, ways to overcome or strengthen them.

Methods
MEDLINE, EMBASE, Global Health, CINAHL Plus, and Africa-Wide Information (1980-April 2019) were searched for studies of hypertensive adults in LMICs reporting details of at least 2 adequately described health system contacts. Data were extracted and analysed by 2 reviewers. Themes were developed using NVivo in patient-related (sociodemographic, knowledge and health beliefs, health status and co-morbidities, trade-offs), social (social relationships and traditions) and health system domains (resources and processes). Results are reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.

Results
From 2584 identified records, 30 were included in the narrative synthesis. At entry, ‘health systems resources and processes’ and ‘knowledge and beliefs about hypertension’ dominated while ‘social relations and traditions’ and ‘comorbidities’ assume greater importance subsequently, with patients making ‘trade-offs’ with family priorities during follow up. Socio-demographic factors play a role, but to a lesser extent than other factors. Context matters.

Conclusion
Understanding the changing barriers to hypertension control along the patient journey is necessary to develop a comprehensive and efficient response to this persisting problem.

Highlights

 

Supplementary File 1 (Download)

 

Keywords


  1. GBD 2015 Risk Factors Collaborators. Global, regional, and national comparative risk assessment of 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks, 1990-2015: a systematic analysis for the Global Burden of Disease Study 2015. Lancet. 2016;388(10053):1659-1724. doi:10.1016/s0140-6736(16)31679-8
  2. Chow CK, Teo KK, Rangarajan S, et al. Prevalence, awareness, treatment, and control of hypertension in rural and urban communities in high-, middle-, and low-income countries. JAMA. 2013;310(9):959-968. doi:10.1001/jama.2013.184182
  3. Barriers and enabling factors to effective care for hypertension in low and middle income countries and high income countries: a systematic literature review. PROSPERO; 2017. http://www.crd.york.ac.uk/PROSPERO/display_record.php?ID=CRD42017074786.
  4. WHO. Everybody's business: Strengthening health systems to improve health outcomes. WHO’s framework for action. Geneva: World Health Organization; 2007.
  5. O'Brien BC, Harris IB, Beckman TJ, Reed DA, Cook DA. Standards for reporting qualitative research: a synthesis of recommendations. Acad Med. 2014;89(9):1245-1251. doi:10.1097/ACM.0000000000000388
  6. Schulz KF, Altman DG, Moher D, Group C. CONSORT 2010 statement: updated guidelines for reporting parallel group randomised trials. PLoS Med. 2010;7(3):e1000251. doi:10.1371/journal.pmed.1000251
  7. von Elm E, Altman DG, Egger M, et al. Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. BMJ. 2007;335(7624):806-808. doi:10.1136/bmj.39335.541782.AD
  8. Haenssgen MJ, Ariana P. Healthcare access: A sequence-sensitive approach. SSM Popul Health. 2017;3:37-47. doi:10.1016/j.ssmph.2016.11.008
  9. Kleinman A. Patients and Healers in the Context of Culture. Berkeley: University of California Press; 1980.
  10. Muela S, Ribera J, Mushi A, Tanner M. Medical syncretism with reference to malaria in a Tanzanian community. Soc Sci Med. 2002;55:403-413.
  11. Baer HA. Medical Pluralism: An Evolving and contested concept in medical anthropology. In:Singer M, Erickso PI, eds. A Companion to Medical Anthropology. Wiley; 2011:405-423.
  12. Scheper-Hughes N. Three propositions for a critically applied medical anthropology. Soc Sci Med. 1990;30(2):189-197. doi:10.1016/0277-9536(90)90079-8
  13. Kielmann K, Cataldo F. Engaging with HIV care systems: why space, time and social relations matter. Sex Transm Infect. 2017;93(Suppl 3). doi:10.1136/sextrans-2017-053173
  14. Brown H. Living with HIV/AIDS: an ethnography of care in Western Kenya [dissertaion]. Manchester: The University of Manchester; 2010.
  15. Magrath P, Nichter M. Paying for performance and the social relations of health care provision: An anthropological perspective. Soc Sci Med. 2012;75(10):1778-1785. doi:10.1016/j.socscimed.2012.07.025
  16. Mogensen HO. Finding a path through the health unit: practical experience of Ugandan patients. Med Anthropol. 2005;24(3):209-236. doi:10.1080/01459740500182659
  17. Gilson L, Hanson K, Sheikh K, Agyepong IA, Ssengooba F, Bennett S. Building the field of health policy and systems research: social science matters. PLOS Med. 2011;8(8):e1001079. doi:10.1371/journal.pmed.1001079
  18. Gilson L. Trust and the development of health care as a social institution. Soc Sci Med. 2003;56(7):1453-1468.
  19. Wong MC, Jiang JY, Gibbs T, Griffiths SM. Factors associated with antihypertensive drug discontinuation among Chinese patients: a cohort study. Am J Hypertens. 2009;22(7):802-810.
  20. Wong MC, Su X, Jiang JY, Tang JL, Griffiths SM. Profiles of discontinuation and switching of thiazide diuretics: a cohort study among 9398 Chinese hypertensive patients. Hypertension Research - Clinical & Experimental. 2011;34(7):888-893.
  21. Wong MC, Tam WW, Wang HH, et al. Duration of initial antihypertensive prescription and medication adherence: a cohort study among 203,259 newly diagnosed hypertensive patients. Int J Cardiol. 2015;182:503-508.
  22. Zhao P, Wang C, Qin L, et al. Effect of clinical pharmacist's pharmaceutical care intervention to control hypertensive outpatients in China. Afr J Pharm Pharmacol. 2012;6(1):48-56.
  23. Nguyen QN, Pham ST, Nguyen VL, et al. Implementing a hypertension management programme in a rural area: local approaches and experiences from Ba-Vi district, Vietnam. BMC Public Health. 2011;11:325.
  24. Ramli A, Ahmad NS, Paraidathathu T. Medication adherence among hypertensive patients of primary health clinics in Malaysia. Patient Preference and Adherence. 2012;6:613-622.
  25. Rahmawati R, Bajorek B. A community health worker-based program for elderly people with hypertension in Indonesia: a qualitative study, 2013. Prev Chronic Dis. 2015;12:E175. doi:10.5888/pcd12.140530
  26. Mekonnen HS, Gebrie MH, Eyasu KH, Gelagay AA. Drug adherence for antihypertensive medications and its determinants among adult hypertensive patients attending in chronic clinics of referral hospitals in Northwest Ethiopia. BMC Pharmacol Toxicol. 2017;18(1):27. doi:10.1186/s40360-017-0134-9
  27. Atinga RA, Yarney L, Gavu NM. Factors influencing long-term medication non-adherence among diabetes and hypertensive patients in Ghana: A qualitative investigation. PLoS One. 2018;13(3):e0193995. doi:10.1371/journal.pone.0193995
  28. Harries TH, Twumasi-Abosi V, Plange-Rhule J, Cappuccio FP. Hypertension management in Kumasi: barriers and prejudice? J Hum Hypertens. 2005;19(12):975-977. doi:10.1038/sj.jhh.1001920
  29. Sarfo FS, Mobula LM, Burnham G, et al. Factors associated with uncontrolled blood pressure among Ghanaians: Evidence from a multicenter hospital-based study. PLoS One. 2018;13(3):e0193494. doi:10.1371/journal.pone.0193494
  30. Rachlis B, Naanyu V, Wachira J, et al. Identifying common barriers and facilitators to linkage and retention in chronic disease care in western Kenya. BMC Public Health. 2016;16:741. Published 2016. doi:10.1186/s12889-016-3462-6
  31. Vedanthan R, Tuikong N, Kofler C, et al. Barriers and facilitators to nurse management of hypertension: A qualitative analysis from western Kenya. Ethn Dis. 2016;26(3):315-322. doi:10.18865/ed.26.3.315
  32. Subramanian S, Gakunga R, Kibachio J, et al. Cost and affordability of non-communicable disease screening, diagnosis and treatment in Kenya: Patient payments in the private and public sectors. PLoS One. 2018;13(1):e0190113. doi:10.1371/journal.pone.0190113
  33. Nashilongo MM, Singu B, Kalemeera F, et al. Assessing adherence to antihypertensive therapy in primary health care in Namibia: findings and implications. Cardiovasc Drugs Ther. 2017;31(5-6):565-578. doi:10.1007/s10557-017-6756-8
  34. Odusola AO, Hendriks M, Schultsz C, et al. Perceptions of inhibitors and facilitators for adhering to hypertension treatment among insured patients in rural Nigeria: a qualitative study. BMC Health Serv Res. 2014;14:624. doi:10.1186/s12913-014-0624-z
  35. Bovet P, Gervasoni JP, Mkamba M, Balampama M, Lengeler C, Paccaud F. Low utilization of health care services following screening for hypertension in Dar es Salaam (Tanzania): a prospective population-based study. BMC Public Health. 2008;8:407. doi:10.1186/1471-2458-8-407
  36. Kotwani P, Balzer L, Kwarisiima D, et al. Evaluating linkage to care for hypertension after community-based screening in rural Uganda. Trop Med Int Health. 2014;19(4):459-468. doi:10.1111/tmi.12273
  37. Youssef RM, Moubarak, II. Patterns and determinants of treatment compliance among hypertensive patients. Eastern Mediterranean Health Journal. 2002;8(4-5):579-592.
  38. Chung VQ, Morley K, O'Neil E, Ken N, Morley M. Evaluation of a hypertension screening programme in Independence, Belize. West Indian Medical Journal. 2005;54(2):130-134.
  39. Ferreira DN, Matos DL, de Loyola Filho AI. Absence of routine medical consultation among hypertensive and/or diabetic elders: an epidemiological study based on the Brazilian National Household Survey 2008. Rev Bras Epidemiol. 2015;18(3):578-594. doi:10.1590/1980-5497201500030005
  40. Nations M, Firmo JO, Lima-Costa MF, Uchoa E. Balking blood pressure "control" by older persons of Bambui, Minas Gerais State, Brazil: an ethno-epidemiological inquiry. Cad Saude Publica. 2011;27 Suppl 3:S378-S389. doi:10.1590/s0102-311x2011001500008
  41. Emmerick ICM, Campos MR, Luiza VL, Chaves LA, Bertoldi AD, Ross-Degnan D. Retrospective interrupted time series examining hypertension and diabetes medicines usage following changes in patient cost sharing in the 'Farmacia Popular' programme in Brazil. BMJ Open. 2017;7(11):e017308. doi:10.1136/bmjopen-2017-017308
  42. Legido-Quigley H, Camacho Lopez PA, Balabanova D, et al. Patients' knowledge, attitudes, behaviour and health care experiences on the prevention, detection, management and control of hypertension in Colombia: a qualitative study. PLoS One. 2015;10(4):e0122112. doi:10.1371/journal.pone.0122112
  43. Duan K, McBain R, Flores H, et al. Implementation and clinical effectiveness of a community-based non-communicable disease treatment programme in rural Mexico: a difference-in-differences analysis. Health Policy Plan. 2018;33(6):707-714. doi:10.1093/heapol/czy041
  44. Gabert R, Ng M, Sogarwal R, et al. Identifying gaps in the continuum of care for hypertension and diabetes in two Indian communities. BMC Health Serv Res. 2017;17(1):846. doi:10.1186/s12913-017-2796-9
  45. Nayeri ND, Dehghan M, Iranmanesh S. Being as an iceberg: hypertensive treatment adherence experiences in southeast of Iran. Glob Health Action. 2015;8:28814. doi:10.3402/gha.v8.28814
  46. Risso-Gill I, Balabanova D, Majid F, et al. Understanding the modifiable health systems barriers to hypertension management in Malaysia: a multi-method health systems appraisal approach. BMC Health Serv Res. 2015;15:254. doi:10.1186/s12913-015-0916-y
  47. Shima R, Farizah MH, Majid HA. A qualitative study on hypertensive care behavior in primary health care settings in Malaysia. Patient Prefer Adherence. 2014;8:1597-1609. doi:10.2147/PPA.S69680
  48. Naanyu V, Vedanthan R, Kamano JH, et al. Barriers Influencing Linkage to Hypertension Care in Kenya: Qualitative Analysis from the LARK Hypertension Study. J Gen Intern Med. 2016;31(3):304-314. doi:10.1007/s11606-015-3566-1
  49. Manto A, Dzudie A, Halle MP, et al. Agreement between home and ambulatory blood pressure measurement in non-dialysed chronic kidney disease patients in Cameroon. Pan Afr Med J. 2018;29:71. doi:10.11604/pamj.2018.29.71.12078
  50. MacKian S. A review of health seeking behaviour: problems and prospects (HSD/WP/05/03). Manchester: Health Systems Development Programme, University of Manchester; 2003.
  51. Atinga RA, Yarney L, Gavu NM. Factors influencing long-term medication non-adherence among diabetes and hypertensive patients in Ghana: A qualitative investigation. PLoS One. 2018;13(3):e0193995. doi:10.1371/journal.pone.0193995
  52. Dowell SF, Blazes D, Desmond-Hellmann S. Four steps to precision public health. Nature News. 2016;540(7632):189.
  53. Olstad DL, McIntyre L. Reconceptualising precision public health. BMJ Open. 2019;9(9):e030279. doi:10.1136/bmjopen-2019-030279
  54. Department for Health Systems Governance and Service Delivery. People-centred care in low- and middle-income countries. Geneva: World Health Organization;2010.
  55. Palafox B, Seguin ML, McKee M, et al. Responsive and Equitable Health Systems-Partnership on Non-Communicable Diseases (RESPOND) study: a mixed-methods, longitudinal, observational study on treatment seeking for hypertension in Malaysia and the Philippines. BMJ Open. 2018;8(7):e024000. doi:10.1136/bmjopen-2018-024000
  56. Schwalm JD, McCready T, Lopez-Jaramillo P, et al. A community-based comprehensive intervention to reduce cardiovascular risk in hypertension (HOPE 4): a cluster-randomised controlled trial. Lancet. 2019;394(10205):1231-1242. doi:10.1016/s0140-6736(19)31949-x
Volume 11, Issue 3
March 2022
Pages 257-268
  • Receive Date: 25 November 2019
  • Revise Date: 23 April 2020
  • Accept Date: 16 June 2020
  • First Publish Date: 01 March 2022