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Patient and Healthcare Provider Barriers to Hypertension Awareness, Treatment and Follow Up: A Systematic Review and Meta-Analysis of Qualitative and Quantitative Studies

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  • Rasha Khatib
  • Jon-David Schwalm
  • Salim Yusuf
  • R Brian Haynes
  • Martin McKee
  • Maheer Khan
  • Robby Nieuwlaat

Abstract

Background: Although the importance of detecting, treating, and controlling hypertension has been recognized for decades, the majority of patients with hypertension remain uncontrolled. The path from evidence to practice contains many potential barriers, but their role has not been reviewed systematically. This review aimed to synthesize and identify important barriers to hypertension control as reported by patients and healthcare providers. Methods: Electronic databases MEDLINE, EMBASE and Global Health were searched systematically up to February 2013. Two reviewers independently selected eligible studies. Two reviewers categorized barriers based on a theoretical framework of behavior change. The theoretical framework suggests that a change in behavior requires a strong commitment to change [intention], the necessary skills and abilities to adopt the behavior [capability], and an absence of health system and support constraints. Findings: Twenty-five qualitative studies and 44 quantitative studies met the inclusion criteria. In qualitative studies, health system barriers were most commonly discussed in studies of patients and health care providers. Quantitative studies identified disagreement with clinical recommendations as the most common barrier among health care providers. Quantitative studies of patients yielded different results: lack of knowledge was the most common barrier to hypertension awareness. Stress, anxiety and depression were most commonly reported as barriers that hindered or delayed adoption of a healthier lifestyle. In terms of hypertension treatment adherence, patients mostly reported forgetting to take their medication. Finally, priority setting barriers were most commonly reported by patients in terms of following up with their health care providers. Conclusions: This review identified a wide range of barriers facing patients and health care providers pursuing hypertension control, indicating the need for targeted multi-faceted interventions. More methodologically rigorous studies that encompass the range of barriers and that include low- and middle-income countries are required in order to inform policies to improve hypertension control.

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  • Rasha Khatib & Jon-David Schwalm & Salim Yusuf & R Brian Haynes & Martin McKee & Maheer Khan & Robby Nieuwlaat, 2014. "Patient and Healthcare Provider Barriers to Hypertension Awareness, Treatment and Follow Up: A Systematic Review and Meta-Analysis of Qualitative and Quantitative Studies," PLOS ONE, Public Library of Science, vol. 9(1), pages 1-12, January.
  • Handle: RePEc:plo:pone00:0084238
    DOI: 10.1371/journal.pone.0084238
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    References listed on IDEAS

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    1. Shulman, N.B. & Martinez, B. & Brogan, D. & Carr, A.A. & Miles, C.G., 1986. "Financial cost as an obstacle to hypertension therapy," American Journal of Public Health, American Public Health Association, vol. 76(9), pages 1105-1108.
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    1. Meznah M. Alanazi & Awatif Ahmed Hendi & N. Ameer Ahammad & Bagh Ali & Sonia Majeed & Nehad Ali Shah, 2023. "Significance of Ternary Hybrid Nanoparticles on the Dynamics of Nanofluids over a Stretched Surface Subject to Gravity Modulation," Mathematics, MDPI, vol. 11(4), pages 1-16, February.
    2. Marta Gorina & Joaquín T. Limonero & María Álvarez, 2019. "Educational diagnosis of self‐management behaviours in patients with diabetes mellitus, hypertension and hypercholesterolaemia based on the PRECEDE model: Qualitative study," Journal of Clinical Nursing, John Wiley & Sons, vol. 28(9-10), pages 1745-1759, May.
    3. Ali, Bagh & Khan, Shahid Ali & Hussein, Ahmed Kadhim & Thumma, Thirupathi & Hussain, Sajjad, 2022. "Hybrid nanofluids: Significance of gravity modulation, heat source/ sink, and magnetohydrodynamic on dynamics of micropolar fluid over an inclined surface via finite element simulation," Applied Mathematics and Computation, Elsevier, vol. 419(C).
    4. Lori A. Spies & Joyce M. Mulenga, 2021. "Provider Perceptions about Hypertension: A Mixed Methods Study in Zambia," Clinical Nursing Research, , vol. 30(2), pages 200-206, February.
    5. Helena Legido-Quigley & Paul Anthony Camacho Lopez & Dina Balabanova & Pablo Perel & Patricio Lopez-Jaramillo & Robby Nieuwlaat & J-D Schwalm & Tara McCready & Salim Yusuf & Martin McKee, 2015. "Patients’ Knowledge, Attitudes, Behaviour and Health Care Experiences on the Prevention, Detection, Management and Control of Hypertension in Colombia: A Qualitative Study," PLOS ONE, Public Library of Science, vol. 10(4), pages 1-16, April.
    6. Emily Lyles & Gilbert Burnham & Zeina Fahed & Kenneth M. Shermock & Paul Spiegel & Shannon Doocy, 2022. "Care-Seeking and Health Service Utilization for Hypertension and Type 2 Diabetes Among Syrian Refugee and Host Community Care-Seekers in Lebanon," Journal of International Migration and Integration, Springer, vol. 23(2), pages 519-541, June.
    7. Magdalena Jasińska-Stroschein, 2022. "The Effectiveness of Pharmacist Interventions in the Management of Patient with Renal Failure: A Systematic Review and Meta-Analysis," IJERPH, MDPI, vol. 19(18), pages 1-28, September.

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