Barriers Influencing Linkage to Hypertension Care in Kenya: Qualitative Analysis from the LARK Hypertension Study

• Published in: Journal of general internal medicine : JGIM 2016-03, Vol.31 (3), p.304-314
• Main Authors: Naanyu, Violet, Vedanthan, Rajesh, Kamano, Jemima H., Rotich, Jackson K., Lagat, Kennedy K., Kiptoo, Peninah, Kofler, Claire, Mutai, Kennedy K., Bloomfield, Gerald S., Menya, Diana, Kimaiyo, Sylvester, Fuster, Valentin, Horowitz, Carol R., Inui, Thomas S.
• Format: Article
• Language: English
• Subjects: Adult; Cognitive ability; Community; Content analysis; Delphi method; Design modifications; Emotional factors; Emotions; Environmental factors; Environmental impact; Fear; Female; Health; Healthcare Disparities - standards; Humans; Hypertension; Hypertension - diagnosis; Hypertension - ethnology; Hypertension - therapy; Internal Medicine; Kenya - ethnology; Male; Medical personnel; Medicine; Medicine & Public Health; Middle Aged; Occupational health; Original Research; Patient Care - standards; Pilot Projects; Poverty; Qualitative analysis; Qualitative research; Quality of Health Care - standards; Risk factors; Rural environments; Rural Population; Social factors; Statistical analysis; Triangulation; Workers
• ISSN: 0884-8734; 1525-1497
• DOI: 10.1007/s11606-015-3566-1

Background Hypertension, the leading global risk factor for mortality, is characterized by low treatment and control rates in low- and middle-income countries. Poor linkage to hypertension care contributes to poor outcomes for patients. However, specific factors influencing linkage to hypertension care are not well known. Objective To evaluate factors influencing linkage to hypertension care in rural western Kenya. Design Qualitative research study using a modified Health Belief Model that incorporates the impact of emotional and environmental factors on behavior. Participants Mabaraza (traditional community assembly) participants ( n  = 242) responded to an open invitation to residents in their respective communities. Focus groups, formed by purposive sampling, consisted of hypertensive individuals, at-large community members, and community health workers ( n  = 169). Approach We performed content analysis of the transcripts with NVivo 10 software, using both deductive and inductive codes. We used a two-round Delphi method to rank the barriers identified in the content analysis. We selected factors using triangulation of frequency of codes and themes from the transcripts, in addition to the results of the Delphi exercise. Sociodemographic characteristics of participants were summarized using descriptive statistics. Key Results We identified 27 barriers to linkage to hypertension care, grouped into individual (cognitive and emotional) and environmental factors. Cognitive factors included the asymptomatic nature of hypertension and limited information. Emotional factors included fear of being a burden to the family and fear of being screened for stigmatized diseases such as HIV. Environmental factors were divided into physical (e.g. distance), socioeconomic (e.g. poverty), and health system factors (e.g. popularity of alternative therapies). The Delphi results were generally consistent with the findings from the content analysis. Conclusions Individual and environmental factors are barriers to linkage to hypertension care in rural western Kenya. Our analysis provides new insights and methodological approaches that may be relevant to other low-resource settings worldwide.