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Title: Patients' experiences on accessing health care services for management of hypertension in rural Bangladesh, Pakistan and Sri Lanka: A qualitative study
Authors: Legido-Quigley H. 
Naheed A.
Asita De Silva H.
Jehan I.
Haldane V. 
Cobb B.
Tavajoh S. 
Chakma N.
Kasturiratne A.
Siddiqui S.
Jafar T.H. 
Clemens J.D.
Hasnat M.
Hameed A.
Khan A.Z.
Ranasinha C.
Fin-Kelstein E. 
Bilger M. 
Pryseley A. 
Gandhi M. 
Ebrahim S.
Turner E.
Keywords: adult
attitude to health
clinical article
controlled study
cultural factor
diagnostic procedure
disease control
doctor patient relationship
general practitioner
groups by age
health auxiliary
health care access
health care availability
health care cost
health care delivery
health care personnel
health care quality
health service
high volume hospital
hospital admission
medical education
medical expert
patient attitude
patient compliance
patient-reported outcome
physician attitude
primary health care
public hospital
qualitative research
rural area
semi structured interview
social background
Sri Lanka
work experience
Issue Date: 2019
Publisher: Public Library of Science
Citation: Legido-Quigley H., Naheed A., Asita De Silva H., Jehan I., Haldane V., Cobb B., Tavajoh S., Chakma N., Kasturiratne A., Siddiqui S., Jafar T.H., Clemens J.D., Hasnat M., Hameed A., Khan A.Z., Ranasinha C., Fin-Kelstein E., Bilger M., Pryseley A., Gandhi M., Ebrahim S., Turner E. (2019). Patients' experiences on accessing health care services for management of hypertension in rural Bangladesh, Pakistan and Sri Lanka: A qualitative study. PLoS ONE 14 (1) : e0211100. ScholarBank@NUS Repository.
Abstract: Hypertension is the leading risk factor for cardiovascular disease and leading cause of premature death globally. In 2008, approximately 40% of adults were diagnosed with hypertension, with more than 1.5 billion people estimated to be affected globally by 2025. Hypertension disproportionally affects low- and middle-income countries, where the prevalence is higher and where the health systems are more fragile. This qualitative study explored patients' experiences on the management and control of hypertension in rural Bangladesh, Sri Lanka and Pakistan. We conducted sixty semi-structured interviews, with 20 participants in each country. Hypertensive individuals were recruited based on age, gender and hypertensive status. Overall, patients' reported symptoms across the three countries were quite similar, although perceptions of hypertension were mixed. The majority of patients reported low knowledge on how to prevent or treat hypertension. The main barriers to accessing health services, as reported by participants, were inadequate services and poor quality of existing facilities, shortage of medicine supplies, busyness of doctors due to high patient load, long travel distance to facilities, and long waiting times once facilities were reached. Patients also mentioned that cost was a barrier to accessing services and adhering to medication. Many patients, when asked for areas of improvement, reported on the importance of the provider-patient relationship and mentioned valuing doctors who spent time with them, provided advice, and could be trusted. However, most patients reported that, especially at primary health care level and in government hospitals, the experience with their doctor did not meet their expectations. Patients in the three countries reported desire for good quality local medical services, the need for access to doctors, medicine and diagnostics and decreased cost for medication and medical services. Patients also described welcoming health care outreach activities near their homes. Areas of improvement could focus on reorienting community health workers' activities; involving family members in comprehensive counseling for medication adherence; providing appropriate training for health care staff to deliver effective information and services for controlling hypertension to patients; enhancing primary health care and specialist services; improving supplies of hypertensive medication in public facilities; taking into account patients' cultural and social background when providing services; and facilitating access and treatment to those who are most vulnerable. © 2019 Legido-Quigley et al.
Source Title: PLoS ONE
ISSN: 19326203
DOI: 10.1371/journal.pone.0211100
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