Patient pathways and perceptions of hypertension treatment, management, and control in rural Bangladesh: a qualitative study

Figures & data

Table 1 Patient characteristics

	Female	Male	Total
Sex	9	11	20
Age-group, years
40–49	4	0	4
50–59	3	5	8
60–69	2	4	6
70+	0	2	2
Location
Lauhajang	2	3	5
Mirzapur	3	2	5
Sirajdikhan	1	4	5
Tangibari	3	2	5
Management of hypertension
Controlled (SBP/DBP <140/90 mmHg)	5	3	8
Uncontrolled (SBP/DBP ≥140/90 mmHg)	4	8	12
Education
0 years	5	2	7
1–5 years	1	5	6
6–10 years	2	4	6
11+ years	1	0	1
Religious group
Islam	7	9	16
Hindu	2	2	4

Abbreviations: SBP, systolic blood pressure; DBP, diastolic blood pressure.

Table 2 Summary interview guide

Knowledge and diagnosis

• Did you experience any symptoms before you were diagnosed with hypertension?

• If yes, can you describe those symptoms of hypertension?

• Do you have other health problems?

• Can you tell me about your other health problems (the one that worries you the most)? (Ask about hypertension and diabetes)

• How did you decide to seek care? Did the family help in the process? Or any organization?

• Can we talk about your experience of this process of seeking care?

• To what extent do you think hypertension is an important disease?

• How much did you know about hypertension before your diagnosis? What were your information sources at the time and now?

Prevention and treatment

• Have you received any advice on preventive and control measures on hypertension from community health workers (CHWs)?

• Was the information received appropriate to your needs?

• Have you changed your behavior (diet and exercise) since knowing about the condition?

• What was the treatment that was first prescribed? Was it subsequently changed?

• Does a family member or organization help you with taking the medication?

• Did you have to pay anything out of pocket for the treatment or for traveling?

• Do you take other alternative medication?

• How were the health-care facilities you visited?

• What difficulties did you face during this process while seeking treatment?

• What in the process of treatment could have been handled better?

Access of services and receiving care

• Are there shortages of drugs and consumables? Or access problems to facilities? Discuss problems.

• Are there problems accessing home health education and other services from CHWs?

• Are there problems accessing subsidies or financial support for additional health services?

Health-care experiences and recommendations

• How would you assess your communication with health providers you have encountered?

• Do you have a trusting relationship with your GP?

• To what extent have you been kept informed about your treatment?

• How can home health education and other services provided by CHWs be improved?

• Have you heard of any initiative to improve prevention of hypertension?

• From your experience, what could be done to make life easier for people suffering from hypertension?

• Are there any changes that need to be made outside the health-care system?

Abbreviation: GP, general practitioner.

Table 3 Key themes and examples of evidence

Key themes	Evidence
Patient awareness and knowledge of hypertension treatment, management, and control	If I forget to take medicine, then I feel neck pain, headache, discomfort in head, then I try to drink lime sherbet if lime is available at home [at] that time. After that, the blood pressure reduces a little, then I make my sons buy me medicines. [IDI-BD-04, age 50–59 years, female]
Adherence to medications	I stopped taking medicine before this for 3 or 4 years. I felt better at that time. After that, I became sick again and I am taking [medicine]. [IDI-BD-19, age 40–49 years, male]
Patient pathways to hypertension diagnosis, treatment, and management	Yes, [a] few days ago, I bought medicine for blood pressure from the local pharmacy. Pharmacy man asked what types of medicine. I said high blood-pressure medicine. I didn’t measure my blood pressure, just took the medicine. I felt better after taking the medicine. [IDI-BD-03, age 50–59 years, male]
Health-system barriers to accessing hypertension care	The government doctors neglect the patient … they do not give any medicine. We need to go there and stand, buy tickets, and many other hassles. That’s why I do not go there. [IDI-BD-13, age 50–59 years, female]
Health-provider relationships with patients	There is a dispensary at the market … the person who gives medicine there is very close with me. He is very good … he sells medicine. He takes care of me more. [IDI-BD-12, age 70–79 years, male]
Ways forward and unmet needs	It will be good. He [community health worker] can caution me. They could confirm if my current habits are suitable for hypertension control … I will be benefited of course. Hypertension will be reduced. [IDI-BD-12, age 70–79 years, male]

Figure 1 Overview of patient pathways.

Abbreviations: BP, blood pressure; HTN, hypertension.

Figure 2 Patient pathway: nonacute symptoms.

Abbreviations: BP, blood pressure; HTN, hypertension.

Figure 3 Patient pathway: acute episode.

Abbreviations: BP, blood pressure; HTN, hypertension; TB, tuberculosis.

Figure 4 Patient pathway: comorbidity symptoms.

Abbreviations: HTN, hypertension; T2DM, type 2 diabetes mellitus.