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. 2016 Mar;31(3):304-14.
doi: 10.1007/s11606-015-3566-1. Epub 2016 Jan 4.

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

Violet Naanyu  1   2   3 , Rajesh Vedanthan  4   5 , Jemima H Kamano  1   2   3 , Jackson K Rotich  2   3 , Kennedy K Lagat  2   3 , Peninah Kiptoo  2   3 , Claire Kofler  6   3 , Kennedy K Mutai  2   3 , Gerald S Bloomfield  3   7 , Diana Menya  1   2   3 , Sylvester Kimaiyo  1   2   3 , Valentin Fuster  6   3   8 , Carol R Horowitz  6   3 , Thomas S Inui  1   2   3   9   10
Affiliations

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

Violet Naanyu et al. J Gen Intern Med. 2016 Mar.

Abstract

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.

Keywords: cardiovascular disease; global health; hypertension; qualitative research; socioeconomic factors.

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Conflict of interest statement

Compliance with Ethical Standards Funders Research reported in this publication was supported by the National Heart, Lung, and Blood Institute of the National Institutes of Health (award number 5U01HL114200), under the Global Alliance for Chronic Diseases programme. RV is supported by the Fogarty International Center of the National Institutes of Health under award number K01 TW 009218–05. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. Conflict of Interest The authors declare that they do not have a conflict of interest.

Figures

Figure 1
Figure 1
Conceptual depiction of the relationship between individual factors [cognitive (purple) and emotional (red)], environmental factors (green), and behavior change (blue). Our model indicates that environmental factors may affect internal cognitive and emotional processes, and also may impact the ability of an individual to successfully carry out behavior change
See this image and copyright information in PMC

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