Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2021 Oct 11:8:716080.
doi: 10.3389/fcvm.2021.716080. eCollection 2021.

Barriers, Enablers and Strategies for the Treatment and Control of Hypertension in Nepal: A Systematic Review

Raja Ram Dhungana  1 , Zeljko Pedisic  1 , Achyut Raj Pandey  2 , Nipun Shrestha  1   3 , Maximilian de Courten  4
Affiliations

Barriers, Enablers and Strategies for the Treatment and Control of Hypertension in Nepal: A Systematic Review

Raja Ram Dhungana et al. Front Cardiovasc Med. .

Abstract

Background: Understanding country-specific factors influencing hypertension care is critical to address the gaps in the management of hypertension. However, no systematic investigation of factors influencing hypertension treatment and control in Nepal is available. This study aimed to systematically review the published literature and synthesise the findings on barriers, enablers, and strategies for hypertension treatment and control in Nepal. Methods: Embase, PubMed, Web of Science, CINAHL, ProQuest and WorldCat, and Nepali journals and government websites were searched for qualitative, quantitative, and mixed-methods studies on factors or strategies related to hypertension treatment and control in Nepal. Information from qualitative studies was analysed using template analysis, while results from quantitative studies were narratively synthesised. Summary findings were framed under "health system", "provider", and "patient" domains. The protocol was registered in PROSPERO (registration number: CRD42020145823). Results: We identified 15 studies; ten related to barriers and enablers and five to strategies. The identified barriers associated with the health system were: lack of affordable services and lack of resources. The barriers at the provider's level were: communication gaps, inadequate counselling, long waiting hours for appointments, lack of national guidelines for hypertension treatment, and provider's unsupportive behaviours. Non-adherence to medication, irregular follow-up visits, lack of awareness on blood pressure target, poor help-seeking behaviours, reluctance to change behaviours, perceived side-effects of anti-hypertensive medication, self-medication, lack of family support, financial hardship, lack of awareness on blood pressure complications, and comorbidity were barriers identified at patient level. The following enablers were identified: free essential health care services, family support, positive illness perception, and drug reminders. Strategies implemented at the health system, provider and patient levels were: establishing digital health records at health centres, health worker's capacity development, and health education. Conclusion: There is a range of barriers for hypertension treatment and control in Nepal pertaining to the health system, health providers, and patients. Comprehensive interventions are needed at all three levels to further improve management and control of hypertension in Nepal.

Keywords: Nepal; barriers; control; facilitators; hypertension; treatment.

PubMed Disclaimer

Conflict of interest statement

AP was employed by the company Abt Associates. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Conceptual framework of barriers, enablers, and strategies for hypertension control.
Figure 2
Figure 2
Study selection flow diagram.
See this image and copyright information in PMC

References

    1. World Health Organization . Political declaration of the High-level Meeting of the General Assembly on the Prevention and Control of Non-communicable Diseases New York: WHO; (2011). Available online at: https://www.who.int/nmh/events/un_ncd_summit2011/political_declaration_e....
    1. Wozniak G, Khan T, Gillespie C, Sifuentes L, Hasan O, Ritchey M, et al. . Hypertension control cascade: a framework to improve hypertension awareness, treatment, and control. J Clin Hypertens (Greenwich). (2016) 18:232–9. 10.1111/jch.12654 - DOI - PMC - PubMed
    1. Mills KT, Bundy JD, Kelly TN, Reed JE, Kearney PM, Reynolds K, et al. . Global disparities of hypertension prevalence and control: a systematic analysis of population-based studies from 90 countries. Circulation. (2016) 134:441–50. 10.1161/CIRCULATIONAHA.115.018912 - DOI - PMC - PubMed
    1. Gupta R, Kaur M, Islam S, Mohan V, Mony P, Kumar R, et al. . Association of household wealth index, educational status, and social capital with hypertension awareness, treatment, and control in South Asia. Am J Hypertens. (2017) 30:373–81. 10.1093/ajh/hpw169 - DOI - PubMed
    1. The World Bank Group . Population, total - Nepal (2020). Available online at: https://data.worldbank.org/indicator/SP.POP.TOTL?locations=NP.

Publication types

LinkOut - more resources