Document Type : Original Article
Authors
1 Department of Health Policy and Management, School of Management and Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran
2 Tabriz Health Services Management Research Center, Department of Health Policy and Management, School of Management and Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran
3 Tabriz Health Services Management Research Center, Department of health policy and management, School of management and medical informatics, Tabriz university of medical sciences, Tabriz, Iran
Abstract
Background: Although the vital role of early diagnosing, and properly controlling hypertension has been emphasized for decades, a large number of hypertension patients still encounter barriers and challenges in accessing qualified cares. This study examined and identified barriers, facilitators, and challenges of providing high-quality care for patients with hypertension in health centers in Tabriz, Iran.
Methods: A descriptive qualitative study was conducted based on purposive sampling. The participants in this study included health care workers at health centers, patients with hypertension, and health centers managers at official positions (n = 19). Data was gathered through semi-structured interviews. Collected data was analyzed thematically.
Results: The mean duration of the interviews was 40 minutes (range: 30 to 60 minutes). The barriers were categorized into areas (sub-themes) of patient-related and health-center barriers. Facilitators included patient-related factors, external and environmental activities of health centers, and activities of Iranian health system. Furthermore, the challenges were categorized into (sub-themes) patient-related, environmental, and health system challenges.
Conclusion: There are major barriers and challenges in providing qualified and comprehensive services for patients with hypertension. Stakeholders should consider removing these barriers and challenges, and facilitators should be used to provide health services to hypertension patients.
Highlights
Keywords
- Roger VL, Go AS, Lloyd-Jones DM, Benjamin EJ, Berry JD, Borden WB, et al. Heart disease and stroke statistics--2012 update: a report from the American Heart Association. Circulation. 2012;125(1):e2-220. doi: 10.1161/ CIR.0b013e31823ac046.
- Piper MA, Evans CV, Burda BU, Margolis KL, O’Connor E, Whitlock EP. Diagnostic and predictive accuracy of blood pressure screening methods with consideration of rescreening intervals: a systematic review for the U.S. Preventive Services Task Force. Ann Intern Med. 2015;162(3):192-204. doi: 10.7326/m14-1539.
- Lyratzopoulos G, Heller RF, McElduff P, Hanily M, Lewis P. Deprivation and trends in blood pressure, cholesterol, body mass index and smoking among participants of a UK primary care-based cardiovascular risk factor screening programme: both narrowing and widening in cardiovascular risk factor inequalities. Heart. 2006;92(9):1198-206. doi: 10.1136/ hrt.2005.081042.
- Nerenberg KA, Zarnke KB, Leung AA, Dasgupta K, Butalia S, McBrien K, et al. Hypertension Canada’s 2018 guidelines for diagnosis, risk assessment, prevention, and treatment of hypertension in adults and children. Can J Cardiol. 2018;34(5):506-25. doi: 10.1016/j.cjca.2018.02.022.
- Hasandokht T, Farajzadegan Z, Dana Siadat Z, Paknahad Z, Rajati F. Lifestyle interventions for hypertension treatment among Iranian women in primary health-care settings: results of a randomized controlled trial. J Res Med Sci. 2015;20(1):54-61.
- Wang W, Lee ET, Fabsitz RR, Devereux R, Best L, Welty TK, et al. A longitudinal study of hypertension risk factors and their relation to cardiovascular disease: the Strong Heart Study. Hypertension. 2006;47(3):403-9. doi: 10.1161/01. hyp.0000200710.29498.80.
- Sadeghi R, Mazloomy SS, Hashemi M, Rezaeian M. The effects of an educational intervention based on the health belief model to enhance HIV-preventive behaviors among male barbers in Sirjan. J Rafsanjan Univ Med Sci. 2016;15(3):235- 46. [Persian].
- Frieden TR, Jaffe MG. Saving 100 million lives by improving global treatment of hypertension and reducing cardiovascular disease risk factors. J Clin Hypertens (Greenwich). 2018;20(2):208-11. doi: 10.1111/jch.13195.
- Walli-Attaei M, Khatib R, McKee M, Lear S, Dagenais G, Igumbor EU, et al. Availability and affordability of blood pressure-lowering medicines and the effect on blood pressure control in high-income, middle-income, and low-income countries: an analysis of the PURE study data. Lancet Public Health. 2017;2(9):e411-9. doi: 10.1016/s2468- 2667(17)30141-x.
- Moucheraud C. Service readiness for noncommunicable diseases was low in five countries in 2013-15. Health Aff (Millwood). 2018;37(8):1321-30. doi: 10.1377/hlthaff.2018.0151.
- Addo J, Agyemang C, Smeeth L, de-Graft Aikins A, Edusei AK, Ogedegbe O. A review of population-based studies on hypertension in Ghana. Ghana Med J. 2012;46(2 Suppl):4-11.
- Basiratnia M, Derakhshan D, Ajdari S, Saki F. Prevalence of childhood obesity and hypertension in south of Iran. Iran J Kidney Dis. 2013;7(4):282-9.
- Kazemi T, Hajihosseini M, Mashreghimoghadam H, Azdaki N, Ziaee M. Prevalence and determinants of hypertension among Iranian adults, Birjand, Iran. Int J Prev Med. 2017;8:36. doi: 10.4103/ijpvm.IJPVM_103_16.
- Jafari Oori M, Mohammadi F, Norozi K, Fallahi-Khoshknab M, Ebadi A, Ghanei Gheshlagh R. Prevalence of HTN in Iran: meta-analysis of Published Studies in 2004-2018. Curr Hypertens Rev. 2019;15(2):113-22. doi: 10.2174/15734021 15666190118142818.
- Sen A, Callisen H, Libricz S, Patel B. Complications of solid organ transplantation: cardiovascular, neurologic, renal, and gastrointestinal. Crit Care Clin. 2019;35(1):169-86. doi: 10.1016/j.ccc.2018.08.011.
- Namayandeh SM, Sadr SM, Ansari Z, Rafiei M. A Cross-sectional study of the prevalence of coronary artery disease traditional risk factors in Yazd urban population, Yazd healthy heart project. Int Cardiovasc Res J. 2017;5(1):e14226.
- Pearson TA, Blair SN, Daniels SR, Eckel RH, Fair JM, Fortmann SP, et al. AHA guidelines for primary prevention of cardiovascular disease and stroke: 2002 update: consensus panel guide to comprehensive risk reduction for adult patients without coronary or other atherosclerotic vascular diseases. Circulation. 2002;106(3):388-91. doi: 10.1161/01. cir.0000020190.45892.75.
- Mahajan KC, Nishtar S, Rajpara SM, Parmar MS, Desapriya EB, Charles AR, et al. South Asian health: what is to be done? BMJ. 2004;328(7443):837-40.
- Maftoon F, Aghasi M, Rafiee Bahabadi M, Naghizadeh Moghari F, Montazeri A. A national campaign on ‘high blood pressure control’ in Iran: a rapid evaluation. Payesh. 2020;19(6):711- 21. doi: 10.29252/payesh.19.6.711. [Persian].
- Khezri R, Ravanipour M, Motamed N, Vahedparast H. Effect of self-management empowering model on the quality of life in the elderly patients with hypertension. Iran J Ageing. 2016;10(4):68-79. [Persian].
- Dehnavieh R, Noorihekmat S, Masoud A, Moghbeli M, Rahimi H, Poursheikhali A, et al. Evaluating the Tabriz health complex model, lessons to learn. Iran J Epidemiol. 2018;13(5):59-70. [Persian].
- Khatib R, Schwalm JD, Yusuf S, Haynes RB, McKee M, Khan M, et al. Patient and healthcare provider barriers to hypertension awareness, treatment and follow up: a systematic review and meta-analysis of qualitative and quantitative studies. PLoS One. 2014;9(1):e84238. doi: 10.1371/journal.pone.0084238.
- Hajizadeh A, Monaghesh E. Telehealth services support community during the COVID-19 outbreak in Iran: activities of Ministry of Health and Medical Education. Inform Med Unlocked. 2021;24:100567. doi: 10.1016/j. imu.2021.100567.
- Wosik J, Fudim M, Cameron B, Gellad ZF, Cho A, Phinney D, et al. Telehealth transformation: COVID-19 and the rise of virtual care. J Am Med Inform Assoc. 2020;27(6):957-62. doi: 10.1093/jamia/ocaa067.
- Carrabba G, Tariciotti L, Guez S, Calderini E, Locatelli M. Neurosurgery in an infant with COVID-19. Lancet. 2020;395(10234):e76. doi: 10.1016/s0140-6736(20)30927-2.
- Baghi V, Baghban Karimi E. Predicting the quality of life of patients with hypertension based on resilience and social support. Iranian Journal of Psychiatric Nursing. 2018;5(6):24- 30. doi: 10.21859/ijpn-05064. [Persian].
- Strine TW, Chapman DP, Balluz L, Mokdad AH. Health-related quality of life and health behaviors by social and emotional support. Their relevance to psychiatry and medicine. Soc Psychiatry Psychiatr Epidemiol. 2008;43(2):151-9. doi: 10.1007/s00127-007-0277-x.
- Gebrezgi MT, Trepka MJ, Kidane EA. Barriers to and facilitators of hypertension management in Asmara, Eritrea: patients’ perspectives. J Health Popul Nutr. 2017;36(1):11. doi: 10.1186/s41043-017-0090-4.
- Moeini M, Sharifi S, Kajbaf MB. Effect of Islam-based religious program on spiritual wellbeing in elderly with hypertension. Iran J Nurs Midwifery Res. 2016;21(6):566-71. doi: 10.4103/1735-9066.197683.
- Abedini S, Pourjalil F, Mohseni S. The impact of an educational program based on the BASNEF model on knowledge and self-care behaviors of patients with hypertension. Health Scope. 2020;9(4):e95588. doi: 10.5812/jhealthscope.95588.
- Chérrez-Ojeda I, Vanegas E, Felix M, Mata VL, Gavilanes AW, Chedraui P. Use and preferences of information and communication technologies in patients with hypertension: a cross-sectional study in Ecuador. J Multidiscip Healthc. 2019;12:583-90. doi: 10.2147/jmdh.s208861.
- Houston M. Handbook of Hypertension. Wiley-Blackwell; 2011.
- Chia YC, Ching SM. Prevalence and predictors of resistant hypertension in a primary care setting: a cross-sectional study. BMC Fam Pract. 2014;15:131. doi: 10.1186/1471- 2296-15-131.
- Al-Hadeethi O, Al Nsour M, Khader Y, Alkhlaifat OK, Al Jawaldeh H, Hayajneh A. The capacity of primary health care centers in Jordan to manage hypertension: areas for improvement. J Hum Hypertens. 2022;36(5):473-81. doi: 10.1038/s41371-020-00433-z.
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