Table 3. Patient-level barriers/facilitators to clinic attendance and medication adherence organized according to the domains of the Andersen’s behavioral model of health services use.
| ABMHSU domain | Barrier/facilitator | Selected patient quotes |
|---|---|---|
| Predisposing Characteristics | Traditional medicine | “Some people believe that a person can be bewitched to be hypertensive. Therefore, people who think like that go to the traditional healers to find medicine.”–M, A, C2 |
| “. . . they (patients) are trying to find cheaper treatments. To the traditional healer, patients pay once and get traditional medicine without any extra cost of clinic visits. So, to a patient, this is a relief.”–H, C2 | ||
| Religious beliefs | “A patient will tell you, "I won’t take medication. I will go to Pastor [name blinded]; he will pray for me."”–H, C1 | |
| "In those churches, other people testify that ‘I was diagnosed with hypertension, but now I do not have hypertension because of prayers am cured,’ but this is not true."–H, C1 | ||
| Medicine beliefs | “I have observed that the traditional treatment is more effective than using drugs from the hospital because it manages blood pressure for an extended time.”–F, A, C1 | |
| “. . . people are saying that if you take too much hospital medicine, it can poison the body. That is why people prefer using traditional medicine.–F, NA, C2 | ||
| Knowledge and awareness of HTN | “I think the community is not aware of the cause of hypertension.”–M, A, C2 | |
| “We need to educate our patients. They need to have proper knowledge of severe hypertension, the signs and symptoms, and the treatments.”–H, C1 | ||
| Stigma | “. . . many are afraid to take hospital medications because they will be told they have HIV.”–F, A, C1 | |
| Enabling Factors | Social support | “My wife always encourages me to attend the clinic every month and take medications as prescribed.”–M, A, C2 |
| "I am grateful for them [children].. . . They remind me to take medicine if I do not remember."–M, A, C2 | ||
| Transport to clinic | “I need money for transport.. . . there are times I don’t attend the clinic because I don’t have money.”–F, A, C1 | |
| “You may be willing to go to the clinic, but you have no money to cover transport.”–M, NA, C1 | ||
| Medication side effects | “I experience some problems when I take antihypertensive medications. I get headaches and feel dizzy.”–M, A, C2 | |
| “There was a time when I took certain antihypertensive medicine, and I did not feel well; it made me sleep for a long time. I felt so weak.”–F, A, C2 | ||
| Health insurance | “Those in the health insurance scheme adhere to medications and have good clinic attendance compared to those not in the health insurance scheme.”–H, C2 | |
| “Most patients not in the health insurance scheme cannot afford to pay for their medications, especially those with low income.”–H, C2 | ||
| Reminder cues | ". . . around noon, we will call our patients to remind them that tomorrow is their clinic."–H, C1 | |
| Perceived Need | HTN symptoms | “Most of the patients will start medication after being hospitalized following hypertension complications …”–H, C1 |
| I am hypertensive, and I know that if I do not take medicine, it can reach a time I can fall down (have a stroke).–M, A, C2 | ||
| Self-efficacy | “I have my ability, and I have complete self-control in taking medications.”–F, A, C3 | |
| "There is nothing beyond my control.. . . at first, I had much trouble taking the medications, but now I am used."–F, A, C1 |
M–male patient, F–female patient, A–Attending clinic, NA–Not attending clinic, C–outpatient clinic at (1: consultant hospital, 2: regional hospital, 3: district hospital), H–healthcare worker.