Table 2.

Strategies to Overcome Barriers to Hypertension Prevention and Control

Barrier	General approach	Specific strategy to overcome barrier
Systems Level
Insufficient time of physician/provider	Team change	Simplify the physician’s/provider’s tasks Assign some responsibility for TLC to CHW*
Lack of reimbursement for TLC counselling	Team change	Assign some responsibility for TLC to CHW
Lack of continuity of care	Team change	CHW facilitates physician appointments
Limited free medications	Policy change	Leverage clinical network to negotiate pharmaceutical prices Work with the Remediar+Redes program to provide additional antihypertensive medications
Provider Level
Lack of adherence to treatment guidelines, “clinical inertia”	Physician education	Interactive, case-based workshops delivered by opinion leaders following adult learning theory Pocket card with guidelines as decision tree
Uncertainty that office BP represents usual BP	Home BP monitoring	Provide automated home BP monitor and BP log to patients Provide home BP monitoring records to physicians at clinical visit
Patient Level
Poor adherence to medications	Reminders, Family-support, Patient education, Home BP monitoring	Text reminders to reinforce adherence to medications Family members help remind each other Provide pill box and review medications Self-monitoring provides immediate feedback
Hypertension knowledge/ risk perception	Patient education	Information on importance of maintaining BP control Counselling tailored to individuals’ risk factors
Poor memory	Reminders, Family support, Patient education	Text reminders to mobile phone or email Family members help remind each other Provide pill box and review medications Transmit consistent, clear messages for TLC
Low health literacy	Patient education	Recruit CHW from local community to ensure that health information is culturally and linguistically appropriate
Poor motivation	Reminders, Family-support, Patient education, Home BP monitoring	Use motivational interviewing to tailor intervention Tailor text/email reminders to reinforce behavior change Family support for TLC Self-monitoring provides immediate feedback to reinforce TLC
Medication costs	Policy change, Physician education, Patient education	Leverage clinical network to improve price and access Train physicians to prescribe free and low cost generic medications Successful TLC may decrease need for medication
Adverse effects	Physician education, Patient education	Discuss any medication adverse effects with providers

^*TLC = therapeutic lifestyle change; CHW = community health worker