. 2021 Aug 18;21:834. doi: 10.1186/s12913-021-06858-7

Table 1.

Patient Reported Barriers to Antihypertensive Medication Adherence from FGD (n = 34)

Category	Sub-Category	Concepts
1. Access Factors	Travel distance to healthcare facility Medication availability Lack of screening programs Physician Access	While pharmacies are more accessible, they are far more expensive than clinics (n = 8) There are extensive distances to travel to the clinic (n = 4) Hospitals are often out of stock (n = 3) Pharmacies will not sell shorter doses to decrease price (n = 1) There is no culture of screening, so people do not go (n = 9) There are no screening programs in place (n = 8) There are many barriers to even being seen by a physician, including a lack of specialists (n = 4) There is a shortage of physicians (n = 3)
2. Cost Factors	Affordability of medications High cost of healthcare screening	Medications are too expensive to buy (n = 25) No reduced cost for senior citizens as cited in the national health insurance schemes (n = 9) Taxes make medications more expensive (n = 2) People cannot be screened or properly check their BP due to high cost (n = 6)
3. Physician Factors	Poor counseling Lack of time to provide patient centered care Physician knowledge	Need sufficient counseling on prevention (n = 1) Do not inform patients how long they will be treated (n = 1) Physicians are distracted and not patient focused (n = 5) There is insufficient time for physicians to counsel (n = 3) Physicians are not educated enough on hypertension (n = 2)
4. Patient Factors	Lack of education and understanding about disease Stop taking the medicine Forgetting to take medicines Lifestyle Habits Role of religion	Patients do not have an understanding of hypertension (n = 15) Actively choose not to take medicines (n = 5) Patients do not even know they have hypertension (n = 3) Patients do not know severity of their disease (n = 3) Patients stop taking medicine once they feel better (n = 8) Patients get tired of taking medicine, so they will only occasionally take it or not take it at all (n = 5) Without seeing improvement, they stop medications (n = 2) Accidently forget to take medicines (n = 3) Elderly populations forget to take medicines (n = 3) Healthy food does not taste as good “Choose a less healthy lifestyle due to convenience or taste” (n = 6) People do not know how to maintain a healthy lifestyle (n = 2) It is very difficult to follow lifestyle advice (n = 3) The disease was sent by God (n = 1) Believe in letting God cure them (n = 3)
5. Medication Factors	Side Effects Herbal Medicines Prescription complexity	Patients are scared of side effects (n = 3) Misconceptions about side effects (n = 2) Side effects are too severe to continue taking medicine (n = 5) Utilize herbal medicines as replacements (n = 10) Polypharmacy is difficult for patients (n = 2)

Category

Sub-Category

Concepts

1. Access Factors

Travel distance to healthcare facility

Medication availability

Lack of screening programs

Physician Access

While pharmacies are more accessible, they are far more expensive than clinics (n = 8)

There are extensive distances to travel to the clinic (n = 4)

Hospitals are often out of stock (n = 3)

Pharmacies will not sell shorter doses to decrease price (n = 1)

There is no culture of screening, so people do not go (n = 9)

There are no screening programs in place (n = 8)

There are many barriers to even being seen by a physician, including a lack of specialists (n = 4)

There is a shortage of physicians (n = 3)

2. Cost Factors

Affordability of medications

High cost of healthcare screening

Medications are too expensive to buy (n = 25)

No reduced cost for senior citizens as cited in the national health insurance schemes (n = 9)

Taxes make medications more expensive (n = 2)

People cannot be screened or properly check their BP due to high cost (n = 6)

3. Physician Factors

Poor counseling

Lack of time to provide patient centered care

Physician knowledge

Need sufficient counseling on prevention (n = 1)

Do not inform patients how long they will be treated (n = 1)

Physicians are distracted and not patient focused (n = 5)

There is insufficient time for physicians to counsel (n = 3)

Physicians are not educated enough on hypertension (n = 2)

4. Patient Factors

Lack of education and understanding about disease

Stop taking the medicine

Forgetting to take medicines

Lifestyle Habits

Role of religion

Patients do not have an understanding of hypertension (n = 15)

Actively choose not to take medicines (n = 5)

Patients do not even know they have hypertension (n = 3)

Patients do not know severity of their disease (n = 3)

Patients stop taking medicine once they feel better (n = 8)

Patients get tired of taking medicine, so they will only occasionally take it or not take it at all (n = 5)

Without seeing improvement, they stop medications (n = 2)

Accidently forget to take medicines (n = 3)

Elderly populations forget to take medicines (n = 3)

Healthy food does not taste as good “Choose a less healthy lifestyle due to convenience or taste” (n = 6)

People do not know how to maintain a healthy lifestyle (n = 2)

It is very difficult to follow lifestyle advice (n = 3)

The disease was sent by God (n = 1)

Believe in letting God cure them (n = 3)

5. Medication Factors

Side Effects

Herbal Medicines

Prescription complexity

Patients are scared of side effects (n = 3)

Misconceptions about side effects (n = 2)

Side effects are too severe to continue taking medicine (n = 5)

Utilize herbal medicines as replacements (n = 10)

Polypharmacy is difficult for patients (n = 2)