Barriers Influencing Linkage to Hypertension Care in Kenya: Qualitative Analysis from the LARK Hypertension Study.

Published

Journal Article

Hypertension, the leading global risk factor for mortality, is characterized by low treatment and control rates in low- and middle-income countries. Poor linkage to hypertension care contributes to poor outcomes for patients. However, specific factors influencing linkage to hypertension care are not well known.To evaluate factors influencing linkage to hypertension care in rural western Kenya.Qualitative research study using a modified Health Belief Model that incorporates the impact of emotional and environmental factors on behavior.Mabaraza (traditional community assembly) participants (n = 242) responded to an open invitation to residents in their respective communities. Focus groups, formed by purposive sampling, consisted of hypertensive individuals, at-large community members, and community health workers (n = 169).We performed content analysis of the transcripts with NVivo 10 software, using both deductive and inductive codes. We used a two-round Delphi method to rank the barriers identified in the content analysis. We selected factors using triangulation of frequency of codes and themes from the transcripts, in addition to the results of the Delphi exercise. Sociodemographic characteristics of participants were summarized using descriptive statistics.We identified 27 barriers to linkage to hypertension care, grouped into individual (cognitive and emotional) and environmental factors. Cognitive factors included the asymptomatic nature of hypertension and limited information. Emotional factors included fear of being a burden to the family and fear of being screened for stigmatized diseases such as HIV. Environmental factors were divided into physical (e.g. distance), socioeconomic (e.g. poverty), and health system factors (e.g. popularity of alternative therapies). The Delphi results were generally consistent with the findings from the content analysis.Individual and environmental factors are barriers to linkage to hypertension care in rural western Kenya. Our analysis provides new insights and methodological approaches that may be relevant to other low-resource settings worldwide.

Full Text

Duke Authors

Cited Authors

  • Naanyu, V; Vedanthan, R; Kamano, JH; Rotich, JK; Lagat, KK; Kiptoo, P; Kofler, C; Mutai, KK; Bloomfield, GS; Menya, D; Kimaiyo, S; Fuster, V; Horowitz, CR; Inui, TS

Published Date

  • March 2016

Published In

Volume / Issue

  • 31 / 3

Start / End Page

  • 304 - 314

PubMed ID

  • 26728782

Pubmed Central ID

  • 26728782

Electronic International Standard Serial Number (EISSN)

  • 1525-1497

International Standard Serial Number (ISSN)

  • 0884-8734

Digital Object Identifier (DOI)

  • 10.1007/s11606-015-3566-1

Language

  • eng