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

Abstract

BACKGROUND: Hypertension, theleading global risk fac- tor for mortality, is characterized by low treatment and control rates in low- and middle-income countries. Poor linkage to hypertension care contributes to poor out- comes for patients. However, specific factors influencing linkage to hypertension care are not well known. OBJECTIVE: To evaluate factors influencing linkage to hypertension care in rural western Kenya. DESIGN: Qualitative research study using a modified Health Belief Model that incorporates the impact of emo- tional and environmental factors on behavior. PARTICIPANTS: Mabaraza (traditional community as- sembly) participants ( n =242) responded to an open invi- tation to residents in their respective communities. Focus groups, formed by purposive sampling, consisted of hy- pertensive individuals, at-large community members, and community health workers ( n =169). APPROACH: We performed content analysis of the tran- scripts 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.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 fac- tors were divided into physical (e.g. distance), socioeco- nomic (e.g. poverty), and health system factors (e.g. pop- ularity of alternative therapies). The Delphi results were generally consistent with the findings from the content analysis. CONCLUSIONS: Individual and environmental factors are barriers to linkage to hypertension care in rural west- ern Kenya. Our analysis provides new insights and meth- odological approaches that may be relevant to other low- resource settings worldwide.