Patient and Doctor Perceptions of Hypertension and its Treatment: a Qualitative Study in Urban Hospitals of Pakistan

Abstract

Hypertension (HTN) is a chronic disease that has become a growing public health problem in countries around the world, including Pakistan. Successful HTN control is an essential cornerstone in the prevention of morbidity and mortality associated with uncontrolled HTN. However, patients’ beliefs about their disease, treatment and control are related to the outcome of successful HTN control and management. Likewise, doctors’ understanding of HTN and its treatment is equally important and can affect their practice and HTN management. There is little qualitative research considering patients’ and doctors’ understanding of HTN, its treatment and how it influences HTN management in Pakistan. Therefore, the current study aimed to elicit patients’ and doctors’ perceptions, attitudes and beliefs about HTN and its treatment in urban areas of Pakistan. A qualitative study that drew on grounded theory principles was undertaken in two public hospitals of Pakistan. Thirty in-depth semi-structured interviews with hypertensive patients and thirty interviews with doctors were conducted in two hospitals. Interviews were translated and transcribed from Urdu into English and NVivo was used to organise the data in a systematic way. Data were analysed using a constant comparative approach based on the principles of grounded theory. The study revealed that patients’ (n=30) beliefs were complex, deep-rooted and influenced their attitude towards HTN treatment. Patients’ beliefs were informed by understanding gleaned from the socio-cultural environment (local norms, social relations, religion), individual factors (e.g. income, co-morbidities) and interactions with doctors. In contrast, doctors’ (n=30) own understandings on what constitutes successful HTN management often contradicted patients’ beliefs. Doctors’ reported that time restraints and work burden affected their approach to treatment and the provision of information to patients. Findings also revealed an overlap between patients’ and doctors’ beliefs, however, in relation to adopting lifestyle changes for management of HTN. In general, though doctors paid less consideration to patients’ beliefs in routine clinical practice and evaluated patients through the filter of their own beliefs. The findings suggest that doctors could provide a better service care by aligning with their patients on a common understanding about HTN management and providing culturally appropriate information. Doctors should be aware of the understanding hypertensive patients attach to HTN and avoid providing treatment based on their own beliefs. Doctors must engage with patients’ beliefs and identify their particular healthcare needs in order to achieve control of HTN in Pakistan.