Barriers and Facilitators to Nurse Management of Hypertension: A Qualitative Analysis from Western Kenya

Abstract

<p><strong>Background: </strong>Hypertension is the leading global risk for mortality. Poor treatment and control of hypertension in low- and middle-income countries is due to several reasons, including insufficient human resources. Nurse management of hypertension is a novel approach to address the human resource challenge. However, specific barriers and facilitators to this strategy are not known. </p><p><strong>Objective: </strong>To evaluate barriers and facilitators to nurse management of hypertensive patients in rural western Kenya, using a qualitative research approach. </p><p><strong>Methods: </strong>Six key informant interviews (five men, one woman) and seven focus group discussions (24 men, 33 women) were conducted among physicians, clinical officers, nurses, support staff, patients, and community leaders. Content analysis was performed using Atlas.ti 7.0, using deductive and inductive codes that were then grouped into themes representing barriers and facilitators. Ranking of barriers and facilitators was performed using triangulation of density of participant responses from the focus group discussions and key informant interviews, as well as investigator assessments using a two-round Delphi exercise. <strong></strong></p><p><strong>Results: </strong>We identified a total of 23 barriers and nine facilitators to nurse management of hypertension, spanning the following categories of factors: health systems, environmental, nurse-specific, patient-specific, emotional, and community. The Delphi resultswere generally consistent with the findings from the content analysis. <strong></strong></p><p><strong>Conclusion: </strong>Nurse management of hypertension is a potentially feasible strategy to address the human resource challenge of hypertension control in low-resource settings. However, successful implementation will be contingent upon addressing barriers such as access to medications, quality of care, training of nurses, health education, and stigma. <em>Ethn Dis. </em>2016;26(3):315-322; doi:10.18865/ed.26.3.315. </p>

Nurse‐Led Interventions for Hypertension: A Scoping Review With Implications for Evidence‐Based Practice

“…Six manuscripts met inclusion criteria, were of average or good quality, were retained for the scoping review, and provided the results of four nurse‐led hypertension intervention studies (Hareri, Abebe, & Asefaw, ; Katende, Groves, & Becker, ; Khabala et al., ; Kumar et al., ; Some et al., ; Vedanthan et al., ). The studies were conducted in outpatient settings in Kenya, Ethiopia, and Uganda.…”

“…() and Vedanthan et al. () were likely conducted in the same setting, a care system in rural western Kenya. However, the samples were composed of different groups.…”

“…Vedanthan et al. () used a sample of healthcare professionals and community leaders to explore the barriers and facilitators of nurse management of hypertension.…”

“…Four of the six studies (66.7%) were conducted in Kenya (Khabala et al., ; Kumar et al, ; Some et al., ; Vedanthan et al., ). Half of the studies were retrospective and used clinic records as the data source (Khabala et al., ; Kumar et al, ; Some et al., ).…”

Educational diagnosis of self‐management behaviours in patients with diabetes mellitus, hypertension and hypercholesterolaemia based on the PRECEDE model: Qualitative study

“…Some of the factors associated with patients which hinder self‐management behaviours that were identified in this study had already been named in other studies: a lack of awareness of the recommended diet and preventative measures for complications (Lou et al, ; Rushforth et al, ; Shoal et al, ), a lack of awareness and misperceptions of the illness (Legido‐Quigley et al, ; Vedanthan et al, ), low socio‐economic status (Rimando, ), a perception that there is a lack of time to prepare adequate meals or do physical exercise (Fukunaga, Uehara, & Tom, ), a lack of self‐motivation (Khatib et al, ), the fact that social relations go hand‐in‐hand with eating habits (Legido‐Quigley et al, ; Shoal et al, ), a fear of self‐injecting insulin (Funnell, Bootle, & Stuckey, ), a lack of family and/or social support (Jones et al, ; Khatib et al, ; Shen et al, ), a perception of social stigma (Fukunaga et al, ), a perception of numerous prohibitions from medical staff (Fukunaga et al, ) and suffering aches and pains after physical exercise (Fukunaga et al, ). Furthermore, this study has identified other key factors, such as the belief that many patients share, in which they consider that taking the prescribed medication is sufficient to manage the illness and prevent any derived health complications.…”