Nasa dugo(‘It’s in the blood’): lay conceptions of hypertension in the Philippines

Abstract

<jats:sec><jats:title>Introduction</jats:title><jats:p>Understanding explanatory models is important for hypertension, a leading risk factor for cardiovascular disease and stroke. This article aims to determine what adult patients with hypertension in the Philippines attribute their condition to, how these views might be explained and what the implications are for hypertension management.</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>This is a qualitative study drawing on 71 semistructured interviews (40 initial and 31 follow-up) and four focus group discussions with patients diagnosed with hypertension. The setting was urban and rural low-income communities in the Philippines.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>Four prominent perceived causes were identified—genetics, heat, stress and diet—for what patients refer to as ‘high blood’. We propose a ‘folk physiology’ that rests on local understandings of blood and blood flow, draws from broader cultural notions of illness causation and accounts for a dynamic, non-chronic view of hypertension that in turn informs the health behaviours of those affected.</jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p>By understanding that hypertension is frequently seen not as a chronic constant condition but rather as an episodic one triggered by external influences, although in those genetically predisposed to it, it may be possible to address patient’s beliefs and thus adherence to treatment.</jats:p></jats:sec>

Strengths and Weaknesses of Digital Diaries as a Means to Study Patient Pathways: Experiences With a Study of Hypertension in the Philippines

“…The first concerns the nature of the condition being studied. In our study, the fact that hypertension was not perceived to be a serious and/or chronic condition requiring constant attention, partly due to local conceptions of the illness (Lasco et al, 2020), may have resulted in low levels of engagement. Nonetheless, for situations or conditions that do have a major impact on the day-to-day experiences of participants, digital diaries may provide promising insights from individuals as they deal with symptomatic episodes, chronic pain, stress, or discrimination (Alaszewski, 2006; Bernays et al, 2014; Furness & Garrud, 2010; Hensel et al, 2012; Herron et al, 2019; Sargeant & Gross, 2011).…”

World Heart Federation Roadmap for Hypertension – A 2021 Update

“…Shifting the attention to a co-production model where patients and families have an important role in decision making helps to scale-up intervention strategies for the control of hypertension [ 77 ]. A broader people-centred model (envisaging roles not only for patients but also for families/networks/society) is a possible way to improve adherence to self-care and therapeutic options in the management of hypertension [ 99 ].…”

Patient pathways for cardiovascular diseases in Malaysia and the Philippines: a systematic review

“…entry or start of medication), providing an incomplete picture of the patient journey. Few consider how the health system might facilitate the patient's journey or how it might take account of their social context, as well as local, cultural conceptions of illness 10 . There are few qualitative or mixed methods studies that could aid interpretation of behavior of patients and providers.…”

“…Corresponding figures for the percentage of individuals with hypertension that is controlled are 12.5% and 13.5% 9 . Effective policy responses are clearly needed but must be informed by a detailed understanding of the barriers that patients with CVD face on their journey through the health system in each country, alongside accounting for socio-cultural contexts that also influence patients' conceptions of -and responses to -illness 10 .…”