Lay community perceptions and treatment options for hypertension in rural northern Ghana: a qualitative analysis

Abstract

ObjectiveAdherence to hypertension treatment is a major public health challenge for low and middle-income countries particularly in sub-Saharan Africa. One potential reason could be the discordance between lay and medical explanatory models of hypertension and its treatment. Understanding community perceptions and practices may contribute to improving hypertension control as they present insights into psychosocial and cultural factors that shape individual behaviour. We explore community perceptions regarding hypertension and its treatment in rural northern Ghana and how they differ from medical understanding.DesignThis was a qualitative study using semi-structured interviews and focus group discussions to collect data, which were analysed using a thematic approach.SettingA multisite study conducted in four rural communities in two regions of northern Ghana.ParticipantsWe conducted 16 semi-structured interviews and eight focus group discussions with community leaders and members, respectively.ResultsThree major themes were identified: community perceptions, treatment options and community support for people with hypertension. Community perceptions about hypertension include hypertension perceived as excess blood in the body and associated with spiritual or witchcraft attacks. Traditional medicine is perceived to cure hypertension completely with concurrent use of biomedical and traditional medicines encouraged in rural communities. Community members did not consider themselves at risk of developing hypertension and reported having inadequate information on how to provide social support for hypertensive community members, which they attributed to low literacy and poverty.ConclusionThere is a substantial mismatch between communities’ perceptions and medical understanding of hypertension and its treatment. These perceptions partly result from structural factors and social norms shaped by collective processes and traditions that shape lay beliefs and influence individual health behaviour. Socioeconomic factors also thwart access to information and contribute to inadequate social support for persons with hypertension. These findings highlight the need for a public health approach to hypertension control targeting families and communities.

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

“…Notably, the notion of 'thick blood' was also reported in one paper among African-American women in New Orleans. 33 A belief that hypertension was due to excess blood in the body was reported in Ghana 34 while stress was invoked in a Kenyan study. 35 Meanwhile, a mixed-methods observational study of seven Asian countries (including the Philippines) found that patients 'were not concerned with reaching any target blood pressure goals and accepted fluctuations in blood pressure'.…”

Is social support associated with hypertension control among Ghanaian migrants in Europe and non-migrants in Ghana? The RODAM study

“…A recent study on HTN self-management in Nigeria found religion and marital status as significant determinants of social support, which contributed to adherence to HTN treatment [16]. Another study on community perceptions of HTN in rural Ghana found that social support could contribute to improvement in adherence to treatment particularly for adherence to dietary regimes and HTN medication [21]. Evidence indicates that social support is one of the main determinants of adherence to HTN treatment among SSA migrants living in high income countries (HICs) [22].…”

“…Evidence indicates that social support is one of the main determinants of adherence to HTN treatment among SSA migrants living in high income countries (HICs) [22]. While these studies [16, 21, 22] have provided evidence on the role of social support to adherence to HTN treatment, the specific indicators of social support, which could influence HTN control among SSA migrants, have not yet been clearly elucidated. Identifying specific indicators of social support, which could enhance patient self-management of HTN is key to identifying pathways for implementing targeted interventions to improve HTN control among these populations.…”

Prevalence and factors associated with arterial hypertension in a Brazilian rural working population

“…Karmakar et al ( 26 ) found that 51.8% of the hypertensive individuals studied in a rural community in West Bengal were not aware of their high BP, 52.9% of those diagnosed were not on pharmacological treatment, and only 8.8% had their BP under control. Nyaaba et al ( 27 ) reported a substantial mismatch between community perceptions and the medical understanding of hypertension and its treatment, resulting both from the structural factors of society and collective traditions that shape beliefs and influence individual health behavior, socioeconomic factors, and adequate access to information. In addition, differences in demographic structures, household affluence, socioeconomic and occupational status, and patterns of consumption contribute to the rural-urban disparity in under-diagnosis and sub-medication rates ( 28 ).…”