Shima Razatul, Farizah Mohd Hairi, Majid Hazreen Abdul
Department of Social and Preventive Medicine, University of Malaya, Kuala Lumpur, Malaysia ; Ministry of Health Malaysia, Putrajaya, Malaysia.
Department of Social and Preventive Medicine, University of Malaya, Kuala Lumpur, Malaysia ; Centre for Population Health, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
Patient Prefer Adherence. 2014 Nov 17;8:1597-609. doi: 10.2147/PPA.S69680. eCollection 2014.
The aim of this study was to explore patients' experiences with their illnesses and the reasons which influenced them in not following hypertensive care recommendations (antihypertensive medication intake, physical activity, and diet changes) in primary health clinic settings.
A qualitative methodology was applied. The data were gathered from in-depth interviews with 25 hypertensive patients attending follow-up in nine government primary health clinics in two districts (Hulu Langat and Klang) in the state of Selangor, Malaysia. The transcribed data were analyzed using thematic analysis.
There was evidence of lack of patient self-empowerment and community support in Malaysian society. Most of the participants did not take their antihypertensive medication or change their physical activity and diet after diagnosis. There was an agreement between the patients and the health care professionals before starting the treatment recommendation, but there lacked further counseling and monitoring. Most of the reasons given for not taking antihypertensive medication, not doing physical activity and not following diet recommendations were due to side effects or fear of the side effects of antihypertensive medication, patients' attitudes, lack of information from health care professionals and insufficient social support from their surrounding environment. We also observed the differences on these reasons for nonadherence among the three ethnic groups.
Health care professionals should move toward supporting adherence in the management of hypertensive patients by maintaining a dialogue. Patients need to be given time to enable them to overcome their inhibition of asking questions and to accept the recommendations. A self-management approach must be responsive to the needs of individuals, ethnicities, and communities.
本研究旨在探讨患者在基层医疗诊所环境中对自身疾病的体验，以及影响他们不遵循高血压护理建议（服用降压药、进行体育活动和改变饮食）的原因。
采用定性研究方法。数据收集自对马来西亚雪兰莪州两个地区（乌鲁冷岳和巴生）九家政府基层医疗诊所中25名接受随访的高血压患者进行的深入访谈。对转录的数据采用主题分析法进行分析。
有证据表明马来西亚社会缺乏患者自我赋权和社区支持。大多数参与者在确诊后未服用降压药，也未改变体育活动和饮食。在开始治疗建议之前，患者与医护人员达成了一致，但缺乏进一步的咨询和监测。未服用降压药、未进行体育活动以及未遵循饮食建议的大多数原因是降压药的副作用或对其副作用的恐惧、患者的态度、医护人员提供的信息不足以及周围环境的社会支持不足。我们还观察到这三种族群体在这些不依从原因上的差异。
医护人员应通过保持对话，朝着支持高血压患者管理中的依从性方向努力。需要给患者时间，使他们能够克服提问的顾虑并接受建议。自我管理方法必须响应个人、种族和社区的需求。
