Odusola Aina O, Hendriks Marleen, Schultsz Constance, Bolarinwa Oladimeji A, Akande Tanimola, Osibogun Akin, Agyemang Charles, Ogedegbe Gbenga, Agbede Kayode, Adenusi Peju, Lange Joep, van Weert Henk, Stronks Karien, Haafkens Joke A
Department of Global Health, Academic Medical Center, University of Amsterdam, Amsterdam Institute for Global Health and Development, Amsterdam, The Netherlands.
Department of Epidemiology and Community Health, University of Ilorin Teaching Hospital, P.M.B. 1459, postal code 240001, Ilorin, Nigeria.
BMC Health Serv Res. 2014 Dec 10;14:624. doi: 10.1186/s12913-014-0624-z.
Universal health care coverage has been identified as a promising strategy for improving hypertension treatment and control rates in sub Saharan Africa (SSA). Yet, even when quality care is accessible, poor adherence can compromise treatment outcomes. To provide information for adherence support interventions, this study explored what low income patients who received hypertension care in the context of a community based health insurance program in Nigeria perceive as inhibitors and facilitators for adhering to pharmacotherapy and healthy behaviors.
We conducted a qualitative interview study with 40 insured hypertensive patients who had received hypertension care for > 1 year in a rural primary care hospital in Kwara state, Nigeria. Supported by MAXQDA software, interview transcripts were inductively coded. Codes were then grouped into concepts and thematic categories, leading to matrices for inhibitors and facilitators of treatment adherence.
Important patient-identified facilitators of medication adherence included: affordability of care (through health insurance); trust in orthodox "western" medicines; trust in Doctor; dreaded dangers of hypertension; and use of prayer to support efficacy of pills. Inhibitors of medication adherence included: inconvenient clinic operating hours; long waiting times; under-dispensing of prescriptions; side-effects of pills; faith motivated changes of medication regimen; herbal supplementation/substitution of pills; and ignorance that regular use is needed. Local practices and norms were identified as important inhibitors to the uptake of healthier behaviors (e.g. use of salt for food preservation; negative cultural images associated with decreased body size and physical activity). Important factors facilitating such behaviors were the awareness that salt substitutes and products for composing healthier meals were cheaply available at local markets and that exercise could be integrated in people's daily activities (e.g. farming, yam pounding, and household chores).
With a better understanding of patient perceived inhibitors and facilitators of adherence to hypertension treatment, this study provides information for patient education and health system level interventions that can be designed to improve compliance.
ISRCTN47894401 .
全民健康覆盖已被视为改善撒哈拉以南非洲（SSA）高血压治疗和控制率的一项有前景的策略。然而，即便能获得优质医疗服务，依从性差仍会影响治疗效果。为了给依从性支持干预措施提供信息，本研究探讨了在尼日利亚一项基于社区的医疗保险项目中接受高血压护理的低收入患者所认为的坚持药物治疗和健康行为的阻碍因素与促进因素。
我们对尼日利亚夸拉州一家农村初级保健医院中40名接受高血压护理超过1年的参保高血压患者进行了定性访谈研究。在MAXQDA软件的支持下，对访谈记录进行归纳编码。然后将编码分组为概念和主题类别，形成治疗依从性阻碍因素和促进因素的矩阵。
患者确定的药物依从性重要促进因素包括：医疗服务的可承受性（通过医疗保险）；对正统“西方”药物的信任；对医生的信任；高血压的可怕危害；以及通过祈祷来增强药物疗效。药物依从性的阻碍因素包括：诊所营业时间不便；等待时间长；处方配药不足；药物副作用；因信仰而改变药物治疗方案；用草药补充/替代药物；以及不知道需要长期用药。当地的习俗和规范被确定为采取更健康行为的重要阻碍因素（例如用盐保存食物；与体型减小和身体活动减少相关的负面文化观念）。促进此类行为的重要因素是意识到当地市场有价格低廉的盐替代品和用于制作更健康膳食的产品，并且运动可以融入人们的日常活动（例如务农、捣山药和家务）。
通过更好地了解患者所认为的高血压治疗依从性的阻碍因素和促进因素，本研究为可设计用于提高依从性的患者教育和卫生系统层面的干预措施提供了信息。
ISRCTN47894401 。
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