St Sauveur Reichling, Sufra Rodney, Jean Pierre Marie Christine, Inddy Joseph, Jean Mirline, Mourra Nour, Sundararajan Radhika, McNairy Margaret L, Pape Jean W, Rouzier Vanessa, Devieux Jessy, Yan Lily D
Haitian Group for the Study of Kaposi's Sarcoma and Opportunistic Infections (GHESKIO), Port-Au-Prince, Haiti.
Center for Global Health, Weill Cornell Medicine, 402 East 67 Street, 2 Floor, New York, NY, 10065, USA.
BMC Public Health. 2025 Jan 3;25(1):18. doi: 10.1186/s12889-024-20793-2.
Uncontrolled hypertension is the leading modifiable risk factor for cardiovascular disease mortality and remains high in low-middle income countries like Haiti. Barriers and facilitators to achieving hypertension control in urban Haiti remain poorly understood. Elucidating these factors could lead to development of successful interventions.
We conducted semi-structured interviews with healthcare providers (10) and patients with hypertension (10) from the Haiti Cardiovascular Disease Cohort, using guides developed using the Consolidated Framework for Implementation Research. Participants were recruited using purposive sampling, and thematic content analysis was conducted in NVIVO software.
At the individual level, barriers to hypertension control included hypertension is asymptomatic, hypertension is due to stress, difficulty changing behaviors within shared households, and fear of becoming dependent on medications. Facilitators included spiritual faith in doctors, high awareness of diet and exercise, belief in medication effectiveness, and family as motivation to treat hypertension. At the inner setting clinic level, barriers included limited physician-patient time during visits, residual stigma around cardiovascular services located on same campus as HIV care, and patient preference for physician guidance. Facilitators included patients treated with respect at clinic, and strong provider-patient rapport. At the outer setting societal level, only barriers were mentioned, including extreme poverty, civil insecurity, and stress making hypertension worse.
These findings can inform the development of future efforts to design interventions to improve hypertension control in Haiti.
未控制的高血压是心血管疾病死亡的主要可改变风险因素，在海地等低收入和中等收入国家中仍然居高不下。在海地城市实现高血压控制的障碍和促进因素仍知之甚少。阐明这些因素可能会促成成功干预措施的制定。
我们对海地心血管疾病队列中的医疗服务提供者（10名）和高血压患者（10名）进行了半结构化访谈，使用基于实施研究综合框架制定的指南。采用目的抽样法招募参与者，并在NVIVO软件中进行主题内容分析。
在个体层面，高血压控制的障碍包括高血压无症状、高血压是由压力引起的、在共同居住家庭中改变行为困难以及担心依赖药物。促进因素包括对医生的精神信仰、对饮食和运动的高度认识、对药物疗效的信念以及家庭作为治疗高血压的动力。在内部诊所层面，障碍包括就诊期间医患时间有限、与艾滋病毒护理位于同一院区的心血管服务存在残留污名以及患者对医生指导的偏好。促进因素包括患者在诊所受到尊重以及医患关系融洽。在外部社会层面，只提到了障碍，包括极端贫困、社会不安全以及压力使高血压病情加重。
这些发现可为未来在海地设计改善高血压控制的干预措施的努力提供参考。
