Lopez-Lopez Jose P, Giraldo-Castrillon Yesica, Otero Johanna, Torres Claudia, Castañeda-Hernandez Alvaro, Martinez-Bello Daniel, Garcia Claudia, Lopez-Cabrera Marianne, Lopez-Jaramillo Patricio
Masira Research Institute, Universidad de Santander (UDES), Bloque G, piso 6, Bucaramanga 680003, Colombia.
Faculty of Dentistry, Universidad Santo Tomás, Bucaramanga 680006, Colombia.
Int J Environ Res Public Health. 2025 Jul 31;22(8):1199. doi: 10.3390/ijerph22081199.
Low medication adherence and low hypertension control are a public health challenge, particularly in low- and middle-income countries (LMICs). Healthcare system- and patient-related barriers hinder the successful management of hypertension. This study aimed to identify the perceptions of barriers and facilitators to hypertension management among health system stakeholders in Santander, Colombia. We conducted a qualitative, phenomenological, and interpretative study, comprising five focus groups, to explore the barriers and facilitators to managing people with hypertension. Each focus group was formed by stakeholders from territorial entities, healthcare insurers, or healthcare providers. Meetings were held between December 2022 and February 2023. The sessions were recorded and transcribed using NVivo Transcription and analyzed using NVivo version 1.6.1. Seven categories of barriers and facilitators were identified: strategies, resources, access, risk assessment, cross-sector collaboration, articulation, and stewardship. Of these categories, articulation and stewardship emerged as the main barriers, as revealed through axial coding and cluster analysis, which highlighted deficiencies in stewardship practices, a lack of clear objectives, and misalignment with public policy frameworks. Multisectoral actions extending beyond healthcare providers and aimed at improving coordination and intersectoral collaboration are essential for enhancing hypertension control in LMICs, such as Colombia. Addressing social determinants and strengthening primary healthcare through community-based strategies are critical, making stewardship and improved access key priorities.
药物依从性低和高血压控制不佳是一项公共卫生挑战，在低收入和中等收入国家（LMICs）尤为如此。医疗保健系统和患者相关的障碍阻碍了高血压的成功管理。本研究旨在确定哥伦比亚桑坦德市卫生系统利益相关者对高血压管理障碍和促进因素的看法。我们进行了一项定性、现象学和解释性研究，包括五个焦点小组，以探讨管理高血压患者的障碍和促进因素。每个焦点小组由来自地区实体、医疗保险公司或医疗服务提供者的利益相关者组成。会议于2022年12月至2023年2月举行。会议进行了录音，并使用NVivo转录软件进行转录，然后使用NVivo 1.6.1版本进行分析。确定了七类障碍和促进因素：策略、资源、获取、风险评估、跨部门协作、衔接和管理。在这些类别中，通过轴心编码和聚类分析发现，衔接和管理是主要障碍，突出了管理实践中的缺陷、缺乏明确目标以及与公共政策框架不一致的问题。超越医疗服务提供者、旨在改善协调和部门间协作的多部门行动对于加强哥伦比亚等低收入和中等收入国家的高血压控制至关重要。解决社会决定因素并通过基于社区的策略加强初级医疗保健至关重要，这使得管理和改善获取成为关键优先事项。
