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Journal article
Explanatory models of hypertension in Guatemala: recognizing the perspectives of patients, family members, health care providers and administrators, and national-level health system stakeholders
BMC public health, Vol.22(1), 2320
12 Dec 2022
PMID: 36510216
Featured in Collection : UN Sustainable Development Goals @ Drexel
Abstract
Uncontrolled hypertension is a major public health burden and the most common preventable risk factor for cardiovascular diseases in Guatemala and other low- and middle-income countries. Prior to an initial trial that evaluated a hypertension intervention in rural Guatemala, we collected qualitative information on the needs and knowledge gaps of hypertension care within Guatemala's public healthcare system. This analysis applied Kleinman's Explanatory Models of Illness to capture how patients, family members, community-, district-, and provincial-level health care providers and administrators, and national-level health system stakeholders understand hypertension. METHODS: We conducted in-depth interviews with three types of participants: 1) national-level health system stakeholders (n = 17), 2) local health providers and administrators from district, and health post levels (25), and 3) patients and family members (19) in the departments of Sololá and Zacapa in Guatemala. All interviews were conducted in Spanish except for 6 Maya-Kaqchikel interviews. We also conducted focus group discussions with auxiliary nurses (3) and patients (3), one in Maya-Tz'utujil and the rest in Spanish. Through framework and matrix analysis, we compared understandings of hypertension by participant type using the Explanatory Model of Illness domains -etiology, symptoms, pathophysiology, course of illness, and treatment.
Health providers and administrators, and patients described hypertension as an illness that spurs from emotional states like sadness, anger, and worry; is inherited and related to advanced age; and produces symptoms that include a weakened body, nerves, pain, and headaches. Patients expressed concerns about hypertension treatment's long-term consequences, despite trying to comply with treatment. Patients stated that they combine biomedical treatment (when available) with natural remedies (teas and plants). Health providers and administrators and family members stated that once patients feel better, they often disengage from treatment. National-level health system stakeholders referred to lifestyle factors as important causes, considered patients to typically be non-compliant, and identified budget limitations as a key barrier to hypertension care. The three groups of participants identified structural barriers to limited hypertension care (e.g., limited access to healthy food and unaffordability of medications).
As understandings of hypertension vary between types of participants, it is important to describe their similarities and differences considering the role each has in the health system. Considering different perceptions of hypertension will enable better informed program planning and implementation efforts.
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Details
- Title
- Explanatory models of hypertension in Guatemala: recognizing the perspectives of patients, family members, health care providers and administrators, and national-level health system stakeholders
- Creators
- Juan Carlos Figueroa - Institute of Nutrition of Central America and PanamaAlejandra Paniagua-Avila - Mailman School of Public Health, Department of Epidemiology, Columbia University, New York City, New York, USAIngrid Sub Cuc - University of California, DavisSayra Cardona - Institute of Nutrition of Central America and PanamaManuel Ramirez-Zea - Institute of Nutrition of Central America and PanamaVilma Irazola - Instituto de Efectividad Clínica y SanitariaMeredith P Fort - Institute of Nutrition of Central America and Panama
- Publication Details
- BMC public health, Vol.22(1), 2320
- Publisher
- BMC
- Grant note
- U01HL138647 / U.S. National Heart, Lung, and Blood Institute of the National Institutes of Health 5K12HL137862 / U.S. National Heart, Lung, and Blood Institute of the National Institutes of Health
- Resource Type
- Journal article
- Language
- English
- Academic Unit
- Urban Health Collaborative; Epidemiology and Biostatistics
- Web of Science ID
- WOS:000898481900007
- Scopus ID
- 2-s2.0-85143994152
- Other Identifier
- 991021860620004721
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- Collaboration types
- Domestic collaboration
- International collaboration
- Web of Science research areas
- Public, Environmental & Occupational Health