Abstract
Background Untreated and uncontrolled hypertension are major challenges in the cascade of care of hypertension in Nepal. The challenge of achieving effective treatment and control of blood pressure is linked to various barriers to hypertension care at different layers of health system. Evidence is emerging globally on the effectiveness of multi-pronged hypertension control strategies, including health system strengthening and population-based interventions. However, no systematic review of the strategies of and factors associated with hypertension treatment and control in Nepal is available. Understanding country-specific factors influencing hypertension care is critical to address the gaps in the management of hypertension. This study, therefore, aimed to systematically review published literature and synthesise the findings on barriers, enablers and strategies for hypertension treatment and control in Nepal. Methods Six databases namely Embase, PubMed, Web of Science, CINAHL (through EBSCOHost), ProQuest and WorldCat were systematically searched for studies investigating the factors or strategies in relation to hypertension treatment and control in Nepal. The methodological quality of selected articles was assessed using Mixed Methods Appraisal Tool (MMAT). Themes on barriers and enablers were generated and framed under “health system excluding provider and patient (HS)”, “provider” and “patient” domains, according to the framework synthesis approach. Findings on hypertension strategies were narratively synthesised. Results We identified 14 published studies; one with mixed, three with qualitative and 10 with quantitative methods, eight relating to barriers and enablers and six of hypertension strategies. The identified barriers associated with the health system (HS) were: lack of affordable services and lack of resources. The commonly reported barriers at the provider’s level were: lack of clear instructions from the providers for medication use, follow-up visits and lifestyle modifications, and long waiting hours for appointments. Poor help-seeking behaviour, non-adherence to medication, perceived side-effects of drugs, financial hardship and lack of family support were barriers identified at patient level. The following enablers were identified: positive illness perception, free essential healthcare services and family support. Strategies implemented across the HS, provider and patient were: establishing digital health records at health centres, health worker’s capacity development, health education and yoga practice. Conclusion There is a range of barriers for hypertension treatment and control in Nepal pertaining to the health system, providers, and patients. Comprehensive interventions are needed at all three levels to further improve management and control of hypertension in Nepal.
Health system strengthening and hypertension awareness, treatment and control: data from the China Health and Retirement Longitudinal Study
