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      Life experiences of patients before having hypertension: a qualitative study

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          Abstract

          Introduction

          Identification of causes of hypertension on the basis of the perspectives and experiences of patients is the key to success in health plans of these patients. The aim of this study was to describe the experiences of life before becoming hypertensive patients.

          Methods

          This qualitative study was conducted during August 2015 to April 2016. Twenty-seven hypertensive patients referred to hospitals affiliated to Tehran University of Medical Sciences were selected based on purposive sampling, and semi-structured in-depth interviews were conducted with them. The data were analyzed by the content analysis method and using qualitative data analysis software MAXqda 2011.

          Results

          Three main categories were extracted from data analysis. Patients experienced factors such as negligence and neglect, life stress, lack of healthy lifestyles and abuse awareness, spirituality abandonee in the main category of “personal experience,” factors such as family conflicts, heredity, inappropriate nutritional and life style in the main category of “family life,” and also factors such as job stress, economic problems, urbanization, chemical agents during the war in the main category of “social life.”

          Conclusions

          Based on the findings, patients before becoming hypertensive under the influence of their culture and beliefs had experienced many risk factors associated with hypertension. Comprehensive planning and appropriate to the cultural, social, and beliefs context about the prevention and correction of these factors is necessary.

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          Most cited references34

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          Patient and Healthcare Provider Barriers to Hypertension Awareness, Treatment and Follow Up: A Systematic Review and Meta-Analysis of Qualitative and Quantitative Studies

          Background Although the importance of detecting, treating, and controlling hypertension has been recognized for decades, the majority of patients with hypertension remain uncontrolled. The path from evidence to practice contains many potential barriers, but their role has not been reviewed systematically. This review aimed to synthesize and identify important barriers to hypertension control as reported by patients and healthcare providers. Methods Electronic databases MEDLINE, EMBASE and Global Health were searched systematically up to February 2013. Two reviewers independently selected eligible studies. Two reviewers categorized barriers based on a theoretical framework of behavior change. The theoretical framework suggests that a change in behavior requires a strong commitment to change [intention], the necessary skills and abilities to adopt the behavior [capability], and an absence of health system and support constraints. Findings Twenty-five qualitative studies and 44 quantitative studies met the inclusion criteria. In qualitative studies, health system barriers were most commonly discussed in studies of patients and health care providers. Quantitative studies identified disagreement with clinical recommendations as the most common barrier among health care providers. Quantitative studies of patients yielded different results: lack of knowledge was the most common barrier to hypertension awareness. Stress, anxiety and depression were most commonly reported as barriers that hindered or delayed adoption of a healthier lifestyle. In terms of hypertension treatment adherence, patients mostly reported forgetting to take their medication. Finally, priority setting barriers were most commonly reported by patients in terms of following up with their health care providers. Conclusions This review identified a wide range of barriers facing patients and health care providers pursuing hypertension control, indicating the need for targeted multi-faceted interventions. More methodologically rigorous studies that encompass the range of barriers and that include low- and middle-income countries are required in order to inform policies to improve hypertension control.
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            Lay perspectives on hypertension and drug adherence: systematic review of qualitative research

            Objective To synthesise the findings from individual qualitative studies on patients’ understanding and experiences of hypertension and drug taking; to investigate whether views differ internationally by culture or ethnic group and whether the research could inform interventions to improve adherence. Design Systematic review and narrative synthesis of qualitative research using the 2006 UK Economic and Social Research Council research methods programme guidance. Data sources Medline, Embase, the British Nursing Index, Social Policy and Practice, and PsycInfo from inception to October 2011. Study selection Qualitative interviews or focus groups among people with uncomplicated hypertension (studies principally in people with diabetes, established cardiovascular disease, or pregnancy related hypertension were excluded). Results 59 papers reporting on 53 qualitative studies were included in the synthesis. These studies came from 16 countries (United States, United Kingdom, Brazil, Sweden, Canada, New Zealand, Denmark, Finland, Ghana, Iran, Israel, Netherlands, South Korea, Spain, Tanzania, and Thailand). A large proportion of participants thought hypertension was principally caused by stress and produced symptoms, particularly headache, dizziness, and sweating. Participants widely intentionally reduced or stopped treatment without consulting their doctor. Participants commonly perceived that their blood pressure improved when symptoms abated or when they were not stressed, and that treatment was not needed at these times. Participants disliked treatment and its side effects and feared addiction. These findings were consistent across countries and ethnic groups. Participants also reported various external factors that prevented adherence, including being unable to find time to take the drugs or to see the doctor; having insufficient money to pay for treatment; the cost of appointments and healthy food; a lack of health insurance; and forgetfulness. Conclusions Non-adherence to hypertension treatment often resulted from patients’ understanding of the causes and effects of hypertension; particularly relying on the presence of stress or symptoms to determine if blood pressure was raised. These beliefs were remarkably similar across ethnic and geographical groups; calls for culturally specific education for individual ethnic groups may therefore not be justified. To improve adherence, clinicians and educational interventions must better understand and engage with patients’ ideas about causality, experiences of symptoms, and concerns about drug side effects.
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              Prevalence, awareness and risk factors of hypertension in a large cohort of Iranian adult population.

              There is considerable variation in hypertension prevalence and awareness, and their correlates, across different geographic locations and ethnic groups. We performed this cross-sectional analysis on data from the Golestan Cohort Study (GCS).
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                Author and article information

                Journal
                Electron Physician
                Electron Physician
                Electronic physician
                Electronic Physician
                Electronic physician
                2008-5842
                March 2017
                25 March 2017
                : 9
                : 3
                : 3925-3933
                Affiliations
                [1 ]M.SC. of Nursing Education, Ph.D. Student, Department of Medical-Surgical Nursing, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
                [2 ]Ph.D. of Nursing Education, Professor, Nursing and Midwifery care Research Center, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
                [3 ]Ph.D. of Nursing Education, Assistant Professor, Nursing and Midwifery Care Research Center, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
                Author notes
                Corresponding author: Professor Dr. Nahid Dehghan Nayeri, Nursing and Midwifery Care Research Center, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran. Tel: +98.2166420739, Fax: +98.2166420739, Email: nahid.nayeri@ 123456gmail.com
                Article
                epj-09-3925
                10.19082/3925
                5407224
                28461866
                f03aacbb-7746-4f02-bb03-4acdcdaff12a
                © 2017 The Authors

                This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.

                History
                : 07 October 2016
                : 15 December 2016
                Categories
                Original Article

                hypertension,qualitative research,life experience
                hypertension, qualitative research, life experience

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