The purpose of the study is to appraise challenges surrounding the care and follow-up of hypertensive patients in Fako Division in the Southwest Region of Cameroon, and recommend a more comprehensive and adaptable approach. Concerning the theoretical scope, the study was guided by the Health Belief Model (HBM) as applied by Tarkang and Zotor (2015), the Theory of Human Caring and the Theory of Health Promotion Model (Devi et al., 2017). It was a hospital-based study that employed a cross-sectional qualitative survey design. All hypertensive patients and their caregivers visiting the hospital during the study period, as well as nurses and prescribers in the study setting, were involved conveniently. Two health facilities were randomly selected, one public and one non-public, from among all the health units in the 4 main subdivisions of Fako, making a total of 8 health facilities of primary, secondary and tertiary levels. Data were collected using an interview guide directed to patients, caregivers, nurses, and prescribers. The abstraction of the data was reduced following the thematic analysis process. The findings unfolded that both nurses and physicians/prescribers recommended the complementarity between pharmacological and non-pharmacological approaches to treatment, with particular attention paid to prevention. Nurses had positive attitudes towards the management of hypertension, and patients were mostly satisfied with treatment. However, a number of barriers were identified and urged to be resolved. Compliance with treatment, as well as treatment outcomes, were hindered by several factors, notably the diversity of treatment guidelines, the high cost of treatment, the inadequate availability of drugs, the ineffectiveness of some drugs, resistance to drugs, inadequacy of staff and motivation, inadequate competency of staff, poverty of patients, inadequacy of equipment notably BP machines that equally hinder self-monitoring by patients, non-compliance to treatment by patients, challenging home follow-up, enslavement of some areas, poor mobile network coverage in some areas, socio-political crisis, and psychological problems such as medication phobia and defection/pessimism.
References
[1]
Atlas.ti, GMBH 5.0 (2021). The Knowledge Workbench, Visual Qualitative Data Analysis Version: WIN 5.0 (Build 63). Scientific Software Development.
[2]
Bray, G. A., Vollmer, W. M., Sacks, F. M., Obarzanek, E., Svetkey, L. P., & Appel, L. J. (2004). A Further Subgroup Analysis of the Effects of the DASH Diet and Three Dietary Sodium Levels on Blood Pressure: Results of the DASH-Sodium Trial. The American Journal of Cardiology, 94, 222-227. https://doi.org/10.1016/j.amjcard.2004.03.070
[3]
Brownstein, J. N., Chowdhury, F. M., Norris, S. L., Horsley, T., Jack, L., Zhang, X. et al. (2007). Effectiveness of Community Health Workers in the Care of People with Hypertension. American Journal of Preventive Medicine, 32, 435-447. https://doi.org/10.1016/j.amepre.2007.01.011
[4]
Chiong, J. R. (2008). Controlling Hypertension from a Public Health Perspective. International Journal of Cardiology, 127, 151-156. https://doi.org/10.1016/j.ijcard.2007.10.039
[5]
CVUC (2019). Commune et villeUnies du Cameroon (CVUC)/United Councils and Cities of Cameroon. http://cvuc.cm/national/index.php/fr/carte-communale/region-du-sud/142-association/carte-administrative/sud-ouest/fako/404-
[6]
Darabont, R. O. (2022). Arterial Hypertension—The Timeline of a Concept. The Journal of Hypertension Research, 8, 9.
[7]
Davis, C. P. (2024). Definition of Hypertensive. https://www.rxlist.com/hypertensive/definition.htm
[8]
Devi, B., Khandelwal, B., & Das, M. (2017). Application of Bandura’s Social Cognitive Theory in the Technology Enhanced, Blended Learning Environment. International Journal of Applied Research, 3, 721-724.
[9]
Dhungana, R. R., Pedisic, Z., Pandey, A. R., Shrestha, N., & de Courten, M. (2021). Barriers, Enablers and Strategies for the Treatment and Control of Hypertension in Nepal: A Systematic Review. Frontiers in Cardiovascular Medicine, 8, Article ID: 716080. https://doi.org/10.3389/fcvm.2021.716080
[10]
Elliott, W. J. (2003). Optimizing Medication Adherence in Older Persons with Hypertension. International Urology and Nephrology, 35, 557-562. https://doi.org/10.1023/b:urol.0000025643.80319.b3
[11]
Fakhri, S., Mona, J. M., & Reza, M. (2011). Knowledge, Awareness, Attitudes and Practice about Hypertension in Hypertensive Patients Referring to Public Health Care Centers in Khoor & Biabanak. Iranian Journal of Nursing and Midwifery Research, 16, 34-40.
[12]
Fihn, S. D., & Wicher, J. B. (1998). Withdrawing Routine Outpatient Medical Services: Effects on Access and Health. Journal of General Internal Medicine, 3, 356-362. https://doi.org/10.1007/bf02595794
[13]
Ghosh, S. K., Priya, A., & Narayan, R. K. (2021). Evolution of the Fabric of Cardiovascular Science: Saga of an Enduring Process of Refinement. Annales de Cardiologie et d’Angéiologie, 70, 220-230. https://doi.org/10.1016/j.ancard.2021.06.002
[14]
Giles, T. D., Berk, B. C., Black, H. R., Cohn, J. N., Kostis, J. B., Izzo, J. L. et al. (2005). Expanding the Definition and Classification of Hypertension. The Journal of Clinical Hypertension, 7, 505-512. https://doi.org/10.1111/j.1524-6175.2005.04769.x
[15]
Gyamfi, J., Plange-Rhule, J., Iwelunmor, J., Lee, D., Blackstone, S. R., Mitchell, A., Ntim, M., Apusiga, K., Tayo, B., Yeboah-Awudzi, K., Cooper, R., & Ogedegbe, G. (2017). Training Nurses in Task-Shifting Strategies for the Management and Control of Hypertension in Ghana: A Mixed-Methods Study. BMC Health Services Research,17, Article No. 104. https://doi.org/10.1186/s12913-017-2026-5
[16]
Herring, N., Kalla, M., & Paterson, D. J. (2019). The Autonomic Nervous System and Cardiac Arrhythmias: Current Concepts and Emerging Therapies. Nature Reviews Cardiology, 16, 707-726. https://doi.org/10.1038/s41569-019-0221-2
[17]
Herxheimer, A., McPherson, A., Miller, R., Shepperd, S., Yaphe, J., & Ziebland, S. (2000). Database of Patients’ Experiences (DIPEx): A Multi-Media Approach to Sharing Experiences and Information. The Lancet, 355, 1540-1543. https://doi.org/10.1016/s0140-6736(00)02174-7
[18]
Klatsky, A. L. (2015). Alcohol and Cardiovascular Diseases: Where Do We Stand Today? Journal of Internal Medicine, 278, 238-250. https://doi.org/10.1111/joim.12390
[19]
Kotchen, T. A. (2011). Historical Trends and Milestones in Hypertension Research: A Model of the Process of Translational Research. Hypertension, 58, 522-538. https://doi.org/10.1161/hypertensionaha.111.177766
[20]
Krousel-Wood, M., Hyre, A., Muntner, P., & Morisky, D. (2005). Methods to Improve Medication Adherence in Patients with Hypertension: Current Status and Future Directions. Current Opinion in Cardiology, 20, 296-300. https://doi.org/10.1097/01.hco.0000166597.52335.23
[21]
Lasker Foundation (2025). First Effective Drugs for Hypertension: 1958 Albert Lasker Clinical Medical Research Award. https://laskerfoundation.org/winners/first-effective-drugs-for-hypertension/
[22]
Lefante, J., Harmon, G., & Krousel-Wood, M. (2006). Overcoming Barriers: The Role of Providers in Improving Patient Adherence to Antihypertensive Medications. Current Opinion in Cardiology, 21, 310-315. https://doi.org/10.1097/01.hco.0000231400.10104.e2
[23]
Lin, H. J., Guo, X., & Rotter, J. I. (2019). The Genetics of Blood Pressure Regulation. In R. E. Pyeritz et al. (Eds.), Emery and Rimoin’s Principles and Practice of Medical Genetics and Genomics (pp. 197-208). Elsevier. https://doi.org/10.1016/b978-0-12-812532-8.00006-9
[24]
Lopes, A. A., James, S. A., Port, F. K., Ojo, A. O., Agodoa, L. Y., & Jamerson, K. A. (2003). Meeting the Challenge to Improve the Treatment of Hypertension in Blacks. The Journal of Clinical Hypertension, 5, 393-401. https://doi.org/10.1111/j.1524-6175.2003.01736.x
[25]
Mayberry, R. M., Nicewander, D. A., Qin, H., & Ballard, D. J. (2008). Improving Quality and Reducing Inequities: A Challenge in Achieving Best Care. World Hospitals and Health Services, 44, 16-31.
[26]
McNamara, K. P., Versace, V. L., Marriott, J. L., & Dunbar, J. A. (2014). Patient Engagement Strategies Used for Hypertension and Their Influence on Self-Management Attributes. Family Practice, 31, 437-444. https://doi.org/10.1093/fampra/cmu026
[27]
McAlister, F. A., Wilkins, K., Joffres, M., Leenen, F. H. H., Fodor, G., Gee, M. et al. (2011). Changes in the Rates of Awareness, Treatment and Control of Hypertension in Canada over the Past Two Decades. Canadian Medical Association Journal, 183, 1007-1013. https://doi.org/10.1503/cmaj.101767
[28]
Mogueo, A., & Defo, B. K. (2022). Patients’ and Family Caregivers’ Experiences and Perceptions about Factors Hampering or Facilitating Patient Empowerment for Self-Management of Hypertension and Diabetes in Cameroon. BMC Health Services Research, 22, Article No. 1381. https://doi.org/10.1186/s12913-022-08750-4
[29]
Mohlokoane, M. J. (2004). Towards a Leadership Model for the Effective Management of Further Education and Training Colleges in the Gauteng Province. PhD Thesis, University of South Africa.
[30]
Mojtabai, R., & Olfson, M. (2000). Medication Costs, Adherence, and Health Outcomes among Medicare Beneficiaries. Health Affairs, 22, 220-229. https://doi.org/10.1377/hlthaff.22.4.220
[31]
Moy, E., Bartman, B. A., & Weir, M. R. (1995). Access to Hypertensive Care. Effects of Income, Insurance, and Source of Care. Archives of Internal Medicine, 155, 1497-1502. https://doi.org/10.1001/archinte.1995.00430140063005
[32]
Mugenda, O. M., & Mugenda, A. G. (2003). Research Methods: Quantitative and Qualitative Approaches. African Centre for Technology Studies.
[33]
Nana, C. (2018). Research Methods and Applied Statistics: Beginners and Advanced Learners. Gooahead.
[34]
Newman, J. H. (2005). Pulmonary Hypertension. American Journal of Respiratory and Critical Care Medicine, 172, 1072-1077. https://doi.org/10.1164/rccm.200505-684oe
[35]
O’Rourke, M. F., & Nichols, W. W. (2005). Aortic Diameter, Aortic Stiffness, and Wave Reflection Increase with Age and Isolated Systolic Hypertension. Hypertension, 45, 652-658. https://doi.org/10.1161/01.hyp.0000153793.84859.b8
[36]
Ogah, O. S., & Rayner, B. L. (2013). Recent Advances in Hypertension in Sub-Saharan Africa. Heart, 99, 1390-1397. https://doi.org/10.1136/heartjnl-2012-303227
[37]
Peng, M., Shi, X., Zhu, L., & Wang, Z. (2022). Follow-Up Management Service and Health Outcomes of Hypertensive Patients in China: A Cross-Sectional Analysis from the National Health Service Survey in Jiangsu Province. Frontiers in Public Health, 10, Article ID: 956711. https://doi.org/10.3389/fpubh.2022.956711
[38]
Qureshi, A. I., Harris-Lane, P., Kirmani, J. F., Ahmed, S., Jacob, M., Zada, Y. et al. (2006). Treatment of Acute Hypertension in Patients with Intracerebral Hemorrhage Using American Heart Association Guidelines. Critical Care Medicine, 34, 1975-1980. https://doi.org/10.1097/01.ccm.0000220763.85974.e8
[39]
Sarafidis, P. A., Li, S., Chen, S., Collins, A. J., Brown, W. W., Klag, M. J. et al. (2008). Hypertension Awareness, Treatment, and Control in Chronic Kidney Disease. The American Journal of Medicine, 121, 332-340. https://doi.org/10.1016/j.amjmed.2007.11.025
[40]
Sawicka, K., Szczyrek, M., Jastrzębska, I., Prasał, M., Zwolak, A., & Daniluk, J. (2011). Hypertension—The Silent Killer. Journal of Pre-Clinical and Clinical Research, 5, 43-46.
[41]
Schutte, A. E., Jafar, T. H., Poulter, N. R., Damasceno, A., Khan, N. A., Nilsson, P. M. et al. (2023). Addressing Global Disparities in Blood Pressure Control: Perspectives of the International Society of Hypertension. Cardiovascular Research, 119, 381-409. https://doi.org/10.1093/cvr/cvac130
[42]
Svensson, S., & Svensson, S. (2003). Patient Perceptions of Hypertension and Its Treatment. Blood Pressure, 12, 5-6. https://doi.org/10.1080/08037050310003370
[43]
Tarkang, E. E., & Zotor, F. B. (2015). Application of the Health Belief Model (HBM) in HIV Prevention: A Literature Review (Vol. 1, pp. 1-8). Science Publishing Group.
[44]
UNISA (2003). Research Methodology: Study Guide for 2 for MEDEM 2-R/MEDEM I-QMEDEM 4-T/MEDEM5-U. Study Guide for 4 MEDEM 3-5. University of South Africa.
[45]
Vollmer, Appel, L. J., Conlin, P. R., Ryan, D. H., Ard, J., & Kennedy, B. M. (1999). Effects of Dietary Patterns on Blood Pressure. Archives of Internal Medicine, 159, 285-293. https://doi.org/10.1001/archinte.159.3.285
[46]
WHO (2024). Hypertension. World Health Organization (WHO). https://www.who.int/health-topics/hypertension#tab=tab_1
[47]
Witmer, A., Seifer, S. D., Finocchio, L., Leslie, J., & O’Neil, E. H. (1995). Community Health Workers: Integral Members of the Health Care Work Force. American Journal of Public Health, 85, 1055-1058. https://doi.org/10.2105/ajph.85.8_pt_1.1055
[48]
Woolhandler, S., & Himmelstein, D. U. (1988). Reverse Targeting of Preventive Care Due to Lack of Health Insurance. JAMA: The Journal of the American Medical Association, 259, 2872-2874. https://doi.org/10.1001/jama.1988.03720190040028