The Long and Winding Road: A Systematic Literature Review Conceptualising Pathways for Hypertension Care and Control in Low- and Middle-Income Countries.
Health Systems
Healthcare Delivery
Hypertension Control
Pathways to Care
Systematic Review
Journal
International journal of health policy and management
ISSN: 2322-5939
Titre abrégé: Int J Health Policy Manag
Pays: Iran
ID NLM: 101619905
Informations de publication
Date de publication:
01 Mar 2022
01 Mar 2022
Historique:
received:
25
11
2019
accepted:
16
06
2020
pubmed:
25
7
2020
medline:
26
3
2022
entrez:
25
7
2020
Statut:
epublish
Résumé
Hypertension control is poor everywhere, especially in low- and middle-income countries (LMICs). An effective response requires understanding factors acting at each stage on the patients' pathway through the health system from entry or first contact with the health system, through to treatment initiation and follow up. This systematic review aimed to identify barriers to and facilitators of hypertension control along this pathway and, respectively, ways to overcome or strengthen them. MEDLINE, EMBASE, Global Health, CINAHL Plus, and Africa-Wide Information (1980-April 2019) were searched for studies of hypertensive adults in LMICs reporting details of at least 2 adequately described health system contacts. Data were extracted and analysed by 2 reviewers. Themes were developed using NVivo in patient-related (sociodemographic, knowledge and health beliefs, health status and co-morbidities, trade-offs), social (social relationships and traditions) and health system domains (resources and processes). Results are reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. From 2584 identified records, 30 were included in the narrative synthesis. At entry, 'health systems resources and processes' and 'knowledge and beliefs about hypertension' dominated while 'social relations and traditions' and 'comorbidities' assume greater importance subsequently, with patients making 'trade-offs' with family priorities during follow up. Socio-demographic factors play a role, but to a lesser extent than other factors. Context matters. Understanding the changing barriers to hypertension control along the patient journey is necessary to develop a comprehensive and efficient response to this persisting problem.
Sections du résumé
BACKGROUND
BACKGROUND
Hypertension control is poor everywhere, especially in low- and middle-income countries (LMICs). An effective response requires understanding factors acting at each stage on the patients' pathway through the health system from entry or first contact with the health system, through to treatment initiation and follow up. This systematic review aimed to identify barriers to and facilitators of hypertension control along this pathway and, respectively, ways to overcome or strengthen them.
METHODS
METHODS
MEDLINE, EMBASE, Global Health, CINAHL Plus, and Africa-Wide Information (1980-April 2019) were searched for studies of hypertensive adults in LMICs reporting details of at least 2 adequately described health system contacts. Data were extracted and analysed by 2 reviewers. Themes were developed using NVivo in patient-related (sociodemographic, knowledge and health beliefs, health status and co-morbidities, trade-offs), social (social relationships and traditions) and health system domains (resources and processes). Results are reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.
RESULTS
RESULTS
From 2584 identified records, 30 were included in the narrative synthesis. At entry, 'health systems resources and processes' and 'knowledge and beliefs about hypertension' dominated while 'social relations and traditions' and 'comorbidities' assume greater importance subsequently, with patients making 'trade-offs' with family priorities during follow up. Socio-demographic factors play a role, but to a lesser extent than other factors. Context matters.
CONCLUSION
CONCLUSIONS
Understanding the changing barriers to hypertension control along the patient journey is necessary to develop a comprehensive and efficient response to this persisting problem.
Identifiants
pubmed: 32702800
doi: 10.34172/ijhpm.2020.105
pmc: PMC9278472
doi:
Types de publication
Journal Article
Systematic Review
Langues
eng
Sous-ensembles de citation
IM
Pagination
257-268Subventions
Organisme : Wellcome Trust
ID : 200346/Z/15/Z
Pays : United Kingdom
Organisme : Medical Research Council
ID : MC_PC_16026
Pays : United Kingdom
Informations de copyright
© 2022 The Author(s); Published by Kerman University of Medical Sciences. This is an open-access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
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