Reasons for non-compliance among patients with hypertension at Vanga Hospital, Bandundu Province, Democratic Republic of Congo: A qualitative study

Background: Hypertension is a serious public health challenge in both economically developing and developed countries. Patients on outpatient medication for hypertension at Vanga Hospital in the Democratic Republic of Congo (DRC) often present with uncontrolled hypertension and some with hypertension emergencies. On enquiry, the problem appeared to revolve around compliance. Method: The study was a qualitative, descriptive study using the focus group interview technique for data collection. Subjects were purposely selected. Interviews were conducted from 23 March to 19 July 2006. Three focus groups were formed: The fi rst was heterogeneous in terms of gender (fi ve males and three females), the second homogeneous (six males) and the last also homogeneous (six females). The group members varied with respect to characteristics such as place of residence, occupation and educational standard. The data collected were analysed using the thematic analysis method within grounded theory. Results: Five themes emerged as possible explanations for non-compliance: Side effects discouraged patients from taking medication; patients took medication only when they experienced perceived symptoms of hypertension; poor knowledge of the disease and the medication used; lack of support by family members; and diffi culty in obtaining antihypertensive medication. Conclusion: Side effects of the medication, lack of information and support, diffi culty in obtaining the medication and the fact that the disease is mainly silent played a major role in the poor adherence to hypertension medication. Sustained health promotion and education should be undertaken at all levels of patient contact to ensure good compliance. Vol. 1 No. 1 Page 1 of 5 INTRODUCTION Hypertension is a serious public health challenge in both economically developing and developed countries.1 In 2000, about 26.4% of the world adult population suffered from hypertension and it was estimated that by 2025 the global percentage will have increased to 29.2%.2 In Africa, the overall prevalence is about 29.4%, with high rates in urban areas.3, 4 In sub-Saharan Africa, hypertension has emerged as a major public health concern in recent years3,5 due to rural-urban migration coupled with modernisation trends, characterised by a sedentary style of life and the consumption of a diet rich in refi ned carbohydrates and animal fat.6,7 Patients managed at an outpatient rural clinic in Vanga, Bandundu Province, Democratic Republic of Congo (DRC), present with inadequate blood pressure control, with subsequent increases in morbidity, mortality and cost of care. On enquiry, the problem appears to revolve around compliance. No previous studies have been conducted to assess adherence to antihypertensive medication in this setting. This study explored reasons for the non-compliance among patients suffering from hypertension.