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Patients’ Attitudes and Approaches to the Self-Management of Hypertension: Perspectives from an Australian Qualitative Study in Community Pharmacy

  • Beata Bajorek
  • Kate Lemay
  • Parker Magin
  • Christopher Roberts
  • Ines Krass
  • Carol Armour
Original Article

Abstract

Introduction

In the management of hypertension, blood pressure (BP) monitoring and medication use are key strategies, but they are dependent on patients’ motivation to practice self-care.

Aim

To gauge patients’ approaches to monitoring their blood pressure, as well as explore their attitudes toward, and actions relating to, high blood pressure readings, as the key components of their self-management of hypertension.

Method

This qualitative study, comprising individual telephone interviews, involved patients attending community pharmacies in Sydney (Australia). Patients’ perspectives were elicited using a purpose-designed, semi-structured interview guide. The verbal responses were audio-recorded, transcribed verbatim, and thematically analysed.

Results

Three key themes arose: (1) approaches to monitoring blood pressure, (2) attitudes to variability in BP, (3) responses to high BP readings. Many patients self-regulated the frequency of monitoring based on perceived need and/or opportunity. Most were indifferent toward their readings, regarding BP fluctuations as ‘normal’. When a high BP was detected, the action taken was highly variable, with no clear action plans in place. Several patients recognised a high BP to be a consequence of not taking their antihypertensive medication, triggering the resumption of short-term adherence to their preferred management strategy, i.e., self-medication with antihypertensives (i.e., restarting their medication) and/or self-management via lifestyle strategies.

Conclusion

This study highlights patients’ inappropriate self-management of hypertension. Misperceptions about hypertension, e.g., accepting BP fluctuations as normal, can produce indifferent attitudes as well as influence patients’ self-management actions. This lack of insight undermines long-term adherence to antihypertensive therapy.

Keywords

Hypertension Self-management Blood pressure monitoring, ambulatory Medication adherence Qualitative research 

Notes

Acknowledgements

All authors participated in development and conduct of the study (data collection and analysis), interpretation of the results, and preparation of the manuscript. All authors have read and approved the submitted version. The conduct of this study would not have been possible without the assistance and support of Pradnya Naik Panvelkar (Project Officer), Dr Jessica Bird (Qualitative researcher), approvals obtained from the relevant institutions and divisions of general practice (Medicare Locals), and the guidance of our specifically convened Advisory Group.

Compliance with Ethical Standards

Funding

This study received funding from the National Heart Foundation, Australia (Award ID G 11S5729).

Conflict of interest

None of the authors have any conflicts of interest to declare.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Conduct of the study was approved by the University of Sydney Human Research Ethics Committee (Application 14483), as well as from the participating Medicare Locals (divisions of general practice).

Informed consent

Informed consent was obtained from all individual participants included in the study.

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Copyright information

© Springer International Publishing Switzerland 2017

Authors and Affiliations

  • Beata Bajorek
    • 1
  • Kate Lemay
    • 2
  • Parker Magin
    • 3
  • Christopher Roberts
    • 4
  • Ines Krass
    • 5
  • Carol Armour
    • 2
    • 6
  1. 1.Graduate School of Health-Pharmacy, CB01.13.31The University of Technology SydneyBroadwayAustralia
  2. 2.Woolcock Institute of Medical ResearchUniversity of SydneyGlebeAustralia
  3. 3.Discipline of General PracticeUniversity of NewcastleCallaghanAustralia
  4. 4.Sydney Medical School-NorthernHornsby Ku-ring-Gai HospitalHornsbyAustralia
  5. 5.Faculty of PharmacyUniversity of SydneyCamperdownAustralia
  6. 6.Sydney Local Health DistrictGlebeAustralia

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