Patients' and healthcare providers' perceptions and practices regarding hypertension, pharmacy-based care, and mHealth in Lagos, Nigeria: a mixed methods study.
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BACKGROUND In sub Saharan Africa cardiovascular disease is becoming a leading cause of death with high blood pressure as number one risk factor In Nigeria access and adherence to hypertension care are poor A pharmacy based hypertension care model with remote monitoring by cardiologists through mHealth was piloted in Lagos to increase accessibility to quality care for hypertensive patients OBJECTIVES To describe patients and healthcare providers perceptions and practices regarding hypertension pharmacy based care and mHealth and explore how this information may improve innovative hypertension service delivery METHODS This study consisted of observations of patient pharmacy staff interactions and hypertension care provided four focus group discussions and in depth interviews with 30 hypertensive patients nine community pharmacists and six cardiologists and structured interviews with 328 patients RESULTS Most patients were knowledgeable about biomedical causes and treatment of hypertension but often ignorant about the silent character of hypertension Reasons mentioned for not adhering to treatment were side effects financial constraints lack of health insurance and cultural or religious reasons Pharmacists additionally mentioned competition with informal cheaper healthcare providers Patients highly favored pharmacy based care because of the pharmacist patient relationship accessibility small scale and a pharmacy s registration at an association The majority of respondents were positive towards mHealth CONCLUSION Facilitating factors for innovative pharmacy based hypertension care were patients biomedical perceptions pharmacies strong position in the community and respondents positive attitude towards mHealth We recommend health education and strengthening pharmacists role to address barriers such as misperceptions that hypertension always is symptomatic treatment nonadherence and unfamiliarity with mHealth Future collaboration with insurance providers or other financing mechanisms may help diminish patients financial barriers to appropriate hypertension treatment