Hypertensive patients perception of their illness: A qualitative study

Background - Studies have shown that as much as 50% of patients diagnosed with hypertension do not adhere to management recommendations. This adherence behaviour is related to the perception of hypertension by these patients. This study is aimed at providing better understanding of the reasons why hypertensive patients do not follow treatment and lifestyle changes recommendations in a primary care setting.Study methods - This study utilised a qualitative methodology. Data were collected from in – depth interviews with twelve hypertensive patients attending follow-up in the government Family Practice clinics of Federal Medical Centre, Abeokuta, Western Nigeria. The transcribed data were analysed using thematic method.Results - There was evidence from the data of inadequate knowledge of hypertension by the patients. Although the patients recognised the need for treatment of hypertension, they are not knowledgeable about the chronic nature of hypertension at the initial consultation. They felt hypertension is curable. They did not participate in decision making on the commencement of antihypertensive drugs. This attitude plays a significant role in non adherence to management recommendations. The patients did not have adequate knowledge of non drug management of hypertension because of inadequate information from care givers during clinic consultation. There was evidence that the patients made use of alternative and complementary medicine for the treatment of hypertension.Conclusion - Hypertensive patients need information during their encounter with health care providers on hypertension and related drug and non – drug management. Adherence to hypertension management recommendations depends on adequate patient information on these issues

Quality of primary care physicians’ communication of diabetes self-management during medical encounters with persons with diabetes mellitus in a resource-poor country

Background: Most of the Nigerian studies on the determinants of diabetes self-management have focused on patient-related factors. There is no previous local study that examined the quality of diabetes self-management education provided by primary care physicians to people with diabetes mellitus.Methods: A descriptive cross-sectional study was conducted among 105 primary care physicians during a workshop. The quality of diabetes self-management education provided by the physicians was assessed using a self-designed scale of 39 Likert questions derived from American Association of Diabetes Educators seven domains of diabetes self-management. Cronbach’s reliability coefficient of each domain/subscale was ≥ 0.7. The data was analysed using the independent sample t-test and one-way ANOVA.Results: Over half of the physicians provided ‘inadequate quality’ diabetes self-management education in all the domains. Physicians had the highest mean score in the ‘taking medication’ domain (4.35 ± 0.59). The mean scores in the ‘problemsolving domain’ (3.63 ± 0.74) and the ‘being active domain’ (3.57 ± 0.71) were low. The quality of diabetes self-management education provided by the physicians was not associated with any of the physician characteristics.Conclusion: The quality of physicians’ communication of diabetes self-management was suboptimal in this study. The majority of the adequately communicated diabetes self-management behaviours were risk factors reduction related and disease-centred. Thus, training of primary care physicians on diabetes self-management education is recommended because of the key role these physicians play in diabetes management in resource-poor countries