Background: Approximately 75% of the mortality and morbidity in low and middle-income countries (LMIC) are from non-communicable diseases (NCDs), with cardiovascular diseases (CVD) accounting for nearly 50% of this burden. This is driven, in part, by suboptimal control of hypertension and diabetes. Yet before designing culturally-appropriate self-management interventions to decrease this burden, we must first understand the reasons why hypertension and diabetes is poorly controlled.
Methods: Project SEHAT is a cluster randomized controlled trial investigating the effect of a community health worker-led program to control hypertension, diabetes and smoking in a semi urban community in West Bengal, India. Seventy- eight participants with hypertension and/or diabetes between 35-70 years of age were enrolled and stratified on gender, medication adherence level, and whether they had seen a physician. Focus group discussions were conducted to examine behavioral factors affecting hypertension and diabetes self-management. All focus groups were digitally recorded and wo coders independently coded the data. Qualitative description was used to analyze the data.
Results: Most patients and their family members were concerned about their hypertension or diabetes. However, only 26% (6/23) of interviewed patients recognized that they were at increased risk for a CVD event. A majority (72% - 23/32) claimed they were unable to adhere to their medications, often because of cost. Participants did not engage in healthy lifestyle behaviors (i.e., diet and exercise) and were unaware of these interventions. Approximately, 80% (40/50) visited modern physician while 10% (5/50) visited informal health practitioners, usually for financial reasons.
Discussion: There is a gap in knowledge about how to prevent CVD, even as most patients expressed concern about it. Poor insight into the disease process, belief in traditional practices, and competing financial needs were significant barriers to adopting healthy lifestyle behaviors. Intervention models should consider the existing level of knowledge and work with local traditions in order to improve self-management among those with hypertension and diabetes in this community.