Perceived barriers to effective medical management of hypertension among the elderly persons in selected rural communities of the Republic Democratic of Congo: A qualitative study

Background: Hypertension is one of the non-communicable diseases, and generally described as a “silent killer”. It is associated with more than three-quarters of cardiovascular disease-related deaths in low-and middle-income countries, with approximately 10.8 million preventable deaths each year and a burden of 235 million years of life lost or lived with disability each year worldwide. The government of the Democratic Republic of the Congo subscribed to the global aim of reducing premature mortality from non-communicable diseases by one-third by 2030. Interventions are being implemented to increase access to screening and effective management of hypertension in the country. However, it is known that the availability of healthcare intervention does not necessarily lead to it uptake by the patients. This study assumed that certain factors related directly or indirectly to the elderly persons suffering from hypertension, and their accumulated experiences with healthcare services can act as barriers to adherence to the existing screening interventions and medical treatment of hypertension. Therefore, this study was conducted with the objective of exploring and describing barriers to effective management of hypertension as perceived by the elderly hypertensive persons in rural communities of Haut-Uélé Province in the Democratic Republic of the Congo. Methods: This study used a qualitative, exploratory, descriptive and contextual design with semi- structured individual interviews. Nineteen individual interviews were conducted with elderly hypertensive persons aged 65 years and above. The comparative thematic content analysis method was used to manage and analyze the data. Results: Eight sub-themes were identified as barriers. These included health illiteracy, perceived inefficacy of modern antihypertensive medicine, financial constraints, increase frailty of old age, culturally insensitive care, perceived discrimination, scarcity of antihypertensive medicines, and the high cost of HBP treatment. Conclusion: The findings of this study provide an insight into the problems affecting adherence to medical management of hypertension within the context of elderly hypertensive persons living in rural areas. Healthcare professionals and policy makers could learn from these findings and use them to maximize effective medical management of hypertension among elderly people living in rural areas.