Burden, Healthcare Access, and Barriers among Adults Living with Coexisting Diabetes and Hypertension in Urban Slums of Bhubaneswar: An Explanatory Sequential Mixed-Methods Study

Background The coexistence of diabetes mellitus and hypertension substantially increases the risk of cardiovascular and renal complications, particularly among socioeconomically disadvantaged populations. Urban slums in India represent high-risk environments where structural inequities may intensify treatment burden and limit effective access to care. This study examined treatment burden, health-care access, and perceived barriers among adults living with coexisting diabetes and hypertension in urban slums of Bhubaneswar, Odisha. Methods An explanatory sequential mixed-methods design was conducted between August and December 2025. Phase I involved a cross-sectional survey of 183 adults diagnosed with both conditions. Treatment burden was assessed using the 13-item Treatment Burden Questionnaire, health-care access using a structured questionnaire which consists of a 15-item scale, and perceived barriers using a 12-item standerdised healthcare access barrier survey questionnaire tool. Descriptive statistics and multivariable linear regression were performed to examine predictors of composite burden scores. Phase II included in-depth semi-structured interviews with 28 purposively selected participants to explore lived experiences and contextual determinants of chronic illness management. Findings from both phases were integrated using triangulation and interpreted through Treatment Burden Theory and Levesque’s patient-centred access framework. Results Quantitative findings revealed that 82.5% of participants experienced moderate to high treatment burden, 59% reported poor to moderate health-care access, and 56.8% reported high levels of perceived barriers. Multivariable analysis showed no significant independent associations between sociodemographic or clinical variables and composite burden scores. Qualitative analysis generated five themes highlighting persistent physical fatigue, emotional distress, financial precarity, role conflict, fragmented health services, and communication gaps. Participants frequently delayed care due to wage loss, long waiting times, and medicine stock-outs. Integration demonstrated that treatment workload consistently exceeded patients’ physical, cognitive, and financial capacity, leading to episodic engagement with care. Conclusions Multimorbidity management in urban slum settings is shaped primarily by structural and systemic constraints rather than individual characteristics. Addressing treatment burden requires capacity-enhancing and system-level interventions, including simplified regimens, flexible service delivery, reliable medicine supply, and strengthened patient–provider communication to improve equitable chronic disease care.