Barriers to Blood Pressure Control in Treated Patients Attending Public Primary Healthcare Clinics in Gaborone, Botswana.

Background: High blood pressure (BP) is prevalent and uncontrolled in many low- and middle-income countries (LMICs). Uncontrolled BP causes cardiovascular diseases (CVDs) and kidney disease. The high morbidity and mortality caused by uncontrolled BP results in high health expenditures for families and governments. Knowledge of the barriers to BP control may help in crafting suitable interventions. The aim of this study was to explore the barriers to BP control among patients who were on treatment for high BP in public clinics in Gaborone, Botswana. Methods: This was a descriptive qualitative study to explore the barriers to BP control among patients already on BP treatment in public primary healthcare (PHC) clinics in Gaborone, Botswana. Data were collected from patients, nurses, doctors and district health managers, through structured interviews. The interviews were conducted using an interview guide, and they were audio recorded. The interviews were translated into English transcripts, and the transcripts were analysed for themes using NVivo, a software that is used in qualitative data analysis. Results: Eighteen participants were interviewed (six patients, four nurses, four doctors and four district health managers). The barriers to BP control were health system-related (e.g., drug and equipment shortages and poor clinic administration), healthcare worker (HCW)-related (e.g., poor attitudes and lack of knowledge), patient-related (e.g., non-adherence to treatment and negative lifestyle habits) and other socioeconomic factors. Conclusions: Barriers to BP control among patients receiving BP treatment were multifactorial and included health system, HCW, patient, and socioeconomic factors. There needs to be a holistic approach to overcome these barriers, and interventions should be aimed at central government funding and planning of health services, district-level management of health services, proper management and resourcing of clinics, as well as HCW and patient education.