Hypertension Care Coordination and Feasibility of Involving Female Community Health Volunteers in Hypertension Management in Kavre District, Nepal: A Qualitative Study

Figures & Tables

Characteristics of two study sites.

Kavre District Area: 1,396 km² Population: 375,211 Wards: 135	Dhunkharka VDC Population: 8,121 No. of FCHV: 9 Health facility: a private primary health center Geographic characteristics: hilly area
Panchkhal VDC Population: 14,930 No. of FCHV: 18 Health facility: a public primary health center Geographic characteristics: flat area

Interview Contents for Each Group of Interviewees.

Interviewee category	Interview guide focus
Individuals with hypertension	Disease history Knowledge of hypertension Hypertension treatment and non-pharmaceutical management Treatment adherence Challenges of disease management
FCHVs	Current responsibility and role Knowledge and experiences about hypertension management Attitudes towards participating in hypertension management Perceived challenges and solutions
Health workers & Health officials	Available hypertension services in the local community Community awareness of hypertension Interaction with FCHVs Perception of FCHV mobilization Suggestion for FCHV mobilization

Demographic Characteristics of all Interviewees.

Characteristics (Mean ± SD or %)	Individuals with Hypertension (n = 9)	FCHVs (n = 12)	Health Workers (n = 6)	Health Officials(n = 4)
Age (years)	64.4 ± 13.3	47.6 ± 8.9	–	–
Female (%)	66.7	100.0	16.7	0
Comorbidities (%)	66.7
HTN duration(years)	6.4 ± 4.4	–
Working (years)	–	20.3 ± 8.7	–	–
Highest education level
illiterate	66.7	41.7	–	–
Primary school	22.2	41.7	–	–
Secondary school	0	16.6	–	–
Higher	11.1	0	–	–
Occupation	4 farmers 1 teacher 1 retired 3 None	– – – –	1 nursing midwife 2 doctors 3 health assistants	1 ward executive 1 senior auxiliary health worker 1 FCHV focal person 1 public health officer

Hypertension awareness and treatment.

Key themes	Major findings
Knowledge of hypertension	Most individuals with hypertension could link hypertension to its causes, symptoms and complications. Misconceptions and home remedies were prevalent among individuals with hypertension.
Hypertension treatment initiation	There was a delay in treatment initiation. Negligence, distance to health institutions and fear of lifelong medication-taking were main barriers to treatment initiation.
Medication adherence	Overall, individuals with hypertension adhered to medication once they started it Some individuals with hypertension occasionally stopped medication due to forgetfulness, negligence, laziness, and affordability issues
Regular checkups	Loss to follow-up was common among individuals with hypertension
Non-pharmaceutical management	Individuals with hypertension complained it was hard to regulate their lifestyle Family support was an important part of regulating a healthy lifestyle.

Health system-related barriers and facilitators of hypertension care utilization.

Key themes	Major findings
Health system-related barriers	Underutilization of primary healthcare institutions, communication gap and lack of grass-roots level educational campaigns were main challenges.
Health system-related facilitators	Community pharmacies and health camps increase hypertension care accessibility Recent NCDs-related actions were favorable for hypertension management improvement.

Feasibility of FCHV mobilization.

Key themes	Major findings
The readiness of FCHV-based hypertension educational, screening and referral campaigns	FCHVs’ responsibility had been expanding to lifestyle education and counselling gradually All stakeholders had a positive attitude to FCHV mobilization
Prerequisites of FCHV-based hypertension educational, screening and referral campaigns	Systematic training, appropriate incentives and adequate access to equipment and medical resource were prerequisites of effective FCHV mobilization