Illness and treatment beliefs in Kathmandu valley Nepalis under hypertensive care

Abstract

The prevalence of actionable (i.e., stage 2 = BP > 140/90) hypertension among Nepalis approaches one-third in the adult population. Long-term drug treatment adherence is low. Western-developed assessment tools present an incomplete picture of the regional Nepali beliefs that guide patient treatment adherence, and the present study seeks to substantiate qualitative findings that suggest a reorientation of patient education content for more effective patient-oriented, culturally consonant care. We conducted a cross-sectional structured interview of 500 men and women under treatment for hypertension in three urban Kathmandu hospital clinics. Interview items were developed from a qualitative survey and investigated patient beliefs about hypertension causes, symptoms, and consequences; treatment costs and sequelae; and general health maintenance. Patients reported experiencing multiple and wide-ranging symptoms that affected how they felt physically and emotionally as well as how they behaved; these were expected to respond to treatment. They were distressed by their condition and were concerned about short- and long-term treatment effects, specifically that long-term treatment may impair the body's natural ability to maintain a healthy blood pressure. While hypertension was described as life-long, there was a range of beliefs on whether successful blood pressure control would, or should, allow a switch to natural remedies, lifestyle management, or no treatment at all. Kathmandu Valley hypertension beliefs suggest adaptation of Western-developed patient communications to address Nepali patient experience and concerns. While Western communications address the "silent" nature of the disease, our Kathmandu population experienced multiple and varied symptoms that guided their behavior. Patient also expressed concerns about medication habituation and dependence reflecting Nepali health models.