Barriers and Facilitators to Risk Reduction of Cardiovascular Disease in Hypertensive Patients in Nigeria

Janet Adeola; Fiona Obiezu; Oluwakemi Odukoya; Ugonnaya Igwilo; Adewunmi Usinoma; Ehete Bahiru; Folasade P May

doi:10.5334/aogh.4131

Barriers and Facilitators to Risk Reduction of Cardiovascular Disease in Hypertensive Patients in Nigeria

Ann Glob Health. 2023 Dec 13;89(1):88. doi: 10.5334/aogh.4131. eCollection 2023.

Authors

Janet Adeola¹, Fiona Obiezu¹, Oluwakemi Odukoya², Ugonnaya Igwilo², Adewunmi Usinoma², Ehete Bahiru³, Folasade P May^{4

5}

Affiliations

¹ David Geffen School of Medicine at the University of California Los Angeles, Los Angeles, California, USA.
² Department of Community Health and Primary Care, College of Medicine, University of Lagos and Lagos University Teaching Hospital, Nigeria.
³ Department of Cardiology, David Geffen School of Medicine at the University of California Los Angeles, Los Angeles, California, USA.
⁴ Vatche and Tamar Manoukian Division of Digestive Diseases, Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA.
⁵ UCLA Center for Cancer Prevention and Control Research, UCLA Kaiser Permanente Center for Health Equity and Department of Health Policy and Management, Jonsson Comprehensive Cancer Center, Los Angeles, California, USA.

Abstract

Background: In Sub-Saharan Africa (SSA), the prevalence of hypertension is increasing due to many factors like rapid population growth, globalization, stress, and urbanization. We aimed to characterize the perceptions of cardiovascular disease (CVD) risk among individuals with hypertension living in Nigeria and identify barriers and facilitators to optimal hypertension management.

Methods: This cross-sectional survey study was conducted at a large teaching hospital in Lagos, Nigeria. We used a convenient sample of males and females, aged 18 or older, with a diagnosis of hypertension who presented for outpatient visits in the cardiology, nephrology, or family medicine clinics between November 1 and 30, 2020. A semiquantitative approach was utilized with a survey consisting of closed and open-ended questionnaires focused on patient knowledge, perceptions of CVD risk, and barriers and facilitators of behavioral modifications to reduce CVD risk.

Results: There were 256 subjects, and 62% were female. The mean age was 58.3 years (standard deviation (SD) = 12.6). The mean duration of the hypertension diagnosis was 10.1 years. Most participants were quite knowledgeable about hypertension; however, we observed some knowledge gaps, including a belief that too much "worrying or overthinking" was a major cause of hypertension and that an absence of symptoms indicated that hypertension was under control. Barriers to hypertension management include age, discomfort or pain, and lack of time as barriers to exercise. Tasteless meals and having to cook for multiple household members were barriers to decreasing salt intake. Cost and difficulty obtaining medications were barriers to medication adherence. Primary facilitators were family support or encouragement and incorporating lifestyle modifications into daily routines.

Conclusion: We identified knowledge gaps about hypertension and CVD among our study population. These gaps enable opportunities to develop targeted interventions by healthcare providers, healthcare systems, and local governments. Our findings also help in the promotion of community-based interventions that address barriers to hypertension control and promote community and family involvement in hypertension management in these settings.

Keywords: Cardiovascular Disease; Hypertension; Nigeria; Sub-Saharan Africa.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Cardiovascular Diseases* / epidemiology
Cardiovascular Diseases* / etiology
Cardiovascular Diseases* / prevention & control
Cross-Sectional Studies
Female
Humans
Hypertension* / drug therapy
Male
Middle Aged
Nigeria / epidemiology
Risk Reduction Behavior

Grants and funding

This study was funded by the UCLA David Geffen School of Medicine (DGSOM) Global Health Department as a part of the Global Short-Term Training Program (GSTTP).