title: A qualitative study on hypertensive care behavior in primary health care settings in Malaysia.
abstract: OBJECTIVE
  The aim of this study was to explore patients' experiences with their illnesses and the reasons which influenced them in not following hypertensive care recommendations (antihypertensive medication intake, physical activity, and diet changes) in primary health clinic settings.
  
  
  METHODS
  A qualitative methodology was applied. The data were gathered from in-depth interviews with 25 hypertensive patients attending follow-up in nine government primary health clinics in two districts (Hulu Langat and Klang) in the state of Selangor, Malaysia. The transcribed data were analyzed using thematic analysis.
  
  
  RESULTS
  There was evidence of lack of patient self-empowerment and community support in Malaysian society. Most of the participants did not take their antihypertensive medication or change their physical activity and diet after diagnosis. There was an agreement between the patients and the health care professionals before starting the treatment recommendation, but there lacked further counseling and monitoring. Most of the reasons given for not taking antihypertensive medication, not doing physical activity and not following diet recommendations were due to side effects or fear of the side effects of antihypertensive medication, patients' attitudes, lack of information from health care professionals and insufficient social support from their surrounding environment. We also observed the differences on these reasons for nonadherence among the three ethnic groups.
  
  
  CONCLUSIONS
  Health care professionals should move toward supporting adherence in the management of hypertensive patients by maintaining a dialogue. Patients need to be given time to enable them to overcome their inhibition of asking questions and to accept the recommendations. A self-management approach must be responsive to the needs of individuals, ethnicities, and communities.
authors.affiliation: Department of Social and Preventive Medicine, University of Malaya, Kuala Lumpur, Malaysia ; Ministry of Health Malaysia, Putrajaya, Malaysia.
authors.forename: Razatul
authors.initials: R
authors.lastname: Shima
authors.affiliation: Department of Social and Preventive Medicine, University of Malaya, Kuala Lumpur, Malaysia ; Centre for Population Health, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
authors.forename: Mohd Hairi
authors.initials: MH
authors.lastname: Farizah
authors.affiliation: Department of Social and Preventive Medicine, University of Malaya, Kuala Lumpur, Malaysia ; Centre for Population Health, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
authors.forename: Hazreen Abdul
authors.initials: HA
authors.lastname: Majid
keywords: adherence; hypertension; in-depth interview; qualitative research