Patients' Attitudes and Approaches to the Self-Management of Hypertension: Perspectives from an Australian Qualitative Study in Community Pharmacy.
BACKGROUND
In the management of hypertension, blood pressure (BP) monitoring and medication use are key strategies, but they are dependent on patients' motivation to practice self-care.


OBJECTIVE
To gauge patients' approaches to monitoring their blood pressure, as well as explore their attitudes toward, and actions relating to, high blood pressure readings, as the key components of their self-management of hypertension.


METHODS
This qualitative study, comprising individual telephone interviews, involved patients attending community pharmacies in Sydney (Australia). Patients' perspectives were elicited using a purpose-designed, semi-structured interview guide. The verbal responses were audio-recorded, transcribed verbatim, and thematically analysed.


RESULTS
Three key themes arose: (1) approaches to monitoring blood pressure, (2) attitudes to variability in BP, (3) responses to high BP readings. Many patients self-regulated the frequency of monitoring based on perceived need and/or opportunity. Most were indifferent toward their readings, regarding BP fluctuations as 'normal'. When a high BP was detected, the action taken was highly variable, with no clear action plans in place. Several patients recognised a high BP to be a consequence of not taking their antihypertensive medication, triggering the resumption of short-term adherence to their preferred management strategy, i.e., self-medication with antihypertensives (i.e., restarting their medication) and/or self-management via lifestyle strategies.


CONCLUSIONS
This study highlights patients' inappropriate self-management of hypertension. Misperceptions about hypertension, e.g., accepting BP fluctuations as normal, can produce indifferent attitudes as well as influence patients' self-management actions. This lack of insight undermines long-term adherence to antihypertensive therapy.
Graduate School of Health-Pharmacy, CB01.13.31, The University of Technology Sydney, Broadway, NSW, 2007, Australia. beata.bajorek@uts.edu.au.
Beata
B
Bajorek
Woolcock Institute of Medical Research, University of Sydney, 431 Glebe Point Road, Glebe, NSW, 2037, Australia.
Kate
K
Lemay
Discipline of General Practice, University of Newcastle, Newbolds Building, University Drive, Callaghan, NSW, 2308, Australia.
Parker
P
Magin
Sydney Medical School-Northern, Hornsby Ku-ring-Gai Hospital, Palmerston Road, Hornsby, NSW, 2077, Australia.
Christopher
C
Roberts
Faculty of Pharmacy, University of Sydney, Building A15 Science Road, Camperdown, NSW, 2006, Australia.
Ines
I
Krass
Woolcock Institute of Medical Research, University of Sydney, 431 Glebe Point Road, Glebe, NSW, 2037, Australia.|Sydney Local Health District, Glebe, Australia.
Carol
C
Armour
D000368:Aged; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D001794:Blood Pressure / Q000187:drug effects*; D018660:Blood Pressure Monitoring, Ambulatory; D003157:Community Pharmacy Services; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D006973:Hypertension / Q000175:diagnosis / Q000188:drug therapy* / Q000503:physiopathology / Q000523:psychology; D007407:Interviews as Topic; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D009517:New South Wales; D010465:Perception; D011237:Predictive Value of Tests; D036301:Qualitative Research; D012648:Self Care / Q000379:methods*; D013997:Time Factors; D016896:Treatment Outcome
D000959:Antihypertensive Agents
Blood pressure monitoring, ambulatory; Hypertension; Medication adherence; Qualitative research; Self-management