(De)constructing 'therapeutic itineraries' of hypertension care

A qualitative study in the Philippines

Bibliographic Data

ID4767908
AuthorsJ Mendoza (0000-0002-8063-290X, University of the Philippines Manila, corresponding author), Jhaki A Mendoza, G Lasco (0000-0002-6402-682X, University of the Philippines Diliman), Alicia Renedo (0000-0001-7159-1723, London School of Hygiene & Tropical Medicine), Lia M Palileo-Villanueva (0000-0002-4635-140X, University of the Philippines Manila), Lia Palileo-Villanueva, Margaret Seguin (0000-0003-4786-9400, London School of Hygiene & Tropical Medicine), Maureen Seguin, Benjamin Palafox (0000-0003-3775-4415, London School of Hygiene & Tropical Medicine), Arianna Maever L Amit (0000-0003-4571-400X, Ateneo de Manila University), Veincent Christian Filipino Pepito (0000-0001-5391-3784, Ateneo de Manila University), Veincent Pepito, Martin Mckee (0000-0002-0121-9683, London School of Hygiene & Tropical Medicine), Dina Balabanova (0000-0001-7163-3428, London School of Hygiene & Tropical Medicine)
Year2022
Volume300
Pages114570
Publication date2022-05-01
Peer ReviewedYes
Open AccessYes
TypeARTICLE
VenueSocial Science & Medicine (JOURNAL)
Journal identifiersISSN: 0277-9536 • E-ISSN: 1873-5347
PublisherElsevier BV (PUBLISHER)
DOI10.1016/j.socscimed.2021.114570
PMID34802782
OpenAlexW3213191166
LanguageEN
Citations received17
References cited45

Hypertension, a major risk factor for non-communicable diseases, remains poorly controlled in many countries. In the Philippines, it is still one of the leading causes of preventable deaths despite the accessibility and availability of essential technologies and medicine to detect and treat hypertension. This paper characterizes the 'therapeutic itineraries' of people with hypertension from poor communities in rural and urban settings in the Philippines. We employ longitudinal qualitative methodology comprised of repeat interviews and digital diaries using mobile phones from 40 recruited participants in 12 months. Our findings demonstrate that therapeutic itineraries, rather than being organized according to categories that stem from the structure of the health system (i.e., diagnosis, treatment, follow-up, adherence), diverge from clinical pathways. Therapeutic itineraries begin at a stage we label as 'pre-diagnosis' (PD). Following this, itineraries diverge according to two possible entry points into the healthcare system: via incidental diagnosis (ID) whereby participants were diagnosed with hypertension without deliberately seeking care for hypertension-related symptoms and symptom-driven diagnosis (SD) whereby their diagnosis was obtained during a clinical encounter specifically prompted by hypertension-related symptoms. Participants whose itineraries follow the SD route typically oscillated between periods of regular and intermittent medical treatment, while participants who were diagnosed incidentally (ID) typically opted for self-care As we follow our participants' therapeutic itineraries, we explore the confluence of factors informing their care journey, namely, their conceptions of hypertension, their social relationships, as well the choices and trade-offs they make. We conclude with policy implications from our findings, chief of which is our proposition that models of care based on mere access and availability of clinical interventions fail to reflect the complexity of people's lay understanding and their lived experiences of hypertension and are thus ultimately unhelpful in improving its control

Economic growth · Family medicine · Health care · Qualitative research · Sociology · Blood Pressure and Hypertension Studies · Global Public Health Policies and Epidemiology · Medicine

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