Globally, hypertension causes 10.8 million deaths annually. However, in Kenya, like in other low-and middle-income countries, access to hypertension care remains limited and inequitable. Understanding patients’ journeys in accessing care along the care cascade is critical to inform patient-centred care and policy improvements. This evidence is limited in Kenya. This study aimed to explore patient journeys in accessing hypertension care in rural Coastal Kenya―a setting with a high hypertension burden. We conducted a qualitative cross-sectional study and collected data using in-depth interviews (n=24) and focus group discussions (n=5) with hypertension patients and their adult family caregivers in two purposively selected sub-counties in Kilifi County. We conducted and transcribed the interviews in Kiswahili and Giriama (local languages) and translated them into English. We used QSR NVivo 12 for data management. We analysed the data using a framework approach and interpreted our findings using Levesque’s access framework. Access to hypertension screening and diagnosis services was undermined by information barriers which led to inadequate awareness and lack of knowledge about hypertension and its causes. There were perceptions of inadequate health facility capacity to offer hypertension screening services, particularly to ‘healthy’ individuals thus presenting as a barrier to demand for screening services. Acceptability of care was undermined by inadequate patient counselling at diagnosis and perceived disrespectful treatment of patients. Access to treatment and diagnostic tests was undermined by unaffordable care, limited availability of medicines and equipment, long waiting times, and inaccessible health facilities. Having health insurance enabled access to care, but most participants did not have a cover. Participants adapted to these access barriers by reducing/skipping daily medication doses, resorting to alternative forms of care (e.g., herbal treatments and faith healing), and changing health facilities for routine clinic appointments. Access to care for older patients and those with complications was enabled by family caregivers who coordinated and navigated the health system on their behalf. People living with hypertension experience a combination of interacting individual, community, and health system-related barriers to accessing care. There is a need to systematically address identified barriers and ensure patient-centred responses that meet patients’ needs. Strengthening the health system’s capacity to ensure availability and affordability of treatment and diagnosis services, creation of community hypertension awareness, adequate patient counselling at screening and diagnosis, and involvement of family caregivers for elderly patients are examples of urgent interventions to improve access to hypertension care.

The authors have declared no competing interest.

This project is funded by the National Institute for Health and Care Research (NIHR) under its ‘Global Health Research Units and Groups Programme’ (Grant Reference Number NIHR134544). The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained.

Yes

The details of the IRB/oversight body that provided approval or exemption for the research described are given below:

Ethical approval was obtained from the KEMRI Scientific and Ethics Review Unit (Reference No. 4631), the Lonon School of Hygiene and Tropical Medicine Ethics Committee (Reference No. 28313), and the National Committee for Science and Technology (Reference No. NACOSTI/P/23/24745). Before initiating the study procedures, we also obtained permission from the County Director of Health, sub-county health management teams, and the respective facility managers of sampled health facilities. All the participants provided written informed consent as well as their demographic data for descriptive analysis.

I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals.

Yes

I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance).

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I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable.

Yes

The data presented in this study are available upon reasonable request from the corresponding author through the email dgc@kemri-wellcome.org. Public deposition of the transcripts would breach compliance with the approved protocol. During ethical approval, the transcripts were stated would be available publicly upon reasonable request through KEMRI-Wellcome Trust’s data governance committee through the email dgc@kemri-wellcome.org. This was because at the time of data collection, it was deemed a sensitive topic, it was paramount not to compromise patient privacy, and allow free participation among the respondents. We are therefore kindly requesting for this exemption.