{
  "abstract": "Background: Hypertension requires lifelong treatment and regular follow-up to prevent complications; however, lost to follow-up (LTFU) remains a major challenge in long-term hypertension care, particularly in resource-constrained settings. Objective: This study explored patient perspectives on barriers contributing to LTFU in hypertension management. Methods: A qualitative study was conducted among 32 hypertensive patients who were LTFU at a tertiary care hospital in Coastal Karnataka, India. Participants were aged 31–69years, with 21 (65.6%) men and 11 (34.4%) women. Participants were identified through hospital records and interviewed using a semi-structured interview guide. Interviews were conducted from February to April 2026 Interviews were audio-recorded, transcribed verbatim, and analysed thematically following COREQ guidelines. Results: Six major themes emerged.: (1) illness perception and self-management practices, (2) care-seeking and follow-up behaviour, (3) structural and socioeconomic barriers, (4) health system and continuity gaps, (5) patient-perceived strategies to improve continuity of care, and (6) health information continuity and interoperability needs. Participants described symptom-driven healthcare seeking, medication non-adherence, occupational responsibilities, and competing family priorities contributing to irregular follow-up. Financial burden, including treatment costs, transportation expenses, and wage loss, substantially affected continuity of care. Long travel distances, dependence on family members, overcrowding, rushed consultations, and inadequate follow-up mechanisms further influenced disengagement from care. Participants also reported fragmented healthcare utilisation, repeated investigations, dependence on paper-based records, and poor continuity of medical information across healthcare facilities. Several participants perceived that integrated digital health information systems, decentralised services, appointment reminders, and improved counselling could strengthen long-term hypertension follow-up. Conclusions: LTFU in hypertension care is influenced by interconnected individual, socioeconomic, and health system-related barriers. A notable finding was the fragmented nature of continuity of care and poor health information continuity across healthcare facilities. Strengthening patient-centred follow-up systems, decentralised chronic disease services, financial protection mechanisms, and interoperable health information systems may improve continuity of hypertension care and reduce long-term disengagement from chronic disease management.",
  "abstract_shown": true,
  "affiliations": [
    "Department of Health Information Management, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, India",
    "Department of Medicine, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, India",
    "Department of Health Informatics, MGM School of Biomedical Sciences, MGM Institute of Health Sciences (MGMIHS), Navi Mumbai, India",
    "Department of Psychology, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, India"
  ],
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  "author_total": 5,
  "authors": [
    {
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        0
      ],
      "name": "Raksha Kamath"
    },
    {
      "affs": [
        1
      ],
      "name": "Weena Stanley"
    },
    {
      "affs": [
        2
      ],
      "name": "Partha Protim Hazarika"
    },
    {
      "affs": [
        3
      ],
      "name": "Shwetha Tumkur Shivakumar"
    },
    {
      "affs": [
        0
      ],
      "name": "Bhageerathy Reshmi",
      "orcid": "0000-0001-9631-6218"
    }
  ],
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  "doi": "10.1371/journal.pone.0359571",
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  "language": "en",
  "licence": "CC-BY-4.0",
  "licence_label": "CC BY 4.0",
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  "native_subjects": [
    [
      "heading",
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  "published": "2026-10-27",
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  "title": "Exploring patient perspectives on barriers contributing to lost to follow-up in hypertension care: A qualitative study in a tertiary-care hospital in Coastal Karnataka, India",
  "title_text": "Exploring patient perspectives on barriers contributing to lost to follow-up in hypertension care: A qualitative study in a tertiary-care hospital in Coastal Karnataka, India",
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