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
4 affiliations
- 1Department of Health Information Management, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, India
- 2Department of Medicine, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, India
- 3Department of Health Informatics, MGM School of Biomedical Sciences, MGM Institute of Health Sciences (MGMIHS), Navi Mumbai, India
- 4Department of Psychology, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, India
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.
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BibTeX
@article{kamath2026exploring,
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}},
author = {Raksha Kamath and Weena Stanley and Partha Protim Hazarika and Shwetha Tumkur Shivakumar and Bhageerathy Reshmi},
journal = {PLOS One},
year = {2026},
month = oct,
doi = {10.1371/journal.pone.0359571},
url = {https://doi.org/10.1371/journal.pone.0359571},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - 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
AU - Raksha Kamath
AU - Weena Stanley
AU - Partha Protim Hazarika
AU - Shwetha Tumkur Shivakumar
AU - Bhageerathy Reshmi
PY - 2026
DA - 2026/10/27
JO - PLOS One
DO - 10.1371/journal.pone.0359571
UR - https://doi.org/10.1371/journal.pone.0359571
AB - 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.
SN - 1932-6203
ER -