(De)constructing ‘therapeutic itineraries’ of hypertension care: A qualitative study in the Philippines

作者：Jhaki Mendoza, Gideon Lasco, Alicia Renedo, Lia M. Palileo‐Villanueva, Maureen Seguin, Benjamin Palafox, Arianna Maever L. Amit, Veincent Christian Filipino Pepito, Martin McKee, Dina Balabanova · 发表于：Social Science & Medicine · 年份：2021 · DOI：10.1016/j.socscimed.2021.114570 · 被引用次数：36 · 研究领域：Blood Pressure and Hypertension Studies、Global Public Health Policies and Epidemiology

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 participant...