Table 2 Explanatory model domains by actor type
Explanatory Model Domains | Patients and family members | Health providers and administrators | National-level health system stakeholders |
|---|---|---|---|
Etiology (causes of hypertension) | It’s inherited, comes from sadness, anger, and worry | It comes from old age, anger, worry, a sedentary life | Hypertension comes from consumption of unhealthy food or energetic causes |
Symptoms (description of sensations, feelings, and physical changes) | Causes pain in the body, headaches, nerves, weakness | Causes pressure in the chest, pain in the body, headaches | Patients don’t identify its symptoms, it’s silent. Symptoms from MoH Primary Health Care Guidelines (headache, blurry vision, dizziness, pressure in the chest, and ringing in the ear) |
Pathophysiology (physiological mechanisms and their measurability) | Caused by salt intake, stress, is inherited, co-occurs with diabetes | High blood pressure is hard to identify and treat using standard parameters (≥ 140/90 mmHg)a; some patients feel normal with high blood pressure | Identification derives from what the MoH Primary Health Care Guidelines identify as hypertension |
Course of illness (kind of disease –chronic or otherwise–, temporality, severity) | Because of its chronic quality, it needs daily attention, but it is hard to comply with recommendations (diet, medication, exercise) | When patients feel better, they stop the treatment or forget to take it. Patients think that having hypertension is normal | Patients take medicines but don’t follow lifestyle recommendations. They think having hypertension is normal. Patients don’t have enough information about hypertension |
Treatment (medical and traditional, habits and behaviors that improve the patients’ condition) | Taking hypertensive medicine is worrisome because of its long-term consequences and secondary effects (such as vomiting). Patients use natural medicine, store-bought, pharmacy, and health post medication when available. Being calm is a way to feel better | Patients self-diagnose and take natural medicines. When available, patients take medicines given at health posts | According to MOH Primary Health Care Guidelines, hypertension should be treated at the primary health care level, but there is no regular medication availability, not enough trained staff, and no medical tools to detect it and treat it properly |