(De)Constructing ‘Therapeutic Itineraries’ of Hypertension Care: A Qualitative Study in the Philippines

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 hyperten...

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Main Authors: Mendoza, Jhaki A., Lasco, Gideon, Renedo, Alicia, Palileo-Villanueva, Lia M, Seguin, Maureen L, Palafox, Benjamin, Amit, Arianna Maever L, Pepito, Veincent Christian F, McKee, Martin, Balabanova, Dina
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Published: Archīum Ateneo 2021
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Online Access:https://archium.ateneo.edu/dev-stud-faculty-pubs/80
https://archium.ateneo.edu/cgi/viewcontent.cgi?article=1084&context=dev-stud-faculty-pubs
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spelling ph-ateneo-arc.dev-stud-faculty-pubs-10842022-01-26T06:13:05Z (De)Constructing ‘Therapeutic Itineraries’ of Hypertension Care: A Qualitative Study in the Philippines Mendoza, Jhaki A. Lasco, Gideon Renedo, Alicia Palileo-Villanueva, Lia M Seguin, Maureen L Palafox, Benjamin Amit, Arianna Maever L Pepito, Veincent Christian F McKee, Martin Balabanova, Dina 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 participants who were diagnosed incidentally (ID) typically opted for self-care As we follow our participants' therapeutic itineraries, we explore the confluence of factors informing their care journey, namely, their conceptions of hypertension, their social relationships, as well the choices and trade-offs they make. We conclude with policy implications from our findings, chief of which is our proposition that models of care based on mere access and availability of clinical interventions fail to reflect the complexity of people's lay understanding and their lived experiences of hypertension and are thus ultimately unhelpful in improving its control. 2021-11-17T08:00:00Z text application/pdf https://archium.ateneo.edu/dev-stud-faculty-pubs/80 https://archium.ateneo.edu/cgi/viewcontent.cgi?article=1084&context=dev-stud-faculty-pubs Development Studies Faculty Publications Archīum Ateneo hypertension chronic disease patient pathways therapeutic itineraries people-centered care people centered health systems Philippines Cardiovascular Diseases Development Studies Rehabilitation and Therapy Therapeutics
institution Ateneo De Manila University
building Ateneo De Manila University Library
continent Asia
country Philippines
Philippines
content_provider Ateneo De Manila University Library
collection archium.Ateneo Institutional Repository
topic hypertension
chronic disease
patient pathways
therapeutic itineraries
people-centered care
people centered health systems
Philippines
Cardiovascular Diseases
Development Studies
Rehabilitation and Therapy
Therapeutics
spellingShingle hypertension
chronic disease
patient pathways
therapeutic itineraries
people-centered care
people centered health systems
Philippines
Cardiovascular Diseases
Development Studies
Rehabilitation and Therapy
Therapeutics
Mendoza, Jhaki A.
Lasco, Gideon
Renedo, Alicia
Palileo-Villanueva, Lia M
Seguin, Maureen L
Palafox, Benjamin
Amit, Arianna Maever L
Pepito, Veincent Christian F
McKee, Martin
Balabanova, Dina
(De)Constructing ‘Therapeutic Itineraries’ of Hypertension Care: A Qualitative Study in the Philippines
description 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 participants who were diagnosed incidentally (ID) typically opted for self-care As we follow our participants' therapeutic itineraries, we explore the confluence of factors informing their care journey, namely, their conceptions of hypertension, their social relationships, as well the choices and trade-offs they make. We conclude with policy implications from our findings, chief of which is our proposition that models of care based on mere access and availability of clinical interventions fail to reflect the complexity of people's lay understanding and their lived experiences of hypertension and are thus ultimately unhelpful in improving its control.
format text
author Mendoza, Jhaki A.
Lasco, Gideon
Renedo, Alicia
Palileo-Villanueva, Lia M
Seguin, Maureen L
Palafox, Benjamin
Amit, Arianna Maever L
Pepito, Veincent Christian F
McKee, Martin
Balabanova, Dina
author_facet Mendoza, Jhaki A.
Lasco, Gideon
Renedo, Alicia
Palileo-Villanueva, Lia M
Seguin, Maureen L
Palafox, Benjamin
Amit, Arianna Maever L
Pepito, Veincent Christian F
McKee, Martin
Balabanova, Dina
author_sort Mendoza, Jhaki A.
title (De)Constructing ‘Therapeutic Itineraries’ of Hypertension Care: A Qualitative Study in the Philippines
title_short (De)Constructing ‘Therapeutic Itineraries’ of Hypertension Care: A Qualitative Study in the Philippines
title_full (De)Constructing ‘Therapeutic Itineraries’ of Hypertension Care: A Qualitative Study in the Philippines
title_fullStr (De)Constructing ‘Therapeutic Itineraries’ of Hypertension Care: A Qualitative Study in the Philippines
title_full_unstemmed (De)Constructing ‘Therapeutic Itineraries’ of Hypertension Care: A Qualitative Study in the Philippines
title_sort (de)constructing ‘therapeutic itineraries’ of hypertension care: a qualitative study in the philippines
publisher Archīum Ateneo
publishDate 2021
url https://archium.ateneo.edu/dev-stud-faculty-pubs/80
https://archium.ateneo.edu/cgi/viewcontent.cgi?article=1084&context=dev-stud-faculty-pubs
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