Hypertension Beyond the Clinic: Patient Perspectives on Self-Management in a Resource-Limited Urban Setting

BackgroundUncontrolled hypertension remains a major contributor to morbidity and mortality in low- and middle-income countries (LMICs), particularly in Sub-Saharan Africa. While progress has been made in the diagnosis and detection of hypertension in Tanzania, effective long-term management continues to be hindered by challenges in patient self-management. Given that hypertension control largely depends on patients daily practices and adherence to lifestyle and treatment recommendations, understanding their experiences is essential. This study aimed to explore the lived experiences and perspectives of hypertensive patients regarding self-management practices in selected referral hospitals in Dar es Salaam, Tanzania. MethodsThis hospital-based qualitative study explored patients strategies and challenges related to hypertension self-management in selected regional referral hospitals in Dar es Salaam, Tanzania. Eleven participants with a diagnosis of hypertension for at least two years were purposively recruited from three facilities--Mwananyamala (n=5), Amana (n=3), and Temeke (n=3). Data were collected through in-depth, face-to-face interviews conducted in Swahili using a semi-structured guide. Interviews were audio-recorded, transcribed verbatim, and translated into English. Thematic analysis was conducted using an iterative process to identify emerging patterns and key themes. Ethical approval was obtained from the relevant institutional review board, and all participants provided written informed consent. ResultsThematic analysis identified three main themes related to hypertension self-management: (1) Barriers to self-management, including limited knowledge, financial constraints, and lack of supportive systems; (2) Strategies to support self-management, such as family support, accessing nearby facilities for blood pressure monitoring, homegrown solutions for healthy eating, utilizing available spaces for physical activity, and seeking health information from providers or informal sources; and (3) Experiences with healthcare access, involving patient-provider relationships, transportation challenges, and prolonged waiting times. These findings highlight the complex interplay between individual agency, family dynamics, healthcare systems, and socioeconomic factors in shaping hypertension self-management practices. ConclusionThis study highlights the importance of context-specific, patient-informed approaches to strengthen hypertension self-management in resource-constrained urban settings. The insights gained point to the need for integrated interventions that go beyond clinical care-- addressing educational, social, and structural factors that shape patients daily management efforts. Empowering patients through tailored support systems and improving health service delivery are critical steps toward more effective and sustainable hypertension control.