Patient support groups: An innovative strategy in management of hypertension

May 16, 2023

The theme of the 2023 World Hypertension Day is “Measure Your Blood Pressure Accurately, Control It, Live Longer”. Untreated or poorly controlled hypertension can lead to serious complications such as heart disease, stroke, kidney damage, and vision loss. Control of blood pressure through lifestyle changes and medication is important to prevent these complications and maintain overall health. Low and middle-income countries bear two-thirds of the hypertension global burden yet they have the least resources to deal with the rising cases of hypertension. In Kenya, the prevalence of hypertension is 25% of the national disease burden. The health care system often faces challenges like shortage of health personnel and medication stock-outs impacting health outcomes. Due to the life-long nature of hypertension, effective self-management approaches are needed to prevent further complications.

Patient support groups are one of the innovative self-management approaches aimed at empowering patients for greater involvement in the management of their condition. It entails bringing together patients with the same medical conditions and equipping them with skills to manage their own conditions whereby they engage in activities to help better manage their conditions. Patient support groups provide a valuable platform for individuals to connect with others facing similar challenges, share experiences, and receive emotional support, which can help reduce feelings of isolation and improve mental well-being. Additionally, these groups often offer educational resources, expert advice, and strategies for managing hypertension, empowering patients to take an active role in their own health and make informed decisions. This was initially implemented among HIV-positive patients and has since been widely adopted for the management of other chronic diseases owing to its linkage to better health, social and psychological outcomes.

In 2021, the African Population and Health Research Center, in partnership with the Nairobi County Division of Non-Communicable Diseases and collaborators from the University of Cape Town, University Medical Centre Utrecht, University of Oxford and International Digital Health and AI collaborative (I-DAIR), launched the ‘Patient-led support groups in the management of hypertension and diabetes in Korogocho and Viwandani informal settlements, Nairobi, Kenya: mixed methods study of an innovative model (MRC PaLs)’ project. The two-year study seeks to generate evidence on the role of patient support groups in effectively controlling blood pressure and blood sugar among patients with hypertension or diabetes or both.

A patient care model was developed through consultative meetings with the NCD division at the Ministry of Health, interviews with patients and desk reviews. Patients were then screened and those with uncontrolled blood pressure and blood sugar were identified from facilities in the two slums. In December 2023, those selected were then put into groups based on the homogeneity of their conditions and were linked to a public health facility within the community. The groups then went through a process of electing their leaders and setting ground rules. The groups continue to run with members meeting once every month for group activities.

Participation in group activities offers benefits that include psycho-social support, health education and peer support. Healthcare providers meet with groups and provide guidance on risk factors, medication adherence, proper nutrition and self-measurement. Each group has been provided with a blood pressure machine and three registers for group attendance, measurement records and document activities that have been undertaken. Peers share their coping mechanisms and experiences in managing the condition. Knowledge-sharing improves management and adherence to medication while being part of a community with the same condition reduces self-stigma and motivates patients to adopt health-promoting lifestyle changes. Chronic diseases often lead to mental distress and the group counseling sessions offered may improve mental health outcomes.

The link between the patient and health-provider is strengthened due to the interactions during group meetings and availability of a web application. The application provides a platform where patient information, blood pressure measurements, appointments and disbursed medication are documented. Patients are able to access a dashboard and track their measurement records which are also relayed to the health provider. The application enables the health provider schedule appointments and sends constant reminders to the patients. In addition, there is a stock management feature that will enable groups keep track of their medication by the re-order level and expiry features. The feature will become functional once the groups accumulate enough funds to procure drugs. Already, the groups have initiated a monthly contribution of KES 200 (USD 1.5) with the aim of pooling finances to purchase medication.

Ultimately, the establishment of hypertension patient support groups is a promising initiative that will enable people to monitor their blood pressure correctly, control it and live longer by increasing awareness and addressing knowledge gaps in management of the condition.

This article was written by Lilian Mburu, a Research Officer at the African Population and Health Research Center.