Perceptions of Self-Care, Treatment Burden, and Quality of Life Among Adults With Uncontrolled Hypertension: A Grounded Theory Study
Keywords:
Uncontrolled hypertension, Self-care, Treatment burden, Quality of life, Grounded theory, Medication adherence, Chronic disease managementAbstract
Objective: This study aimed to develop a grounded theory explaining how adults with uncontrolled hypertension perceive and negotiate self-care, treatment burden, and quality of life.
Methods and Materials: This qualitative study was conducted using a grounded theory design among 34 adults with uncontrolled hypertension in Ontario, Canada. Participants were recruited from primary health care clinics, community health centers, and outpatient cardiovascular services through purposive and theoretical sampling. Eligibility criteria included being 30 years of age or older, having a diagnosis of hypertension for at least one year, and having uncontrolled blood pressure based on recent clinical records. Data were collected through semi-structured individual interviews, demographic and clinical information forms, and researcher field notes. Interviews were audio-recorded, transcribed verbatim, and analyzed concurrently with data collection using constant comparative analysis, including initial coding, focused coding, axial coding, and theoretical integration. Recruitment continued until theoretical saturation was achieved.
Findings: The analysis generated one core category, “negotiating control under cumulative treatment burden,” and five main categories: living with an invisible but threatening condition, translating medical advice into daily self-care, carrying the burden of treatment, quality of life under pressure, and reconstructing control through practical adaptation. The findings indicated that participants experienced uncontrolled hypertension as a condition marked by uncertainty, emotional strain, and repeated self-care demands. Treatment burden emerged through the accumulation of medication routines, lifestyle restrictions, home monitoring, appointments, costs, information management, and relational pressures. Participants’ quality of life was affected by worry, guilt, reduced confidence, social restriction, and diminished spontaneity. However, participants also developed adaptive strategies, including selective adherence, family-supported routines, trigger recognition, and realistic self-care prioritization.
Conclusion: Adults with uncontrolled hypertension experience self-care as a continuous negotiation between clinical expectations and everyday capacity. Hypertension care should therefore address treatment burden, emotional distress, feasibility of self-care behaviors, and quality of life alongside blood pressure control.
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