Lived Experience of People With Hypertension in Ethiopia: A Phenomenological Study, 2025

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Significant knowledge gaps remain about how patients experience and manage the condition within their social, cultural, and economical context. Therefore, this study aimed to asses lived experience of patients with hypertension in Ethiopia using qualitative approach. The study might contribute to address the existing gaps in managements and controlling of hypertension, and support sustainable, equitable, and patient centered hypertensive patient care in Ethiopia. This study aimed to asses lived experience of patients with hypertension in Ethiopia using qualitative phenomenological study using socioecological model, July, 2025 Methods Data was collected from participants who are lived experience with HTN in north west Amhara tertiary hospitals, Ethiopia in July, 2025. Participants were recruited using purposive sampling. The study was used heterogeneous sampling technique to recruit study participants, which included all age groups above 18 years old and both male and female living with HTN were incorporated. Data was collected using the local language (Amharic) so that translated in to English for coding and analysis. Data was imported and analyzed using the ATLAS Ti, v. 7 software following standardized transcription. A thematic analysis was used to analyze the data. To possess the rigor and trustworthiness of the study, credibility, dependability, confirmability, and transferability were considered. Results The eight themes that emerged from the analysis are (1) Emotional and cognitive response to diagnosis with two sub-themes comprises existing initial reaction and patient understanding of hypertension (HTN); (2) health provider interaction and communication with a sub-theme includes health care support and information. (3) adaptation and self-management with three subthemes comprehending lifestyle changes and medication use, (4) treatment challenges and complications, which include medication side effects, access to medication, and adherence to treatment, (5) social and family support, which contains two themes, including family, friends, and social encouragement and assistance, (6) Impact on daily life comprises two, which include daily activities (work) and functioning and social life. (7) Perception and perception of control through two themes that encompass belief in treatment efficacy and disease understanding (8) health care system and access barriers through three themes, which include transportation barriers, long waiting times, and quality of health services. Conclusion This study implied tailored patient education, strength, provider communication, and community engagement are essential for improving adherence and health outcome. Majority of the participates stated they had varied emotional and physical reaction up on being realization of their hypertension. Most of them accepted the condition coolly. Prior experience of knowledge about hypertension through family history, media significantly affect their initial emotional reaction to the diagnosis. Interaction with health providers mainly influenced patients’ understanding of their illness condition. The most important theme got from participants’ experience was how they adapted to living with hypertension. Those include, lifestyle changes, adherence to dietary restriction and treatment. The majority of participants reported that hypertension had minimal impact on their daily life, activities and social life. Some participants identified substantial health system challenges that complicated their hypertension management for instance, transportation, medication unavailability’s, and longtime waiting. Lived experience Hypertension Phenomenological Study Ethiopia Figures Figure 1 INTRODUCTION The increased burden of chronic disease (CD) such as hypertension causes significant global health and economic challenges especially, among low and middle-income countries (LMICs). Recently, hypertension is elevation of blood pressure > 139/89 mmHg and it doesn’t have clear symptom initially, called silent killer. It is the main causes of cardiovascular disease, stroke, kidney failure, and premature death [ 1 , 2 ]. Globally, the prevalence of hypertension has increased over recent years, Globally, the prevalence of hypertension has increased dramatically over recent decades, triggered by urbanization, change in dietary habit, aging population, and sedentary lifestyle [ 3 ]. Effective and efficient management of HTN requires timely diagnosis, lifelong medication adherence, lifestyle modifications and consistence engagement in health care system. Nevertheless, those demand present considerable challenges in LMICs, as poor health care infrastructure and limited resources [ 4 ]. In Ethiopia, hypertension is found to be a major public health problem, with national surveys indicating increasing prevalence rates in both urban and rural populations [ 5 ]. Despite these challenges, hypertension remain undiagnosed, untreated, and poorly controlled, leading to substantial mortality and morbidity. Factors such as limited health care access, shortage trained professionals, financial barriers, and geographical challenges hider effective hypertension (HTN) management in several regions of the country [ 6 ]. Additionally, culture beliefs, traditional healing practice, health literacy levels and social stigma influence individual perceptions of HTN and their willingness to engage in biomedical care [ 7 ]. Although substantial studies in Ethiopia have focused on the epidemiology, risk factors, and treatment gap of HTN, there is a lack in qualitative survey of patients lived experiences in hypertension. Quantitative data provide essential prevalence figures and risk estimates, but fail to capture personal, cultural, social, and emotional data about chronic disease such as HTN [ 8 , 9 ]. Particularly, there are limited understanding of how patients interpret and respond to symptoms of their HTN [ 10 ]. They faced psychological challenges, and fail the strategies used to manage chronic illness with in their daily life. Patients’ belief about cause, treatment effectiveness, and prognosis, significantly affects medication adherence and their engagement with health care professionals in health care setting, this affects overall quality of patient life [ 11 , 12 ]. Additionally, the burden of hypertension in Ethiopia intersects with broader social determinants of health, including poverty, gender dynamics, family responsibilities, and community norms. For many individuals, the cost of medication, transportation to health institutions, and time away from work or family obligations pose a major barrier to consistent care [ 13 ]. The lifelong nature of HTN usually brings the patient for feeling of anxiety, uncertain, and fear about future complications, which may remain hidden or unaddressed health care challenges [ 14 ]. Without clear understanding of these lived realistic intervention risk poorly tailored to patients’ needs, potentially leading to poor adherence engage in modern health care and early treatment initiations. This condition leads to in effective treatment outcome, high existence of complications, and continue high rate of HTN [ 12 , 15 ]. Thus, infers the urgent need to generate qualitative evidence exploring the lived experience of people with HTN in Ethiopia. A phenomenological approach provides a deep investigation of how people perceive, make sense, and cope with their illness. The evidence obtained from such a study will provide clinical guidance for health care providers, police makers, and program designers seeking to build culturally sensitive, patient centered approach to hypertension care. By enlightening patients’ voices, this research aims to contribute to more effective strategies for hypertension control, ultimately expand health outcomes and minimize burden of cardiovascular disease in Ethiopia. In general, while hypertension present substantial and increasing challenge in Ethiopia. Significant knowledge gaps remain about how patients experience and manage the condition within their social, cultural, and economical context. Therefore, this study aimed to asses lived experience of patients with HTN in north west Amhara tertiary hospitals, Ethiopia, 2025. The study might contribute to address the existing gaps in managements and controlling of HTN, and support sustainable, equitable, and patient centered hypertensive patient care in Ethiopia. METHODS AND MATERIALS The study was conducted using phenomenological qualitative approach. Data was collected from participants who are lived experience with HTN in north west Amhara tertiary hospitals, Ethiopia in July, 2025. Participants were recruited using purposive sampling which is a quite common sampling technique for qualitative studies. The study was used heterogeneous sampling technique to recruit study participants, which included all age groups above 18 years old and both male and female living with HTN were incorporated. Data was collected using the local language (Amharic) in a private space by four trained and experienced fieldworkers, who were probe responses to explore the views and reasoning of the participants. Data collection Semi structured interview guide was used as a tool for in depth interview (IDI), and focused group discussions FGD. All IDI and FGDs were tape-recorded with the consent of participants and at the saturation level. Extensive field notes were taken to capture key points and the overall process of the data collection process. The interviewers were developing a rapport with participants at the beginning of interviews to create an environment where respondents feel encouraged and relaxed to discuss freely. Training was given for five days before data collection for data collectors and supervisors on overall process of the study. Four trained nurses and two supervisors were involved in data collection process in one month period. Rigor and trustworthiness of the study The rigor and trustworthiness of the study was maintained based on Lincoln and Guba’s criteria of credibility, dependability, confirmability, and transferability. Credibility was assured by keeping the consistency of procedures and the neutrality of the investigator about findings or decisions. Peer debriefing was performed to cross-check the processes, evaluate the findings, and get feedback. Transferability was achieved by describing the study setting, sample, and data collection procedure clearly and using qualitative experts for peer debriefing. Dependability was attained through accurate documentation by including all documents in the final report such as including the notes that were written during the interview and ensuring that the details of the procedures were described to allow the readers to see the basis upon which conclusions were made. Confirmability of the study was ensured by the recording of every activity of the participants during the time of the interview. In addition, the audio-taped interviews were not destroyed which can enable others to track the process. Moreover, peer debriefing was conducted before synthesizing the final outputs. Data analysis The preliminary analysis was initiated alongside the data collection. Before the actual analysis, the data collected in a digital recorder was transcribed word by word with participant language (Amharic) and translated into English, and double checked for its consistency. Data was imported and analyzed using the ATLAS Ti, v. 7 software following standardized transcription. A thematic analysis was used to analyze the data. The data was transcribed, translated, coded and categorized. After coding the first couple of interviews, the team of researchers was coming together to discuss the appropriateness and meaning of the codes. Further interviews were coded accordingly. Individual codes were assigned into categories and individual categories was linked to themes that were developed based on the assessment objectives and emerging issues. The assessment report was following the final themes developed. The results were synthesized to inform the lived experience of people with HTN. RESULTS Sociodemographic characteristics of study participants A total of four IDI, and three FGD (8 participants in each FGD) were conducted. Of the 28 participants 18 of them were male. Their occupational status ranged from retirement to actively working, most of them in self-employ. The participant educational level showed first degree to no formal education (Table 1 ). Table 1 Characteristics of FGD and IDI Participants (N = 28) Characteristics Category Frequency (%) Age 36–65 22 (79%) > 65 6 (21%) Sex Male 18 (64%) Female 10(36%) Marital Status Married 23(82%) Single 2 (7%) Divorced 1 (4%) Widowed 2 (7%) Religion Orthodox 23(82%) Muslim 4 (14%) Protestant 1 (4%) Education Status No formal education 10 (42%) Primary-Secondary (1–12) 11 (39%) Diploma 3 (10.7%) Degree 4 (14%) Occupation Farmer 6 (21.4%) Housewife 6 (21.4%) Merchant 5(18%) Government employ 6 (21.4%) Others 5 (18%) Years with HTN ≤ 5 years 12 (43%) 6–10 years 12(43%) > 10 years 4 (14%) Family History of HTN Yes 10 (36%) No 18 (64%) Note: FGD; Focused group discussion, IDI; In-depth interview Lived experience of people with hypertension Themes and sub-themes are used to present and organize the conclusions that resulted from the IDI and FGD. Data analysis has revealed eight themes that express (1) emotional and cognitive response, comprising existing initial reaction to their diagnosis and patient understanding of their hypertension (HTN), (2) Health provider interaction and communication include health care support and information, (3) adaptation and self-management comprehending lifestyle changes and medication use, (4) treatment challenges and complications, which include medication side effects, access to medication, and adherence to treatment, (5) social and family support, which contains encouragement and assistance, (6) Impact on daily life comprises daily activities (work) and functioning and social life. (7) perception and perception of control through belief in treatment efficacy and disease understanding, (8) health care system and access barriers through transportation barriers, long waiting times, and quality of health services (Fig. 1 ). Theme 1: Emotional and cognitive response to diagnosis Most participants expressed a range of emotional reactions upon realized their hypertension by health care providers. They feel fear, shock so that accept their illness once after understanding of the characteristic, diagnosis and management of the disease. These cognitive and emotional response were formed by their prior knowledge, literacy level, family history, believe and support from their family and communities. How participants initially processed their diagnosis played important role in determining their later involvement with treatment and self-management. Sub theme 1: Initial reaction The study participants experienced diverse initial reactions upon diagnosis of hypertension, ranging from shock and fear to calm acceptance. Many participants described feeling frightened, hopeless, or anxiety, especially when first challenged with unfamiliar medical terms or physical symptoms like headaches or dizziness. However, prior knowhow from family history of illness, community awareness, or media minimize fear for some individual that facilitate quick emotional adjustment. Whereas individual with no family history of hypertension, no prior knowledge has been more depressed and fear while realizing their illness. The first movement of diagnosis became defining memory for many, influencing attitudes towards treatment and self-care. Generally, initial reactions represented a blend of emotional confusion and subsequent psychological accommodation, formed profoundly via prior knowledge, literacy level and experience with chronic illness. “Before I had HTN, I didn’t know what hypertension meant… Therefore, I felt hopeless when the doctor told me.” (IDI, 64 years old male respondent (R1) “When I realized I had hypertension… I was scared and under some stressful conditions. However, I had previously known about the illness from my mother and older sister, so I calmed down subsequently.” (FGD1, 75 years old male respondent (R1)) Subtheme 2: Understanding Understanding of HTN varied significantly among patients, which influenced by level education, family history of the same illness, age, and accessibility of health information through media and communities. Some patients expressed basic knowledge of hypertension, its genetic factors, and importance of medication adherence and lifestyle changes. Others, especially those who were illiterate, elderly, faced challenges to easily understanding of their illness, and relay primarily on their health care providers verbal explanations. Even among the educated, confusion existed regarding chronicity and lifelong treatment requirements. This difference in understanding shaped treatment adherence and confidence in disease management. Generally, knowledge gaps highlighted the need for tailored, accessible health education to improve patients’ comprehension and involvement. “My educational status did not affect my understanding of my illness. I already knew enough about hypertension before I had it.” (FGD1, 58 years old male respondent (R5)) “Yes, I still don’t know enough about HTN because I can’t read or write. I feel that my occupation and educational status might have affected my knowledge.” (FGD1, 57 years old male respondent (R4)) Theme 2: Health provider interaction and communication Interaction with health providers mainly influenced patients’ understanding of their illness condition and confidence in managing hypertension. Most patients esteemed clear, patient explanation and support from health care providers, while others experienced gaps in communications, causes to misperception and frustration. These interactions were essential in shaping trust, treatment adherence, and patient engagement in managing their illness. Subtheme 1 : Health care support and information Most participants emphasized the critical role of health care professionals in explaining their illness condition and treatment. Most participants expressed, adequate, brief and genuine information from the health care professionals minimize fear, anxiety, and increased patient confidence and hopefulness. Many admired physicians and nurses for full clarifications about the risks of untreated hypertension and the benefit of medication and lifestyle changes. On the other hand, some participants described displeasure when provider didn’t provide adequate information about their questions and illness condition. Good health care provider-patient interaction was associated with trust, better treatment adherence, sense of wellbeing, security, and confidence in managing hypertension. Overall, effective communication and support from health providers proved essential for strengthen patients controlling their hypertension. “The doctor who was treating me had explained to me thoroughly about the illness and the problems it would cause if I didn’t control my blood pressure.” (IDI, 38 years old female respondent (R3)) “I come from across the Nile for treatment… After I get here, health professionals do not respond well to my questions.” (IDI, 38 years old female respondent (R3)) Theme 3: Adaptation and self-management The most important theme got from participants’ experience was how they adapted to living with hypertension. Those include, lifestyle changes, adherence to dietary restriction and treatment. Although some participants described straggle with dietary habit, medication side effect and interrupt medication, particularly during social occasions. Subtheme 1 life style changes lifestyle modification is a corner stone of HTN management among participants. The modifications include, adapting low salt diet, reduce alcohol, coffee, fatty food intake, and adapting regular exercise. Most participant described strong commitment to these modifications, despite initial challenges such desire and cultural pressure, especially during social adversaries. some participants expressed creative substitutes like adding pepper instead of salt. Generally, lifestyle modifications were seen as essential. Although, components of disease management components with social and cultural factors significantly influencing adherence. “I avoid salty foods, and I do not drink alcohol, coffee, or tea. I also take my medication every day as prescribed. When the doctor first advised me… I struggled to quit and adjust to eating low-salt foods because I was addicted to coffee.” (FGD3, 45 years old female respondent (R3)) “After being diagnosed with hypertension, I tried to manage it by eating only unsalted food and adding pepper for about a year… However, after a year, I became tired of unsalted food and started adding a little salt back into my meals.” (FGD3, 48 years old female respondent (R7)) Subtheme 2: Medication use Medication use was centered to hypertension management, although it induced mixed feelings. Majority of participants adhere to diligently, crediting medication with symptom relief and blood pressure monitoring. However, some expressed uncertainty, initially resisting medication in favor of life style modifications. The participants expressed side effects such as impotence, dizziness and physical discomfort, impact on medication adherence and sometimes discontinued their medication. Some participants also described about fearing of wrong dosage prescription and instruction. Despite these encounters, most participants recognized medication as essential for long-term health and worked to integrate it into their daily life. “I have managed my HTN by taking my medicine regularly, selecting healthy or compatible foods for my illness, and exercising regularly.” (IDI, 64 years old male respondent (R1)) “Some of the medicines I was taking also caused some harm to my body. There was a red pill that would cause impotency. And by changing that pill, the problem was solved.” (FGD2, 67 years old male respondent (R6)) Theme 4: Treatment challenges and Complications Some participants expressed living with hypertension brough many challenges, including side effects, issue with consistency and access barriers. Other, expressed faced with emotional and physical burden of side effects, and tension between social life and treatment demands. Even if encountered these challenges, most participants showed resilience and dedicated their hypertension management, follow up and engagement in health care. Subtheme 1: Side effects Some participants told facing medication side effects as major problem in managing hypertension. Some experience dizziness and weakness. While some participants manage their feeling by adjusting their medication with health care providers, others tolerated discomfort to avoid complications from untreated hypertension. Concerns about side effects sometimes fueled skepticism toward medical treatment, delaying adherence. Despite this problem, most participants described continued their treatment, balancing discomfort against the perceived benefits of controlled and monitor their blood pressure. “And some of the medicines I was taking also caused some harm to my body. When I was taking the blood pressure pill, there was a red pill that would cause impotency.” (FGD2, 67 years old male respondent (R6)) “But recently, in these two months, it's just painful in my leg. And when I sit down and get up, it creates a squeezing type of pain, but the medication suits me perfectly now.” (FGD2, 48years old male respondent (R4)) Subtheme 2: Access to medication Most participants explained inaccessibility of most important medication in public hospitals and faced in financial crisis due to high cost of this medication in private health institutions. Patients coming from rural area encountered transportation fee, food and other expense, leading challenge in treatment adherence. Urban patients generally reported fewer issues, while rural residents faced many transportation barriers and higher out-of-pocket costs, especially when drugs were unavailable at public hospitals. Participants frequently described buying medications privately or improvising with leftover drugs, raising concerns about treatment consistency and safety. Despite these obstacles, most patients have strong commitment to continue their management, highlighting systemic challenges in equitable healthcare delivery. “I come from across the Nile for treatment… the taxi queue is long, and after I arrive at the hospital, the queue of patients is also long.” (IDI, 50 years old male respondent (R2)) “Now, the medicine they gave me three months ago is not for three months, they ordered it for two months. I’m buying one month and taking it from the private pharmacy.” (FGD2, 58 years old male respondent (R8)) Subtheme 3: Adherence Most participants explained consistently taking their medications, adhering health care provider instructions and lifestyle changes including dietary preference. However, some participants reported medication interaction and lack of trust with health care providers and disbelief in the necessity of lifelong medicine. Among some patient’s alcohol drinking was a recurring theme, despite understanding of health risk. Family inspiration and community support were central in enhancing adherence. Generally, participants realized adherence as vital but emphasized the challenges of integrating strict regimen into daily life. “First, when we have to take it on time, there will be deviations. There is no need to deviate, that is, there will be skipping.” (FGD2, 67 years of male respondent (R6)) “We patients have a problem with monitoring our health condition. We do things that we are told not to do, for example, drinking alcohol… we get to four [drinks], we get to six, and also, we take medicine.” (FGD2, 65 years old male respondent (R3)) Theme 5: Social and Family Support Family and community support is essential in reinforce patient overall management continuity, integrity and resilience. Beside emotional reassurance, practical support and encouragement such as preparing suitable food, remind medication time, and follow up were vital. This social context provided both psychological support and tangible assistance, minimize the burden of self-care and enhancing hope and resilience. Subtheme 1: Encouragement all participants described they received significant emotional and physical support from their family, friend, and communities. Family member reassured them that hypertension is manageable, helping alleviate fear and anxiety, especially while they were realizing their diagnosis. This continuous empowerment contributed to maintain lifestyle changes and treatment adherence. Most participants expressed this collaborative support enhance psychological safety. “My family, health professionals, and community have helped me by reassuring me, encouraging me to take my medicine, and providing access to a healthy diet.” (IDI, 64 years old male respondent (R1)) “However, my blood pressure raised, so I started medicine immediately… my family, friends, and community reassured me that HTN is a controlled disease and that I can live with it lifelong.” (IDI, 64 years old male respondent (R1)) Subtheme 2: Assistance The assistance given from the family and the communities are equally essential. All participants explained children, spouse, and community members have been helping by preparing salt free diet, reminding them about medication intake, assisting with transportation to health facilities. This support fills among patients who are gap in illiteracy and low education level, contributing to good treatment outcome. “Yes, my son supports me in taking my medication on time.” (FGD1, 53 years old male respondent (R6)) “Even my family, friends, and community understand my illness, even during ceremonies.” (FGD1, 72 years old male respondent(R3)) Theme 6: impact on daily life The majority of participants reported that hypertension had minimal impact on their daily life, activities and social life, especially those patients who were effectively controlled their blood pressure. However, in some patient’s dietary changes and medication regimen posed occasional inconsistences, most contained their routes., preserving a sense of normality and keeping their social and occupational roles. Subtheme 1: Daily activities (work) and functioning Most participants reported even if they had hypertension, they maintained routine activities without major challenges. Even those with physically demanding job adapted managing stress level, adjusted workloads, adhering their treatment, Participants explained a desire to remain productive and independent, viewing continued work as both financially and psychologically important. This resilience contributes to positive outlook and a sense of normality in daily life. Generally, most participants retained normal physical working and ability to care out daily task without challenges. Especially, those who were managed hypertension effectively, didn’t faced challenges while they were performing daily task. However, some experienced interfered with daily activities. “My hypertension does not affect my work, family relations, or social life.” (IDI, 64 years old male respondent (R1)) “My problem has not affected my daily work, family, or social relationships. “Now I have been living with HTN without any problems by following the doctor’s instructions, such as taking medicine accordingly, restricting my diet, and making lifestyle changes.” (IDI, 64 years old male respondent (R1)) “I grasped the information quickly. The worries I had about growing older or the possibility of not being able to read and write did not affect my ability to understand the situation clearly.” (FGD3, 55 years old female respondent (R1)) Subtheme 2: Social life The majority of participants maintained their social connections despite living with hypertension. While they faced occasional dietary and alcohol restrictions during gatherings, most of them continued participating in social events such as adversaries and religious ceremonies. Social inclusion contributes to emotional wellbeing and reduced feeling of isolation. However, some recognized minor struggles between social custom and dietary restriction, requiring personal discipline and family support to navigate these circumstances. “Even my family, friends, and community understand my illness, even during ceremonies.” (FGD1, 72 years old male respondent (R3)) “However, after a year, I became tired of unsalted food and started adding a little salt back into my meals… Although I was advised not to drink coffee, I couldn't resist and began having one cup a day.” (FGD3,48 years old female respondent (R7)) . Theme 7: Perception and perception of control Study participants varied in confidently manage their illness. Some participants explained high self-esteem and control their HTN, believing their ability to follow medical guidance and sustained treatment. Others, complaint to their treatment, expressed enduring uncertainties or enquiries about the chronic nature of HTN and the need for lifelong medication. Generally, belief in personal agency and good understanding of the disease were closely associated to confidence levels. Subtheme 1: Efficacy Most participants conveyed strong confidence in their ability to manage HTN, strictly adhering to treatment regimens and life style changes. They saw themselves as active agents. They focused discipline and personal responsibilities. However, some participants explained uncertainty about the need of lifelong medication. Even if with the occasional uncertainties, the dominant attitude reflected hopefulness and a sense of agency over health outcomes. “I have managed my HTN effectively at home and obey the health professionals’ instructions.” (FGD1, 67 years old male respondent (R1)) “I am confidently managing my illness; however, I have not utilized any telemedicine services.” (FGD1, 72 years old male respondent (R3)) Subtheme 2: Disease Understanding Participants varied in their understanding of hypertension as a chronic condition. Some possessed a solid grasp of hypertension’s causes and long-term management, while others struggled with gaps in knowledge, especially around the idea of lifelong treatment. Illiteracy and limited health literacy posed significant barriers for some participants. Overall, understanding the nature of hypertension significantly shaped confidence and engagement in self-care. “But what is the saying, once you start taking blood pressure pills, you can't stop. I haven't found an answer to the question of why you can't stop if it's fixed and balanced. I hope that this study can find it.” (FGD2, 67 years old male respondent (R6)) “If we stop doing what the doctor says, or if we do what we need to do, we will be healthy.” (FGD2, 58 years old male respondent (R8)) Theme 8: Health care system and Access Barriers Some participants identified substantial health system challenges that complicated their hypertension management, including transportation difficulties, medication unavailability’s, high out-pocket cost, long time waiting and poor service quality. These barriers were especially, pronounced for rural patients and those who had financial constraints. Despite these challenges, most participants remained dedicated to follow-up and Despite frustrations, most participants remained committed to follow-up and care, indicative of good perseverance. Subtheme 1: transportation Most participants reported transport appeared as a substantial barrier, especially for rural participants. Long distance, unreliable public transit, and related costs complicated access to follow-up care and medication fill-ups. Urban residents experienced fewer encounters but remained emphatic to rural patents’ struggles. The transportation issue also contributed to delays in seeking care, potentially affecting hypertension control and outcomes. “I am currently residing in Bahir Dar City, so I am not far from the hospital, only 2 km. However, when I think about the rural population, they are much farther from the health facility.” (IDI, 64 years old male respondent (R1)) “There is a transportation problem to get here from my home.” (IDI, 38 years old female respondent(R3)) Subtheme 2: waiting time long waiting time in hospitals and clinics were commonly reported by many patients. Most participants described lengthy queues for registration, laboratory services, and consultations which often spent entire days. These delays were exhausting and discouraged frequent follow-up visit, especially for those who balancing work and family responsibilities. Despite hindrance, participants continued appearing follow-ups, realizing their importance for disease management. “When I leave my house in the morning, the taxi queue is long, and after I arrive at the hospital, the queue of patients is also long.” (IDI, 50 years old male respondent (R2)) “Even when my turn finally comes, others are frequently allowed to go ahead of me… Although they say it's my time, we often end up waiting until the next day.” (FGD3, 50 years old female respondent (R5)) Subtheme 3: Quality of Health Services Most participants experienced varies among hospitals and health care providers. Some participants praised providers’ competence and attentiveness, whereas others, complained lack of clear consultation, counseling and information about their illness. The challenges included receiving incorrect medication dosages, limited time for counseling, and perceived inconsequence from overworked staff. The quality-of-service shaped trust in the health system and influenced participants’ willing to seek timely care. “Health professionals do not respond well to my questions.” (IDI, 38 years old female respondent (R3) DISCUSSION This qualitative study explored the lived experience of people diagnosed with hypertension in Ethiopia, showing emotional responses, health care interactions, self-management, treatment challenges, social support, daily life impact, confidence, and system barriers. These findings provide a comprehensive understanding of patient experiences in managing HTN within a low resource setting. Participants emotional reaction during diagnosis ranges from fear and shock to acceptance, consistent with studies that report anxiety and uncertainty as common initial responses [ 16 , 17 ]. Prior knowledge and family history of HTN helped to reduced fear, enabling quicker emotional adjustment. This is aligned with study emphasized the role of community awareness in improving patients’ initial coping and engagement in their care [ 18 ]. Addressing patients’ emotional needs at the time of diagnosis is vital, as these responses shape succeeding treatment adherence [ 19 ]. Communications with health professionals were crucial in inducing patients’ understanding and confidence. This concept aligns with evidence showing that patient centered communication helps minimize fear and improve adherence to treatment, by fostering open dialogue and understanding, such communication enhances chronic disease management outcomes [ 20 , 21 ]. Though, some participants experienced inadequate communication, pointing to challenges such as limited provider time and training. This supports the concept that improving communication skills and allowing more consultation time could reinforce patient-provider relations and faith [ 22 ]. Lifestyle changes and medication adherence were vital to disease management. Despite social and cultural behavior, most participants showed dedicated to dietary changes and reduce harmful behavior. This is comparable to study from other low- and middle-income countries [ 23 ]. Medication adherence was complicated by side effects and skepticism, underscoring the need for better patient education about medication benefits and side effect management. This concept is comparable with culturally sensitivity counseling and medication support, which remain essential components of HTN care [ 24 ]. Moreover, providing consistent medication support address barriers such as cost and access, which are critical for sustained blood pressure control. Together, these approach enhance patient-centered care and contribute to better HTN management outcomes [ 22 ]. Treatment challenges included medication side effects, limited access, and occasional interaction. This is aligned with the study conducted which showed that side effects such as dizziness and sexual dysfunction are known barriers to adherence globally sexual dysfunction are known barriers to adherence globally [ 25 ]. Access difficulties include, transportation problems and medication shortages, were especially pronounced for rural residents, contributing to health disparities. These challenges emphasize the need for health system improvements to ensure steady medication supply and reduce geographic and financial barriers [ 26 ]. Family and community support played a significant role in helping participant management in hypertension. Emotional encouragement and practical help, such as meal preparation and medication reminders, aligned with literature identifying social support as critical factor in chronic disease management [ 27 ]. Leveraging family and community networks could enhance adherence and coping, particularly for patient with low educational level [ 28 ]. The majority of participants expressed that hypertension had minimal impact on their work and social life, demonstrating resilience and effective disease control. Maintaining social roles reflects the concept of normalization in chronic illness [ 28 ]. Hower, some reported tensions between social customs and treatment requirements., signifying the importance of culturally appropriate intervention that address these challenges. Confident and perception of control varied, with many expressing strong self-efficacy in managing their HTN. However, some expressed doubts about the chronic nature of HTN and necessity of lifelong treatment, consistent with studies on health literacy gaps. Educational effort to improve understanding of HTN chronicity may enhance long-term adherence and self-management. Systemic barriers such as a long waiting time, transportation difficulties and inconsistency service quality were widely reported. These are common challenges in resources limited health system and can obstruct effective patient care Addressing infrastructure and service delivery issue is critical to improving access patient satisfaction [ 29 , 30 ]. CONCLUSION This study implies the complexity of hypertension management beyond clinical treatment, emphasizing psychosocial, cultural, and systemic dimensions. Tailored patient education, strength, provider communication, and community engagement are essential for improving adherence and health outcome. Health system reform to reduce access and ensure consistence medication supply are critical, especially for rural populations. Intervention should adopt a holistic approach that integrates medical, behavioral, and social support strategies to address hypertension effectively across low and middle-income countries including Ethiopia. Abbreviations CD Chronic Disease FGD Focused Group Discussion HTN Hypertension IDI In-depth Interview LMICs Low- and Middle-income Countries NCD Non-Communicable Disease Declarations Authors’ Contributions EB : Selected the title, drafted the proposal (conceptualized and designed the study), analyzed and interpreted the data, and drafted the manuscript. MM and AB : Approved the title, wrote the proposal, and thesis with some revisions. DE and AD : Approved the proposal and thesis with some revisions, finalized the thesis, revised the manuscript, and provided constructive comments. YT and TA : Analyzed the data, and wrote the thesis with some revision OA : Approved the analysis, made some revision on the thesis, wrote and finalized the manuscript. All authors have read and approved the final manuscript. Availability of Data and Materials The data supporting the findings of this study are available within the manuscript. Ethical approval and consent to participate Verbal informed consent to participate was obtained from all participants in the study, and it has been approved by the ethical committee. The study was reviewed and approved by the Institutional Review Board of Bahir Dar University (IRB), approval number 2345/25. The IRB ensured that all ethical guidelines were followed, and participants were fully informed about the nature and purpose of the research before consenting to participate. Consent for publication Not applicable Funding : Not applicable. Competing Interests The authors declare that no competing interests exist. Acknowledgements The authors are grateful to the data collectors, Bahir Dar University, and all study participants for their contributions to the study's success . References Ma H, Wang M, Qin C, Shi Y, Mandizadza OO, Ni H, et al. Trends in the burden of chronic diseases attributable to diet-related risk factors from 1990 to 2021 and the global projections through 2030: a population-based study. Front Nutr. 2025;12:1570321. WHO GS. Global status report on noncommunicable diseases 2010. 2014. Mills KT, Bundy JD, Kelly TN, Reed JE, Kearney PM, Reynolds K, et al. Global disparities of hypertension prevalence and control: a systematic analysis of population-based studies from 90 countries. Circulation. 2016;134(6):441–50. Shiferaw F, Letebo M, Misganaw A, Feleke Y, Gelibo T, Getachew T et al. Non-communicable Diseases in Ethiopia: Disease burden, gaps in health care delivery and strategic directions. Ethiop J Health Dev. 2018;32(3). 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Opportunities, challenges, and strategies for engaging family in diabetes and hypertension management: a qualitative study. J Health Care Poor Underserved. 2020;31(2):827–44. Maslakpak MH, Rezaei B, Parizad N. Does family involvement in patient education improve hypertension management? A single-blind randomized, parallel group, controlled trial. Cogent Med. 2018;5(1):1537063. Zhang X, Zheng Y, Qiu C, Zhao Y, Zang X. Well-being mediates the effects of social support and family function on self-management in elderly patients with hypertension. Psychol Health Med. 2020;25(5):559–71. Carey RM, Whelton PK, Committee* AAHGW. Prevention, detection, evaluation, and management of high blood pressure in adults: synopsis of the 2017 American College of Cardiology/American Heart Association Hypertension Guideline. Ann Intern Med. 2018;168(5):351–8. Costa RS, Nogueira LT. Family support in the control of hypertension. Rev Latinoam Enferm. 2008;16:871–6. Israfil I, Sinaga M, Ludji IDR. Effect of patients behavior and family health companion role on hypertension complication occurrence. Unnes J Public Health. 2018;7(2):133–41. Frieden TR, Garg R, Moran AE, Whelton PK. Improved hypertension care requires measurement and management in health facilities, not mass screening. Lancet. 2025;405(10492):1879–82. Idris H, Nugraheni WP, Rachmawati T, Kusnali A, Yulianti A, Purwatiningsih Y, et al. How is telehealth currently being utilized to help in hypertension management within primary healthcare settings? A scoping review. Int J Environ Res Public Health. 2024;21(1):90. Fontil V, Gupta R, Moise N, Chen E, Guzman D, McCulloch CE, et al. Adapting and evaluating a health system intervention from Kaiser Permanente to improve hypertension management and control in a large network of safety-net clinics. Circulation: Cardiovasc Qual Outcomes. 2018;11(7):e004386. Sambah F, McBain-Rigg K, Seidu A-A, Emeto TI, editors. A qualitative study on the barriers and enablers to effective hypertension management in Ghana. Healthcare: MDPI; 2025. Nozato Y. Hypertension research 2024 update and perspectives: blood pressure management. Hypertens Res. 2025:1–6. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. 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08:39:16","extension":"html","order_by":6,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":117223,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-7381169/v1/ca31ab9db234ec58c308e840.html"},{"id":91826770,"identity":"82ff3e37-6505-4a0b-87a3-cace4d891a6a","added_by":"auto","created_at":"2025-09-22 08:39:16","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":907748,"visible":true,"origin":"","legend":"\u003cp\u003eDiagram showing themes and sub-themes for the lived experience of people with hypertension.\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-7381169/v1/c2f2cd5d05de8e67b50f643b.png"},{"id":108805681,"identity":"7349a4bd-f5c8-4cb8-8d85-61aa1491b734","added_by":"auto","created_at":"2026-05-08 15:26:37","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":953365,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7381169/v1/fe479be6-35ae-4feb-9646-34480261de94.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"\u003cp\u003eLived Experience of People With Hypertension in Ethiopia: A Phenomenological Study, 2025\u003c/p\u003e","fulltext":[{"header":"INTRODUCTION","content":"\u003cp\u003eThe increased burden of chronic disease (CD) such as hypertension causes significant global health and economic challenges especially, among low and middle-income countries (LMICs). Recently, hypertension is elevation of blood pressure\u0026thinsp;\u0026gt;\u0026thinsp;139/89 mmHg and it doesn\u0026rsquo;t have clear symptom initially, called silent killer. It is the main causes of cardiovascular disease, stroke, kidney failure, and premature death [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Globally, the prevalence of hypertension has increased over recent years, Globally, the prevalence of hypertension has increased dramatically over recent decades, triggered by urbanization, change in dietary habit, aging population, and sedentary lifestyle [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Effective and efficient management of HTN requires timely diagnosis, lifelong medication adherence, lifestyle modifications and consistence engagement in health care system. Nevertheless, those demand present considerable challenges in LMICs, as poor health care infrastructure and limited resources [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eIn Ethiopia, hypertension is found to be a major public health problem, with national surveys indicating increasing prevalence rates in both urban and rural populations [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Despite these challenges, hypertension remain undiagnosed, untreated, and poorly controlled, leading to substantial mortality and morbidity. Factors such as limited health care access, shortage trained professionals, financial barriers, and geographical challenges hider effective hypertension (HTN) management in several regions of the country [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. Additionally, culture beliefs, traditional healing practice, health literacy levels and social stigma influence individual perceptions of HTN and their willingness to engage in biomedical care [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eAlthough substantial studies in Ethiopia have focused on the epidemiology, risk factors, and treatment gap of HTN, there is a lack in qualitative survey of patients lived experiences in hypertension. Quantitative data provide essential prevalence figures and risk estimates, but fail to capture personal, cultural, social, and emotional data about chronic disease such as HTN [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. Particularly, there are limited understanding of how patients interpret and respond to symptoms of their HTN [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. They faced psychological challenges, and fail the strategies used to manage chronic illness with in their daily life. Patients\u0026rsquo; belief about cause, treatment effectiveness, and prognosis, significantly affects medication adherence and their engagement with health care professionals in health care setting, this affects overall quality of patient life [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eAdditionally, the burden of hypertension in Ethiopia intersects with broader social determinants of health, including poverty, gender dynamics, family responsibilities, and community norms. For many individuals, the cost of medication, transportation to health institutions, and time away from work or family obligations pose a major barrier to consistent care [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. The lifelong nature of HTN usually brings the patient for feeling of anxiety, uncertain, and fear about future complications, which may remain hidden or unaddressed health care challenges [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. Without clear understanding of these lived realistic intervention risk poorly tailored to patients\u0026rsquo; needs, potentially leading to poor adherence engage in modern health care and early treatment initiations. This condition leads to in effective treatment outcome, high existence of complications, and continue high rate of HTN [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eThus, infers the urgent need to generate qualitative evidence exploring the lived experience of people with HTN in Ethiopia. A phenomenological approach provides a deep investigation of how people perceive, make sense, and cope with their illness. The evidence obtained from such a study will provide clinical guidance for health care providers, police makers, and program designers seeking to build culturally sensitive, patient centered approach to hypertension care. By enlightening patients\u0026rsquo; voices, this research aims to contribute to more effective strategies for hypertension control, ultimately expand health outcomes and minimize burden of cardiovascular disease in Ethiopia.\u003c/p\u003e\u003cp\u003eIn general, while hypertension present substantial and increasing challenge in Ethiopia. Significant knowledge gaps remain about how patients experience and manage the condition within their social, cultural, and economical context. Therefore, this study aimed to asses lived experience of patients with HTN in north west Amhara tertiary hospitals, Ethiopia, 2025. The study might contribute to address the existing gaps in managements and controlling of HTN, and support sustainable, equitable, and patient centered hypertensive patient care in Ethiopia.\u003c/p\u003e"},{"header":"METHODS AND MATERIALS","content":"\u003cp\u003eThe study was conducted using phenomenological qualitative approach. Data was collected from participants who are lived experience with HTN in north west Amhara tertiary hospitals, Ethiopia in July, 2025. Participants were recruited using purposive sampling which is a quite common sampling technique for qualitative studies. The study was used heterogeneous sampling technique to recruit study participants, which included all age groups above 18 years old and both male and female living with HTN were incorporated. Data was collected using the local language (Amharic) in a private space by four trained and experienced fieldworkers, who were probe responses to explore the views and reasoning of the participants.\u003c/p\u003e\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003eData collection\u003c/h2\u003e\u003cp\u003eSemi structured interview guide was used as a tool for in depth interview (IDI), and focused group discussions FGD. All IDI and FGDs were tape-recorded with the consent of participants and at the saturation level. Extensive field notes were taken to capture key points and the overall process of the data collection process. The interviewers were developing a rapport with participants at the beginning of interviews to create an environment where respondents feel encouraged and relaxed to discuss freely. Training was given for five days before data collection for data collectors and supervisors on overall process of the study. Four trained nurses and two supervisors were involved in data collection process in one month period.\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eRigor and trustworthiness of the study\u003c/h3\u003e\n\u003cp\u003eThe rigor and trustworthiness of the study was maintained based on Lincoln and Guba\u0026rsquo;s criteria of credibility, dependability, confirmability, and transferability. Credibility was assured by keeping the consistency of procedures and the neutrality of the investigator about findings or decisions. Peer debriefing was performed to cross-check the processes, evaluate the findings, and get feedback. Transferability was achieved by describing the study setting, sample, and data collection procedure clearly and using qualitative experts for peer debriefing. Dependability was attained through accurate documentation by including all documents in the final report such as including the notes that were written during the interview and ensuring that the details of the procedures were described to allow the readers to see the basis upon which conclusions were made.\u003c/p\u003e\u003cp\u003e Confirmability of the study was ensured by the recording of every activity of the participants during the time of the interview. In addition, the audio-taped interviews were not destroyed which can enable others to track the process. Moreover, peer debriefing was conducted before synthesizing the final outputs.\u003c/p\u003e\u003cdiv id=\"Sec5\" class=\"Section2\"\u003e\u003ch2\u003eData analysis\u003c/h2\u003e\u003cp\u003eThe preliminary analysis was initiated alongside the data collection. Before the actual analysis, the data collected in a digital recorder was transcribed word by word with participant language (Amharic) and translated into English, and double checked for its consistency. Data was imported and analyzed using the ATLAS Ti, v. 7 software following standardized transcription. A thematic analysis was used to analyze the data. The data was transcribed, translated, coded and categorized. After coding the first couple of interviews, the team of researchers was coming together to discuss the appropriateness and meaning of the codes. Further interviews were coded accordingly. Individual codes were assigned into categories and individual categories was linked to themes that were developed based on the assessment objectives and emerging issues. The assessment report was following the final themes developed. The results were synthesized to inform the lived experience of people with HTN.\u003c/p\u003e\u003c/div\u003e"},{"header":"RESULTS","content":"\u003cdiv id=\"Sec7\" class=\"Section2\"\u003e\u003ch2\u003eSociodemographic characteristics of study participants\u003c/h2\u003e\u003cp\u003eA total of four IDI, and three FGD (8 participants in each FGD) were conducted. Of the 28 participants 18 of them were male. Their occupational status ranged from retirement to actively working, most of them in self-employ. The participant educational level showed first degree to no formal education (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eCharacteristics of FGD and IDI Participants (N\u0026thinsp;=\u0026thinsp;28)\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"3\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCharacteristics\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCategory\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eFrequency (%)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAge\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e36\u0026ndash;65\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e22 (79%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026gt;\u0026thinsp;65\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e6 (21%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSex\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e18 (64%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e10(36%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMarital Status\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMarried\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e23(82%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSingle\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2 (7%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eDivorced\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1 (4%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eWidowed\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2 (7%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eReligion\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eOrthodox\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e23(82%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMuslim\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4 (14%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eProtestant\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1 (4%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEducation Status\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo formal education\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e10 (42%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePrimary-Secondary (1\u0026ndash;12)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e11 (39%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eDiploma\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3 (10.7%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eDegree\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4 (14%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOccupation\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eFarmer\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e6 (21.4%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eHousewife\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e6 (21.4%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMerchant\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e5(18%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eGovernment employ\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e6 (21.4%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eOthers\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e5 (18%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYears with HTN\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026le;\u0026thinsp;5 years\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e12 (43%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e6\u0026ndash;10 years\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e12(43%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026gt;\u0026thinsp;10 years\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4 (14%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFamily History of HTN\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e10 (36%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e18 (64%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"3\"\u003eNote: FGD; Focused group discussion, IDI; In-depth interview\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\u003ch2\u003eLived experience of people with hypertension\u003c/h2\u003e\u003cp\u003eThemes and sub-themes are used to present and organize the conclusions that resulted from the IDI and FGD. Data analysis has revealed eight themes that express (1) emotional and cognitive response, comprising existing initial reaction to their diagnosis and patient understanding of their hypertension (HTN), (2) Health provider interaction and communication include health care support and information, (3) adaptation and self-management comprehending lifestyle changes and medication use, (4) treatment challenges and complications, which include medication side effects, access to medication, and adherence to treatment, (5) social and family support, which contains encouragement and assistance, (6) Impact on daily life comprises daily activities (work) and functioning and social life. (7) perception and perception of control through belief in treatment efficacy and disease understanding, (8) health care system and access barriers through transportation barriers, long waiting times, and quality of health services (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eTheme 1: Emotional and cognitive response to diagnosis\u003c/h3\u003e\n\u003cp\u003e Most participants expressed a range of emotional reactions upon realized their hypertension by health care providers. They feel fear, shock so that accept their illness once after understanding of the characteristic, diagnosis and management of the disease. These cognitive and emotional response were formed by their prior knowledge, literacy level, family history, believe and support from their family and communities. How participants initially processed their diagnosis played important role in determining their later involvement with treatment and self-management.\u003c/p\u003e\n\u003ch3\u003eSub theme 1: Initial reaction\u003c/h3\u003e\n\u003cp\u003eThe study participants experienced diverse initial reactions upon diagnosis of hypertension, ranging from shock and fear to calm acceptance. Many participants described feeling frightened, hopeless, or anxiety, especially when first challenged with unfamiliar medical terms or physical symptoms like headaches or dizziness. However, prior knowhow from family history of illness, community awareness, or media minimize fear for some individual that facilitate quick emotional adjustment. Whereas individual with no family history of hypertension, no prior knowledge has been more depressed and fear while realizing their illness. The first movement of diagnosis became defining memory for many, influencing attitudes towards treatment and self-care. Generally, initial reactions represented a blend of emotional confusion and subsequent psychological accommodation, formed profoundly via prior knowledge, literacy level and experience with chronic illness.\u003c/p\u003e\u003cp\u003e\u003cem\u003e\u0026ldquo;Before I had HTN, I didn\u0026rsquo;t know what hypertension meant\u0026hellip; Therefore, I felt hopeless when the doctor told me.\u0026rdquo; (IDI, 64 years old male respondent (R1)\u003c/em\u003e\u003c/p\u003e\u003cp\u003e\u003cem\u003e\u0026ldquo;When I realized I had hypertension\u0026hellip; I was scared and under some stressful conditions. However, I had previously known about the illness from my mother and older sister, so I calmed down subsequently.\u0026rdquo; (FGD1, 75 years old male respondent (R1))\u003c/em\u003e\u003c/p\u003e\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e\u003ch2\u003eSubtheme 2: Understanding\u003c/h2\u003e\u003cp\u003eUnderstanding of HTN varied significantly among patients, which influenced by level education, family history of the same illness, age, and accessibility of health information through media and communities. Some patients expressed basic knowledge of hypertension, its genetic factors, and importance of medication adherence and lifestyle changes. Others, especially those who were illiterate, elderly, faced challenges to easily understanding of their illness, and relay primarily on their health care providers verbal explanations. Even among the educated, confusion existed regarding chronicity and lifelong treatment requirements. This difference in understanding shaped treatment adherence and confidence in disease management. Generally, knowledge gaps highlighted the need for tailored, accessible health education to improve patients\u0026rsquo; comprehension and involvement.\u003c/p\u003e\u003cp\u003e\u003cem\u003e\u0026ldquo;My educational status did not affect my understanding of my illness. I already knew enough about hypertension before I had it.\u0026rdquo; (FGD1, 58 years old male respondent (R5))\u003c/em\u003e\u003c/p\u003e\u003cp\u003e\u003cem\u003e\u0026ldquo;Yes, I still don\u0026rsquo;t know enough about HTN because I can\u0026rsquo;t read or write. I feel that my occupation and educational status might have affected my knowledge.\u0026rdquo; (FGD1, 57 years old male respondent (R4))\u003c/em\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec12\" class=\"Section2\"\u003e\u003ch2\u003eTheme 2: Health provider interaction and communication\u003c/h2\u003e\u003cp\u003eInteraction with health providers mainly influenced patients\u0026rsquo; understanding of their illness condition and confidence in managing hypertension. Most patients esteemed clear, patient explanation and support from health care providers, while others experienced gaps in communications, causes to misperception and frustration. These interactions were essential in shaping trust, treatment adherence, and patient engagement in managing their illness.\u003c/p\u003e\u003cp\u003e\u003cb\u003eSubtheme 1\u003c/b\u003e: Health care support and information\u003c/p\u003e\u003cp\u003eMost participants emphasized the critical role of health care professionals in explaining their illness condition and treatment. Most participants expressed, adequate, brief and genuine information from the health care professionals minimize fear, anxiety, and increased patient confidence and hopefulness. Many admired physicians and nurses for full clarifications about the risks of untreated hypertension and the benefit of medication and lifestyle changes. On the other hand, some participants described displeasure when provider didn\u0026rsquo;t provide adequate information about their questions and illness condition. Good health care provider-patient interaction was associated with trust, better treatment adherence, sense of wellbeing, security, and confidence in managing hypertension. Overall, effective communication and support from health providers proved essential for strengthen patients controlling their hypertension.\u003c/p\u003e\u003cp\u003e\u003cem\u003e\u0026ldquo;The doctor who was treating me had explained to me thoroughly about the illness and the problems it would cause if I didn\u0026rsquo;t control my blood pressure.\u0026rdquo; (IDI, 38 years old female respondent (R3))\u003c/em\u003e\u003c/p\u003e\u003cp\u003e\u003cem\u003e\u0026ldquo;I come from across the Nile for treatment\u0026hellip; After I get here, health professionals do not respond well to my questions.\u0026rdquo; (IDI, 38 years old female respondent (R3))\u003c/em\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec13\" class=\"Section2\"\u003e\u003ch2\u003eTheme 3: Adaptation and self-management\u003c/h2\u003e\u003cp\u003eThe most important theme got from participants\u0026rsquo; experience was how they adapted to living with hypertension. Those include, lifestyle changes, adherence to dietary restriction and treatment. Although some participants described straggle with dietary habit, medication side effect and interrupt medication, particularly during social occasions.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec14\" class=\"Section2\"\u003e\u003ch2\u003eSubtheme 1 life style changes\u003c/h2\u003e\u003cp\u003elifestyle modification is a corner stone of HTN management among participants. The modifications include, adapting low salt diet, reduce alcohol, coffee, fatty food intake, and adapting regular exercise. Most participant described strong commitment to these modifications, despite initial challenges such desire and cultural pressure, especially during social adversaries. some participants expressed creative substitutes like adding pepper instead of salt. Generally, lifestyle modifications were seen as essential. Although, components of disease management components with social and cultural factors significantly influencing adherence.\u003c/p\u003e\u003cp\u003e\u003cem\u003e\u0026ldquo;I avoid salty foods, and I do not drink alcohol, coffee, or tea. I also take my medication every day as prescribed. When the doctor first advised me\u0026hellip; I struggled to quit and adjust to eating low-salt foods because I was addicted to coffee.\u0026rdquo; (FGD3, 45 years old female respondent (R3))\u003c/em\u003e\u003c/p\u003e\u003cp\u003e\u003cem\u003e\u0026ldquo;After being diagnosed with hypertension, I tried to manage it by eating only unsalted food and adding pepper for about a year\u0026hellip; However, after a year, I became tired of unsalted food and started adding a little salt back into my meals.\u0026rdquo; (FGD3, 48 years old female respondent (R7))\u003c/em\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec15\" class=\"Section2\"\u003e\u003ch2\u003eSubtheme 2: Medication use\u003c/h2\u003e\u003cp\u003eMedication use was centered to hypertension management, although it induced mixed feelings. Majority of participants adhere to diligently, crediting medication with symptom relief and blood pressure monitoring. However, some expressed uncertainty, initially resisting medication in favor of life style modifications. The participants expressed side effects such as impotence, dizziness and physical discomfort, impact on medication adherence and sometimes discontinued their medication. Some participants also described about fearing of wrong dosage prescription and instruction. Despite these encounters, most participants recognized medication as essential for long-term health and worked to integrate it into their daily life.\u003c/p\u003e\u003cp\u003e\u003cem\u003e\u0026ldquo;I have managed my HTN by taking my medicine regularly, selecting healthy or compatible foods for my illness, and exercising regularly.\u0026rdquo; (IDI, 64 years old male respondent (R1))\u003c/em\u003e\u003c/p\u003e\u003cp\u003e\u003cem\u003e\u0026ldquo;Some of the medicines I was taking also caused some harm to my body. There was a red pill that would cause impotency. And by changing that pill, the problem was solved.\u0026rdquo; (FGD2, 67 years old male respondent (R6))\u003c/em\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec16\" class=\"Section2\"\u003e\u003ch2\u003eTheme 4: Treatment challenges and Complications\u003c/h2\u003e\u003cp\u003eSome participants expressed living with hypertension brough many challenges, including side effects, issue with consistency and access barriers. Other, expressed faced with emotional and physical burden of side effects, and tension between social life and treatment demands. Even if encountered these challenges, most participants showed resilience and dedicated their hypertension management, follow up and engagement in health care.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec17\" class=\"Section2\"\u003e\u003ch2\u003eSubtheme 1: Side effects\u003c/h2\u003e\u003cp\u003eSome participants told facing medication side effects as major problem in managing hypertension. Some experience dizziness and weakness. While some participants manage their feeling by adjusting their medication with health care providers, others tolerated discomfort to avoid complications from untreated hypertension. Concerns about side effects sometimes fueled skepticism toward medical treatment, delaying adherence. Despite this problem, most participants described continued their treatment, balancing discomfort against the perceived benefits of controlled and monitor their blood pressure.\u003c/p\u003e\u003cp\u003e\u003cem\u003e\u0026ldquo;And some of the medicines I was taking also caused some harm to my body. When I was taking the blood pressure pill, there was a red pill that would cause impotency.\u0026rdquo; (FGD2, 67 years old male respondent (R6))\u003c/em\u003e\u003c/p\u003e\u003cp\u003e\u003cem\u003e\u0026ldquo;But recently, in these two months, it's just painful in my leg. And when I sit down and get up, it creates a squeezing type of pain, but the medication suits me perfectly now.\u0026rdquo; (FGD2, 48years old male respondent (R4))\u003c/em\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec18\" class=\"Section2\"\u003e\u003ch2\u003eSubtheme 2: Access to medication\u003c/h2\u003e\u003cp\u003eMost participants explained inaccessibility of most important medication in public hospitals and faced in financial crisis due to high cost of this medication in private health institutions. Patients coming from rural area encountered transportation fee, food and other expense, leading challenge in treatment adherence. Urban patients generally reported fewer issues, while rural residents faced many transportation barriers and higher out-of-pocket costs, especially when drugs were unavailable at public hospitals. Participants frequently described buying medications privately or improvising with leftover drugs, raising concerns about treatment consistency and safety. Despite these obstacles, most patients have strong commitment to continue their management, highlighting systemic challenges in equitable healthcare delivery.\u003c/p\u003e\u003cp\u003e\u003cem\u003e\u0026ldquo;I come from across the Nile for treatment\u0026hellip; the taxi queue is long, and after I arrive at the hospital, the queue of patients is also long.\u0026rdquo; (IDI, 50 years old male respondent (R2))\u003c/em\u003e\u003c/p\u003e\u003cp\u003e\u003cem\u003e\u0026ldquo;Now, the medicine they gave me three months ago is not for three months, they ordered it for two months. I\u0026rsquo;m buying one month and taking it from the private pharmacy.\u0026rdquo; (FGD2, 58 years old male respondent (R8))\u003c/em\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec19\" class=\"Section2\"\u003e\u003ch2\u003eSubtheme 3: Adherence\u003c/h2\u003e\u003cp\u003eMost participants explained consistently taking their medications, adhering health care provider instructions and lifestyle changes including dietary preference. However, some participants reported medication interaction and lack of trust with health care providers and disbelief in the necessity of lifelong medicine. Among some patient\u0026rsquo;s alcohol drinking was a recurring theme, despite understanding of health risk. Family inspiration and community support were central in enhancing adherence. Generally, participants realized adherence as vital but emphasized the challenges of integrating strict regimen into daily life.\u003c/p\u003e\u003cp\u003e\u003cem\u003e\u0026ldquo;First, when we have to take it on time, there will be deviations. There is no need to deviate, that is, there will be skipping.\u0026rdquo; (FGD2, 67 years of male respondent (R6))\u003c/em\u003e\u003c/p\u003e\u003cp\u003e\u003cem\u003e\u0026ldquo;We patients have a problem with monitoring our health condition. We do things that we are told not to do, for example, drinking alcohol\u0026hellip; we get to four [drinks], we get to six, and also, we take medicine.\u0026rdquo; (FGD2, 65 years old male respondent (R3))\u003c/em\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec20\" class=\"Section2\"\u003e\u003ch2\u003eTheme 5: Social and Family Support\u003c/h2\u003e\u003cp\u003eFamily and community support is essential in reinforce patient overall management continuity, integrity and resilience. Beside emotional reassurance, practical support and encouragement such as preparing suitable food, remind medication time, and follow up were vital. This social context provided both psychological support and tangible assistance, minimize the burden of self-care and enhancing hope and resilience.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec21\" class=\"Section2\"\u003e\u003ch2\u003eSubtheme 1: Encouragement\u003c/h2\u003e\u003cp\u003e all participants described they received significant emotional and physical support from their family, friend, and communities. Family member reassured them that hypertension is manageable, helping alleviate fear and anxiety, especially while they were realizing their diagnosis. This continuous empowerment contributed to maintain lifestyle changes and treatment adherence. Most participants expressed this collaborative support enhance psychological safety.\u003c/p\u003e\u003cp\u003e\u003cem\u003e\u0026ldquo;My family, health professionals, and community have helped me by reassuring me, encouraging me to take my medicine, and providing access to a healthy diet.\u0026rdquo; (IDI, 64 years old male respondent (R1))\u003c/em\u003e\u003c/p\u003e\u003cp\u003e\u003cem\u003e\u0026ldquo;However, my blood pressure raised, so I started medicine immediately\u0026hellip; my family, friends, and community reassured me that HTN is a controlled disease and that I can live with it lifelong.\u0026rdquo; (IDI, 64 years old male respondent (R1))\u003c/em\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec22\" class=\"Section2\"\u003e\u003ch2\u003eSubtheme 2: Assistance\u003c/h2\u003e\u003cp\u003eThe assistance given from the family and the communities are equally essential. All participants explained children, spouse, and community members have been helping by preparing salt free diet, reminding them about medication intake, assisting with transportation to health facilities. This support fills among patients who are gap in illiteracy and low education level, contributing to good treatment outcome.\u003c/p\u003e\u003cp\u003e\u003cem\u003e\u0026ldquo;Yes, my son supports me in taking my medication on time.\u0026rdquo; (FGD1, 53 years old male respondent (R6))\u003c/em\u003e\u003c/p\u003e\u003cp\u003e\u003cem\u003e\u0026ldquo;Even my family, friends, and community understand my illness, even during ceremonies.\u0026rdquo; (FGD1, 72 years old male respondent(R3))\u003c/em\u003e\u003c/p\u003e\u003cdiv id=\"Sec23\" class=\"Section3\"\u003e\u003ch2\u003eTheme 6: impact on daily life\u003c/h2\u003e\u003cp\u003eThe majority of participants reported that hypertension had minimal impact on their daily life, activities and social life, especially those patients who were effectively controlled their blood pressure. However, in some patient\u0026rsquo;s dietary changes and medication regimen posed occasional inconsistences, most contained their routes., preserving a sense of normality and keeping their social and occupational roles.\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv id=\"Sec24\" class=\"Section2\"\u003e\u003ch2\u003eSubtheme 1: Daily activities (work) and functioning\u003c/h2\u003e\u003cp\u003e Most participants reported even if they had hypertension, they maintained routine activities without major challenges. Even those with physically demanding job adapted managing stress level, adjusted workloads, adhering their treatment, Participants explained a desire to remain productive and independent, viewing continued work as both financially and psychologically important. This resilience contributes to positive outlook and a sense of normality in daily life. Generally, most participants retained normal physical working and ability to care out daily task without challenges. Especially, those who were managed hypertension effectively, didn\u0026rsquo;t faced challenges while they were performing daily task. However, some experienced interfered with daily activities.\u003c/p\u003e\u003cp\u003e\u003cem\u003e\u0026ldquo;My hypertension does not affect my work, family relations, or social life.\u0026rdquo; (IDI, 64 years old male respondent (R1))\u003c/em\u003e\u003c/p\u003e\u003cp\u003e\u003cem\u003e\u0026ldquo;My problem has not affected my daily work, family, or social relationships.\u003c/em\u003e\u003c/p\u003e\u003cp\u003e\u003cem\u003e\u0026ldquo;Now I have been living with HTN without any problems by following the doctor\u0026rsquo;s instructions, such as taking medicine accordingly, restricting my diet, and making lifestyle changes.\u0026rdquo; (IDI, 64 years old male respondent (R1))\u003c/em\u003e\u003c/p\u003e\u003cp\u003e\u003cem\u003e\u0026ldquo;I grasped the information quickly. The worries I had about growing older or the possibility of not being able to read and write did not affect my ability to understand the situation clearly.\u0026rdquo; (FGD3, 55 years old female respondent (R1))\u003c/em\u003e\u003c/p\u003e\u003cdiv id=\"Sec25\" class=\"Section3\"\u003e\u003ch2\u003eSubtheme 2: Social life\u003c/h2\u003e\u003cp\u003eThe majority of participants maintained their social connections despite living with hypertension. While they faced occasional dietary and alcohol restrictions during gatherings, most of them continued participating in social events such as adversaries and religious ceremonies. Social inclusion contributes to emotional wellbeing and reduced feeling of isolation. However, some recognized minor struggles between social custom and dietary restriction, requiring personal discipline and family support to navigate these circumstances.\u003c/p\u003e\u003cp\u003e\u003cem\u003e\u0026ldquo;Even my family, friends, and community understand my illness, even during ceremonies.\u0026rdquo; (FGD1, 72 years old male respondent (R3))\u003c/em\u003e\u003c/p\u003e\u003cp\u003e\u003cem\u003e\u0026ldquo;However, after a year, I became tired of unsalted food and started adding a little salt back into my meals\u0026hellip; Although I was advised not to drink coffee, I couldn't resist and began having one cup a day.\u0026rdquo; (FGD3,48 years old female respondent (R7))\u003c/em\u003e.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec26\" class=\"Section3\"\u003e\u003ch2\u003eTheme 7: Perception and perception of control\u003c/h2\u003e\u003cp\u003eStudy participants varied in confidently manage their illness. Some participants explained high self-esteem and control their HTN, believing their ability to follow medical guidance and sustained treatment. Others, complaint to their treatment, expressed enduring uncertainties or enquiries about the chronic nature of HTN and the need for lifelong medication. Generally, belief in personal agency and good understanding of the disease were closely associated to confidence levels.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec27\" class=\"Section3\"\u003e\u003ch2\u003eSubtheme 1: Efficacy\u003c/h2\u003e\u003cp\u003eMost participants conveyed strong confidence in their ability to manage HTN, strictly adhering to treatment regimens and life style changes. They saw themselves as active agents. They focused discipline and personal responsibilities. However, some participants explained uncertainty about the need of lifelong medication. Even if with the occasional uncertainties, the dominant attitude reflected hopefulness and a sense of agency over health outcomes.\u003c/p\u003e\u003cp\u003e\u003cem\u003e\u0026ldquo;I have managed my HTN effectively at home and obey the health professionals\u0026rsquo; instructions.\u0026rdquo; (FGD1, 67 years old male respondent (R1))\u003c/em\u003e\u003c/p\u003e\u003cp\u003e\u003cem\u003e\u0026ldquo;I am confidently managing my illness; however, I have not utilized any telemedicine services.\u0026rdquo; (FGD1, 72 years old male respondent (R3))\u003c/em\u003e\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv id=\"Sec28\" class=\"Section2\"\u003e\u003ch2\u003eSubtheme 2: Disease Understanding\u003c/h2\u003e\u003cp\u003eParticipants varied in their understanding of hypertension as a chronic condition. Some possessed a solid grasp of hypertension\u0026rsquo;s causes and long-term management, while others struggled with gaps in knowledge, especially around the idea of lifelong treatment. Illiteracy and limited health literacy posed significant barriers for some participants. Overall, understanding the nature of hypertension significantly shaped confidence and engagement in self-care.\u003c/p\u003e\u003cp\u003e\u003cem\u003e\u0026ldquo;But what is the saying, once you start taking blood pressure pills, you can't stop. I haven't found an answer to the question of why you can't stop if it's fixed and balanced. I hope that this study can find it.\u0026rdquo; (FGD2, 67 years old male respondent (R6))\u003c/em\u003e\u003c/p\u003e\u003cp\u003e\u003cem\u003e\u0026ldquo;If we stop doing what the doctor says, or if we do what we need to do, we will be healthy.\u0026rdquo; (FGD2, 58 years old male respondent (R8))\u003c/em\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec29\" class=\"Section2\"\u003e\u003ch2\u003eTheme 8: Health care system and Access Barriers\u003c/h2\u003e\u003cp\u003eSome participants identified substantial health system challenges that complicated their hypertension management, including transportation difficulties, medication unavailability\u0026rsquo;s, high out-pocket cost, long time waiting and poor service quality. These barriers were especially, pronounced for rural patients and those who had financial constraints. Despite these challenges, most participants remained dedicated to follow-up and Despite frustrations, most participants remained committed to follow-up and care, indicative of good perseverance.\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eSubtheme 1: transportation\u003c/h3\u003e\n\u003cp\u003eMost participants reported transport appeared as a substantial barrier, especially for rural participants. Long distance, unreliable public transit, and related costs complicated access to follow-up care and medication fill-ups. Urban residents experienced fewer encounters but remained emphatic to rural patents\u0026rsquo; struggles. The transportation issue also contributed to delays in seeking care, potentially affecting hypertension control and outcomes.\u003c/p\u003e\u003cp\u003e\u003cem\u003e\u0026ldquo;I am currently residing in Bahir Dar City, so I am not far from the hospital, only 2 km. However, when I think about the rural population, they are much farther from the health facility.\u0026rdquo; (IDI, 64 years old male respondent (R1))\u003c/em\u003e\u003c/p\u003e\u003cp\u003e\u003cem\u003e\u0026ldquo;There is a transportation problem to get here from my home.\u0026rdquo; (IDI, 38 years old female respondent(R3))\u003c/em\u003e\u003c/p\u003e\u003cdiv id=\"Sec31\" class=\"Section2\"\u003e\u003ch2\u003eSubtheme 2: waiting time\u003c/h2\u003e\u003cp\u003elong waiting time in hospitals and clinics were commonly reported by many patients. Most participants described lengthy queues for registration, laboratory services, and consultations which often spent entire days. These delays were exhausting and discouraged frequent follow-up visit, especially for those who balancing work and family responsibilities. Despite hindrance, participants continued appearing follow-ups, realizing their importance for disease management.\u003c/p\u003e\u003cp\u003e\u003cem\u003e\u0026ldquo;When I leave my house in the morning, the taxi queue is long, and after I arrive at the hospital, the queue of patients is also long.\u0026rdquo; (IDI, 50 years old male respondent (R2))\u003c/em\u003e\u003c/p\u003e\u003cp\u003e\u003cem\u003e\u0026ldquo;Even when my turn finally comes, others are frequently allowed to go ahead of me\u0026hellip; Although they say it's my time, we often end up waiting until the next day.\u0026rdquo; (FGD3, 50 years old female respondent (R5))\u003c/em\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec32\" class=\"Section2\"\u003e\u003ch2\u003eSubtheme 3: Quality of Health Services\u003c/h2\u003e\u003cp\u003eMost participants experienced varies among hospitals and health care providers. Some participants praised providers\u0026rsquo; competence and attentiveness, whereas others, complained lack of clear consultation, counseling and information about their illness. The challenges included receiving incorrect medication dosages, limited time for counseling, and perceived inconsequence from overworked staff. The quality-of-service shaped trust in the health system and influenced participants\u0026rsquo; willing to seek timely care.\u003c/p\u003e\u003cp\u003e\u003cem\u003e\u0026ldquo;Health professionals do not respond well to my questions.\u0026rdquo; (IDI, 38 years old female respondent (R3)\u003c/em\u003e\u003c/p\u003e\u003c/div\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eThis qualitative study explored the lived experience of people diagnosed with hypertension in Ethiopia, showing emotional responses, health care interactions, self-management, treatment challenges, social support, daily life impact, confidence, and system barriers. These findings provide a comprehensive understanding of patient experiences in managing HTN within a low resource setting. Participants emotional reaction during diagnosis ranges from fear and shock to acceptance, consistent with studies that report anxiety and uncertainty as common initial responses [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. Prior knowledge and family history of HTN helped to reduced fear, enabling quicker emotional adjustment. This is aligned with study emphasized the role of community awareness in improving patients\u0026rsquo; initial coping and engagement in their care [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. Addressing patients\u0026rsquo; emotional needs at the time of diagnosis is vital, as these responses shape succeeding treatment adherence [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eCommunications with health professionals were crucial in inducing patients\u0026rsquo; understanding and confidence. This concept aligns with evidence showing that patient centered communication helps minimize fear and improve adherence to treatment, by fostering open dialogue and understanding, such communication enhances chronic disease management outcomes [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. Though, some participants experienced inadequate communication, pointing to challenges such as limited provider time and training. This supports the concept that improving communication skills and allowing more consultation time could reinforce patient-provider relations and faith [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eLifestyle changes and medication adherence were vital to disease management. Despite social and cultural behavior, most participants showed dedicated to dietary changes and reduce harmful behavior. This is comparable to study from other low- and middle-income countries [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. Medication adherence was complicated by side effects and skepticism, underscoring the need for better patient education about medication benefits and side effect management. This concept is comparable with culturally sensitivity counseling and medication support, which remain essential components of HTN care [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. Moreover, providing consistent medication support address barriers such as cost and access, which are critical for sustained blood pressure control. Together, these approach enhance patient-centered care and contribute to better HTN management outcomes [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eTreatment challenges included medication side effects, limited access, and occasional interaction. This is aligned with the study conducted which showed that side effects such as dizziness and sexual dysfunction are known barriers to adherence globally sexual dysfunction are known barriers to adherence globally [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. Access difficulties include, transportation problems and medication shortages, were especially pronounced for rural residents, contributing to health disparities. These challenges emphasize the need for health system improvements to ensure steady medication supply and reduce geographic and financial barriers [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eFamily and community support played a significant role in helping participant management in hypertension. Emotional encouragement and practical help, such as meal preparation and medication reminders, aligned with literature identifying social support as critical factor in chronic disease management [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. Leveraging family and community networks could enhance adherence and coping, particularly for patient with low educational level [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eThe majority of participants expressed that hypertension had minimal impact on their work and social life, demonstrating resilience and effective disease control. Maintaining social roles reflects the concept of normalization in chronic illness [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. Hower, some reported tensions between social customs and treatment requirements., signifying the importance of culturally appropriate intervention that address these challenges.\u003c/p\u003e\u003cp\u003eConfident and perception of control varied, with many expressing strong self-efficacy in managing their HTN. However, some expressed doubts about the chronic nature of HTN and necessity of lifelong treatment, consistent with studies on health literacy gaps. Educational effort to improve understanding of HTN chronicity may enhance long-term adherence and self-management.\u003c/p\u003e\u003cp\u003eSystemic barriers such as a long waiting time, transportation difficulties and inconsistency service quality were widely reported. These are common challenges in resources limited health system and can obstruct effective patient care Addressing infrastructure and service delivery issue is critical to improving access patient satisfaction [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e].\u003c/p\u003e"},{"header":"CONCLUSION","content":"\u003cp\u003eThis study implies the complexity of hypertension management beyond clinical treatment, emphasizing psychosocial, cultural, and systemic dimensions. Tailored patient education, strength, provider communication, and community engagement are essential for improving adherence and health outcome. Health system reform to reduce access and ensure consistence medication supply are critical, especially for rural populations. Intervention should adopt a holistic approach that integrates medical, behavioral, and social support strategies to address hypertension effectively across low and middle-income countries including Ethiopia.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eCD\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eChronic Disease\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eFGD\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eFocused Group Discussion\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eHTN\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eHypertension\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eIDI\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eIn-depth Interview\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eLMICs\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eLow- and Middle-income Countries\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eNCD\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eNon-Communicable Disease\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAuthors\u0026rsquo; Contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEB\u003c/strong\u003e: Selected the title, drafted the proposal (conceptualized and designed the study), analyzed and interpreted the data, and drafted the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMM and AB\u003c/strong\u003e: Approved the title, wrote the proposal, and thesis with some revisions.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDE and AD\u003c/strong\u003e: Approved the proposal and thesis with some revisions, finalized the thesis, revised the manuscript, and provided constructive comments.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eYT and TA\u003c/strong\u003e: Analyzed the data, and wrote the thesis with some revision\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eOA\u003c/strong\u003e: Approved the analysis, made some revision on the thesis, wrote and finalized the manuscript.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAll authors have read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of Data and Materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data supporting the findings of this study are available within the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthical approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eVerbal informed consent to participate was obtained from all participants in the study, and it has been approved by the ethical committee. The study was reviewed and approved by the Institutional Review Board of Bahir Dar University (IRB), approval number 2345/25. The IRB ensured that all ethical guidelines were followed, and participants were fully informed about the nature and purpose of the research before consenting to participate.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e:\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting Interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that no competing interests exist.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors are grateful to the data collectors, Bahir Dar University, and all study participants for their contributions to the study\u0026apos;s success\u003cstrong\u003e.\u003c/strong\u003e\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eMa H, Wang M, Qin C, Shi Y, Mandizadza OO, Ni H, et al. 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Int J Multiphys. 2024;18(3).\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eNamdar H, Jamshidi F, Rezabakhsh A, Ezzati D, Zakeri R, Sadat-Ebrahimi SR. Strict association between development of psychological conditions and hypertension incidence: A cross‐sectional study. J Gen Family Med. 2024;25(4):198\u0026ndash;205.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eHussein MS, Albadi AA, Alsuhaibani AS, Alsameen RM, Alsaedi BMB, Alzaher HA et al. Psychological interventions in the treatment of hypertension: Efficacy and applications. Revista iberoamericana de psicolog\u0026iacute;a del ejercicio y el deporte. 2024;19(6):641\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBurlacu A, Kuwabara M, Brinza C, Kanbay M. Key Updates to the 2024 ESC Hypertension Guidelines and Future Perspectives. Medicina. 2025;61(2):193.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eTomitani N, Hoshide S, Kario K. Sleep and hypertension\u0026ndash;up to date 2024. Hypertens Res. 2024:1\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eGupta R, Kaur M, Islam S, Mohan V, Mony P, Kumar R, et al. Association of household wealth index, educational status, and social capital with hypertension awareness, treatment, and control in South Asia. Am J Hypertens. 2017;30(4):373\u0026ndash;81.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eVelez CM. UNDERSTANDING THE ROLE OF VALUES IN LATIN AMERICAN HEALTH SYSTEMS. 2019.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSales PCd, McCarthy MM, Dickson VV, Sullivan-Bolyai S, Melkus GDE, Chyun D. Family Management of Hypertension in Brazil: A Cross-Sectional Study. Clin Nurs Res. 2025;34(1):12\u0026ndash;22.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAfkarina M, Yunita R. The Correlation Between Family Roles and Hypertension Control in The Working Area of Rogotrunan Public Health Center, Lumajang. Health Technol J (HTechJ). 2024;2(6):633\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eFort MP, Steiner JF, Santos C, Moore KR, de los Angeles Villaverde M, Nease DE Jr, et al. Opportunities, challenges, and strategies for engaging family in diabetes and hypertension management: a qualitative study. J Health Care Poor Underserved. 2020;31(2):827\u0026ndash;44.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMaslakpak MH, Rezaei B, Parizad N. Does family involvement in patient education improve hypertension management? A single-blind randomized, parallel group, controlled trial. Cogent Med. 2018;5(1):1537063.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eZhang X, Zheng Y, Qiu C, Zhao Y, Zang X. Well-being mediates the effects of social support and family function on self-management in elderly patients with hypertension. Psychol Health Med. 2020;25(5):559\u0026ndash;71.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eCarey RM, Whelton PK, Committee* AAHGW. Prevention, detection, evaluation, and management of high blood pressure in adults: synopsis of the 2017 American College of Cardiology/American Heart Association Hypertension Guideline. Ann Intern Med. 2018;168(5):351\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eCosta RS, Nogueira LT. Family support in the control of hypertension. Rev Latinoam Enferm. 2008;16:871\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eIsrafil I, Sinaga M, Ludji IDR. Effect of patients behavior and family health companion role on hypertension complication occurrence. Unnes J Public Health. 2018;7(2):133\u0026ndash;41.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eFrieden TR, Garg R, Moran AE, Whelton PK. Improved hypertension care requires measurement and management in health facilities, not mass screening. Lancet. 2025;405(10492):1879\u0026ndash;82.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eIdris H, Nugraheni WP, Rachmawati T, Kusnali A, Yulianti A, Purwatiningsih Y, et al. How is telehealth currently being utilized to help in hypertension management within primary healthcare settings? A scoping review. Int J Environ Res Public Health. 2024;21(1):90.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eFontil V, Gupta R, Moise N, Chen E, Guzman D, McCulloch CE, et al. Adapting and evaluating a health system intervention from Kaiser Permanente to improve hypertension management and control in a large network of safety-net clinics. Circulation: Cardiovasc Qual Outcomes. 2018;11(7):e004386.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSambah F, McBain-Rigg K, Seidu A-A, Emeto TI, editors. A qualitative study on the barriers and enablers to effective hypertension management in Ghana. Healthcare: MDPI; 2025.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eNozato Y. Hypertension research 2024 update and perspectives: blood pressure management. Hypertens Res. 2025:1\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Lived experience, Hypertension, Phenomenological Study, Ethiopia","lastPublishedDoi":"10.21203/rs.3.rs-7381169/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7381169/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e\u003cp\u003eHypertension present substantial and increasing challenge in Ethiopia. Significant knowledge gaps remain about how patients experience and manage the condition within their social, cultural, and economical context. Therefore, this study aimed to asses lived experience of patients with hypertension in Ethiopia using qualitative approach. The study might contribute to address the existing gaps in managements and controlling of hypertension, and support sustainable, equitable, and patient centered hypertensive patient care in Ethiopia. This study aimed to asses lived experience of patients with hypertension in Ethiopia using qualitative phenomenological study using socioecological model, July, 2025\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003e Data was collected from participants who are lived experience with HTN in north west Amhara tertiary hospitals, Ethiopia in July, 2025. Participants were recruited using purposive sampling. The study was used heterogeneous sampling technique to recruit study participants, which included all age groups above 18 years old and both male and female living with HTN were incorporated. Data was collected using the local language (Amharic) so that translated in to English for coding and analysis. Data was imported and analyzed using the ATLAS Ti, v. 7 software following standardized transcription. A thematic analysis was used to analyze the data. To possess the rigor and trustworthiness of the study, credibility, dependability, confirmability, and transferability were considered.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eThe eight themes that emerged from the analysis are (1) Emotional and cognitive response to diagnosis with two sub-themes comprises existing initial reaction and patient understanding of hypertension (HTN); (2) health provider interaction and communication with a sub-theme includes health care support and information. (3) adaptation and self-management with three subthemes comprehending lifestyle changes and medication use, (4) treatment challenges and complications, which include medication side effects, access to medication, and adherence to treatment, (5) social and family support, which contains two themes, including family, friends, and social encouragement and assistance, (6) Impact on daily life comprises two, which include daily activities (work) and functioning and social life. (7) Perception and perception of control through two themes that encompass belief in treatment efficacy and disease understanding (8) health care system and access barriers through three themes, which include transportation barriers, long waiting times, and quality of health services.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e\u003cp\u003eThis study implied tailored patient education, strength, provider communication, and community engagement are essential for improving adherence and health outcome. Majority of the participates stated they had varied emotional and physical reaction up on being realization of their hypertension. Most of them accepted the condition coolly. Prior experience of knowledge about hypertension through family history, media significantly affect their initial emotional reaction to the diagnosis. Interaction with health providers mainly influenced patients\u0026rsquo; understanding of their illness condition. The most important theme got from participants\u0026rsquo; experience was how they adapted to living with hypertension. Those include, lifestyle changes, adherence to dietary restriction and treatment. The majority of participants reported that hypertension had minimal impact on their daily life, activities and social life. Some participants identified substantial health system challenges that complicated their hypertension management for instance, transportation, medication unavailability\u0026rsquo;s, and longtime waiting.\u003c/p\u003e","manuscriptTitle":"Lived Experience of People With Hypertension in Ethiopia: A Phenomenological Study, 2025","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-09-22 08:39:11","doi":"10.21203/rs.3.rs-7381169/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"004cbdc6-495d-4b75-bdd8-f7b52061fec9","owner":[],"postedDate":"September 22nd, 2025","published":true,"recentEditorialEvents":[{"type":"decision","content":"Rejected","date":"2026-05-06T09:51:16+00:00","index":"","fulltext":""}],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-05-06T09:58:14+00:00","versionOfRecord":[],"versionCreatedAt":"2025-09-22 08:39:11","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7381169","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7381169","identity":"rs-7381169","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}