What drives patients to utilise regular hypertension care at primary health care facilities in Vietnam? A sequential mixed-methods study.

Abstract

BackgroundVietnam has expanded primary health care (PHC) services and the health insurance (HI) scheme to increase access to NCD services at PHC facilities.ObjectivesTo examine patterns of regular hypertension care across health facility levels, identify factors associated with PHC use, and explore barriers to regular PHC engagement.MethodsWe conducted a sequential explanatory mixed-methods study. The quantitative phase analysed a household survey conducted in six provinces, including 1,706 adults with self-reported hypertension. Regular care was categorised as no regular facility-based care, PHC care, or non-PHC care. Multinomial logistic regression analyses identified factors associated with care-seeking. The qualitative phase involved in-depth interviews with 13 patients in two rural communes within Hanoi city. Interviews were audio-recorded, transcribed verbatim, and analysed using reflexive thematic analysis.ResultsOverall, 44.2% of patients did not seek regular care. Among those seeking regular care, less than half used PHC-level services: 23.7% attended district hospitals and 23.5% visited commune health stations. Older age, rural residence, lower socioeconomic status, good hypertension knowledge, health insurance ownership, and NCD comorbidity were associated regular care for hypertension at the PHC level. Qualitative findings revealed barriers at both individual and system levels. At the individual level, misconceptions, limited awareness, and financial constraints, despite high HI coverages, led to irregular care, prompting patients to resort to self-medication or traditional remedies. At the system level, structural challenges, including out-of-pocket costs, medicine stockouts, long waiting times and poor provider communication, weakened patients' trust and continuity of care at PHC facilities.ConclusionHI and PHC reforms have improved access, particularly for disadvantaged groups, but implementation gaps still limit regular hypertension care. Improving patient education, medicine availability, service organisation and provider communication is essential for stronger PHC-based chronic disease management.