MEDIA PENELITIAN DAN
PENGEMBANGAN KESEHATAN
Vol 35 No 4.
Desember 2025 e-ISSN: 2338-3445 p-ISSN: 0853-9987 BARRIERS TO HYPERTENSION THERAPY ADHERENCE:
A SCOPING REVIEW
Hambatan terhadap Kepatuhan Terapi Hipertensi: A Scoping Review Tiara Amidhea Febriyanti1* .
Sri Winarni2 .
Zen Rahfiludin3 Department of Health Promotion.
Universitas Diponegoro.
Semarang.
Indonesia Department of Biostatistics and Population.
Universitas Diponegoro.
Semarang.
Indonesia Department of Public Health Nutrition.
Universitas Diponegoro.
Semarang.
Indonesia *Email: tiaraamidheaf26@gmail.
ABSTRAK
Hipertensi merupakan penyakit kronik tidak menular bersifat Ausilent killerAy tidak menunjukkan gejala yang jelas yang dapat menyebabkan komplikasi serius jika tidak di Penelitian ini bertujuan untuk mengidentifikasi dan memetakan hambatan yang mempengaruhi kepatuhan pasien terhadap terapi hipertensi, baik pengobatan farmakologis maupun perubahan gaya hidup, serta mengeksplorasi faktor sosial, psikologis, ekonomi, budaya, dan sistem kesehatan yang berkontribusi terhadap rendahnya kepatuhan pasien.
Penelitian ini menerapkan metode cakupan berdasarkan kerangka kerja yang ditulis oleh Arksey dan O'Malley.
Artikel dicari melalui data dasar Science Direct.
Scopus, dan ProQuest dengan menggunakan kata kunci ("Antihipertensi" ATAU "Hipertensi") DAN ("Hambatan") DAN ("Orang Dewasa") DAN ("Terapi" ATAU "Perawatan") DAN ("Modifikasi gaya hidup"), meliputi publikasi tahun 2020 sampai dengan 2025, berbahasa Inggris dan teks lengkap.
Setelah melalui tahap seleksi, diperoleh 21 artikel yang memenuhi kriteria inklusi untuk dianalisis lebih lanjut.
Analisis ini menunjukkan ada berbagai hambatan kepatuhan terapi yaitu faktor pasien, terapi, kondisi medis, sosial ekonomi dan sistem kesehatan.
Faktor pasien kurangnya pengetahuan, literasi kesehatan rendah, dan motivasi rendah.
Faktor terapi meliputi efek samping obat dan ketersediaan obat tidak konsisten.
Faktor kondisi medis yaitu komorbiditas, hipertensi asimtomatik.
Faktor sosial ekonomi yaitu pendapatan rendah dan pendidikan rendah.
Faktor sistem kesehatan meliputi komunikasi rendah dan perawatan primer terbatas.
Hambatan tersebut bersifat kompleks dan saling terkait.
Meningkatkan kepatuhan membutuhkan pendekatan holistik yang mempertimbangkan aspek individu, sosial, budaya dan sistem kesehatan.
Kata kunci: hambatan kepatuhan, hipertensi, kepatuhan terapi, scoping review
ABSTRAK
Hypertension is a chronic non-communicable disease that is a Ausilent killerAy with no obvious symptoms that can cause serious complications if left untreated.
This study aims to identify and map the barriers affecting patient adherence to hypertension therapy, both pharmacological treatment and lifestyle changes, as well as explore the social, psychological, economic, cultural, and health system factors that contribute to low patient This study applies a scoping method based on the framework written by Arksey and O'Malley.
Articles were searched through the Science Direct.
Scopus, and ProQuest databases using the keywords (AuAntihypertensiveAy OR AuHypertensionA.
AND (AuBarriersA.
AND (AoAdultsA.
AND (AuTherapyAy OR AuCareA.
AND (AuLifestyle ModificationA.
, covering publications from 2020 to 2025, in English and full text.
After the selection process, twenty-one articles meeting the inclusion criteria were analyzed.
This analysis revealed various barriers to treatment adherence, namely patient factors, treatment factors, medical conditions, socioeconomic factors, and healthcare system factors.
Patient factors included lack of knowledge, low health literacy, and low motivation.
Treatment factors included drug side effects and inconsistent drug availability.
Medical condition factors included comorbidities and asymptomatic hypertension.
https://doi.
org/10.
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MEDIA PENELITIAN DAN
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Vol 35 No 4.
Desember 2025 e-ISSN: 2338-3445 p-ISSN: 0853-9987 Socioeconomic factors included low income and low education.
Health system factors included poor communication and limited primary care.
These barriers are complex and Improving adherence requires a holistic approach that considers individual, social, cultural, and health system aspects.
Keywords: barriers to compliance, hypertension, scoping review, treatment
INTRODUCTION
Hypertension is one of the biggest global health problems, with a prevalence of more than 1 billion people worldwide .
This condition is a major cause of cardiovascular disease, including stroke and heart disease, and contributes to approximately 9.
4 million deaths each year .
The WHO reports that only one in five people with hypertension successfully controls their blood pressure .
The high prevalence and low control rate have led to hypertension being dubbed the Ausilent killerAy because it often goes undetected until complications arise .
Risk factors for hypertension are divided into unmodifiable factors, such as age, gender, and genetics, and modifiable factors such as obesity, salt intake, high-fat diet, smoking, alcohol, stress, and lack of physical activity.
Prevention efforts through healthy lifestyle changes and early detection are key strategies in reducing the global burden of hypertension .
Pathophysiologically, hypertension is divided into primary hypertension .
Ae95% of case.
, which is influenced by genetic and lifestyle interactions, and secondary hypertension .
Ae10% of case.
due to kidney disease, hormonal disorders, or the use of certain medications.
Blood pressure increases due to peripheral resistance, sodium retention, and hormonal dysregulation that disrupts blood vessel elasticity.
Adherence to therapy plays an important role in keeping blood pressure under control and preventing further complications .
However, many patients remain noncompliant with treatment and lifestyle changes due to limited knowledge, perceptions of vulnerability, disease severity, and self-efficacy .
Therefore, further research on risk factors, pathophysiological mechanisms, and treatment adherence is essential as a basis for hypertension control interventions.
, .
In addition to the factors mentioned above, psychosocial and cultural factors also play a significant role.
Studies show that stress, anxiety, depression, and social stigma associated with long-term medication use can reduce patient adherence.
Reliance on traditional or herbal remedies, which are cheaper and more reliable in some communities, is also a reason for patients to discontinue prescribed antihypertensive medication .
This study shows that adherence is influenced by complex factors such as personal beliefs, risk perception, self-efficacy, social stigma, family support, financial constraints, and access to healthcare, which vary across local contexts, including reliance on traditional medicine and high-salt dietary habits.
Although many studies have examined patient adherence to hypertension therapy, most focus only on partial aspects such as individual behavior or drug-related side effects.
There is still a lack of comprehensive studies that map barriers to adherence across multiple dimensions Ai including patient, therapeutic, medical, socioeconomic, cultural, and health system This gap highlights the need for a scoping review that synthesizes findings from various studies to provide an integrated perspective.
By identifying these multidimensional barriers, this review aims to generate evidence that can serve as a basis for holistic interventions to improve therapy adherence and reduce hypertension Therefore, this study aims to identify barriers to adherence in hypertension patients, both related to medication and lifestyle changes, as well as the social, psychological, economic, cultural, and healthcare system factors that influence https://doi.
org/10.
34011/jmp2k.
e-ISSN: 2338-3445
p-ISSN: 0853-9987
MEDIA PENELITIAN DAN
PENGEMBANGAN KESEHATAN
Vol 35 No 4.
Desember 2025 Identification METHODS This study employs a scoping review methodology to map barriers influencing compliance among patients with hypertension, both related to medication and lifestyle changes, with the methodological framework of Arksey and O'Malley .
Articles were searched through Science Direct.
Scopus, and ProQuest databases using keywords (AuAntihypertensiveAy OR AuHypertensionA.
AND (AuBarriersA.
AND (AuAdultsA.
AND (AuTherapyAy OR AuTreatmentA.
AND (AuLifestyle modificationA.
, covering full-text English publications from 2020Ae2025.
The search yielded 961 articles .
from Science Direct, 50 from Scopus, and 650 from ProQues.
After thorough screening and reading, 29 articles were identified, and 8 were removed for not meeting the inclusion criteria, leaving 21 articles for further analysis.
The selection process is shown in the Prisma Flowchart in Figure 1.
Total Records identified from :
All sources .
Scopus .
Science Direct .
Proquest .
Screening Total Records after duplicates removed .
=936 ) Records Selected by title .
=40 ) Included Records Selected by abstract .
= .
Duplicates Excluded .
Records excluded .
Records excluded .
Reports excluded:
Not RCT= 1 Not Digital/M health Intervention= 1 Intervention Not Inclusion=3 Population Not Relevant = 1 Among the studies were .
Figure 1.
PRISMA Flowchart Identifying Research Questions The research questions identified are as follows: What are the main obstacles that influence patient compliance with hypertension therapy, both in the form of medication and lifestyle changes, and what are the social, psychological, economic, cultural, and health system factors that cause low compliance with hypertension therapy?.
Identification of Relevant Studies and Study Selection Through a literature search in several databases such as Science Direct.
Scopus, and Proquest.
The search was conducted using keywords ("Antihypertensive" OR "Hypertension") AND ("Barrier") AND ("Adult") AND ("Therapy" OR "Treatment") AND ("Lifestyle Modification").
Articles published between 2020 and 2025 and in English.
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Desember 2025 Minimum 6 months old.
Selected articles were in English, available in full text, and open access .
The study selection process used the Rayyan application to screen articles.
Articles were uploaded to Rayyan and screened based on predetermined inclusion and exclusion criteria, such as discussing barriers to adherence to hypertension therapy in adults, being relevant, being in English, and being published in the last five years.
Duplicate articles were removed, and then title and abstract screening were performed.
Articles that did not address barriers to adherence, were published within the last five years, involved individuals under 40 years of age, were not open access, or were not in English were Articles that met the criteria proceeded to full-text screening.
Data extraction The data extraction process was performed periodically using Microsoft Excel.
The extraction table included information such as the identity of the study author, year, country, objective, study design, location, population, and factors associated with barriers to adherence to hypertension therapy .
RESULT
Characteristics of research Author.
/Year/Title Hussien dkk.
, 2021 .
/ AuThe Role of Health Care Quality in Hypertension SelfManagement: A Qualitative Study of the Experience of Patients in a Public Hospital.
North-West Ethiopia.
Ay Shim et al, 2020 .
/ AuFactors adherence to the guidelines for prevention and treatment Korean adults with and without hypertension.
Ay Yaqoob dkk, 2022 .
/ AuAwareness, treatment, and patients attending the tertiary care hospital of Karachi: A cross-sectional study.
Ay Adeola J.
Obiezu F Odukoya O.
Igwilo U.
Usinoma A.
Bahiru E.
May FP, dkk.
AuBarriers and Facilitators to Risk Reduction Cardiovascular Disease in NigeriaAy Tjandrarini dkk, 2024 .
/ Au Pandemic Pressure:
Table 1.
Data Charting Study Objective Locations Experiences of Bahir Dar.
Hypertension patients Etiopia regarding the quality of Barat Laut health service and selfmanagement practice To identify factors adherence to dietary hypertension in Korean adults, both with and without hypertension To evaluate the level of awareness, treatment, and lifestyle change hypertensive patients diagnosed and are undergoing treatment perceptions of heart hypertensive patients and identify barriers and enabling factors to reduce the risk of heart to analyze compliance Methods Population & Sample Qualitative, ical approach, in-depth 11 patients and 2 nurses were selected purposively using the maximum variation South Korea Quantitative, survey using and physical Population :
Adults aged 34 Ae 69 years from the CMERC cohort study Sample :
497 individuals purposively sampled .
ollow-up data from cohort participant.
Distrik Korangi Karachi.
Pakistan Quantitative Method (Questionnaire Lagos University Teaching Hospital Crosectional, survey, semiquantitative using closed Observational with two data Population:
Hypertensive patients treated as outpatients and inpatients at Jinnah Medical College Hospital Sample :
Population :
Hypertensive receiving outpatient care at cardiology, nephrology, and family medicine clinics Sample:
256 hypertension patients Bogor City.
West 880 hypertensive patients https://doi.
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Desember 2025 Author.
/Year/Title Objective Changes in Hypertensive Management Adherence in Indonesia.
Ay including therapy and monitoring, before and during the COVID-19 experiences of elderly hypertensive patients in Bangkok regarding Assessing socioeconomic factors hypertensive patients in Lombok.
Indonesia Apichaya Kongsa.
Praleena Thongsri.
Araya Chiangkhong.
Angkana Chongjarearn .
/ Au Perceptions of Medication Adherence among Elderly Patients with Hypertension in Bangkok: A Qualitative Study Setiadi AP.
Widiyastuti S.
Mariati IGAD.
Sunderland B.
Wibowo YI .
/ AuSocioeconomic impacts on medication adherence among patients with hypertension: A cross-sectional study in Lombok.
Indonesia Diane Macquart de Terline .
/ Au Poor adherence to medication and salt restriction as barriers to reaching blood pressure control in patients with Crosectional study from 12 subSaharan countries.
Ay Anika Bushra Boitchi.
Shabnam Naher.
Sabbir Pervez.
Md.
Majibul Anam .
/ Au Patients understanding, management practices and challenges regarding hypertension: A hypertensive women in a rural Bangladesh.
Ay Gebremedhin Hailu.
Muluken Yigezu.
Hardof Gutema, dkk.
/ AuSelf-care factors among hypertensive patients who have follow-ups in public hospitals of BahirDar City.
Northwest Ethiopia:
a mixed study Assen Muhe dkk.
/ Au Self-care behaviors and Associated Patients at Dassie Study Locations Java.
Indonesia Bangkok.
Thailand Methods Population & Sample sources .
repandemic from a 2019 cohort study, and a Qualitative, indepth purposively because they meet the research criteria Lombok Island.
West Nusa Tenggara Province.
Indonesia Multicentre cross-sectional Population :
Outpatients with hypertension in 6 public hospitals Sample:
693 hypertensive patients To assess adherence to medication and salt hypertensive patients in 12 Sub-Saharan African countries, and relationship between adherence and blood pressure control.
challenges of women with hypertension in rural Bangladesh Afrika SubSaharan Crosectional Population :
Hypertensive Sample:
Kushtia.
District.
Banglade Qualitative study with a ical approach, using in-depth Population :
Women with hypertension in rural areas Sample:
ged 35-65 year.
were selected using purposive and snowball sampling To assess self-care associated factors, and explore barriers to hypertensive patients Northwest Ethiopia A descriptive cross-sectional To assess self-care behaviors and related factors in outpatients Dessie.
Ethiopia Mixedmethods Population :
All hypertensive patients undergoing routine check-ups at public hospitals Sample:
Quantitative:
hypertensive patients Qualitative: 8 participants purposively selected for indepth interviews Population :
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Desember 2025 Study Locations Timur Laut Author.
/Year/Title Objective Referral Hospital.
Northeast EthiopiaAo with hypertension at Dassie Referral Hospital.
Ethiopia Alireza Ghannadi.
Fatemeh Mohammadkhah.
Pooyan Afzali Harsini.
Afsaneh Ghasemi.
Amirhossein Kamyab.
Ali Khani Jeihooni .
/ AuEffect of Educational intervention by application of PRECEDEPROCEED model on Lifestyle Change Hypertensive Patients.
Ay Yusupha Dibba dkk.
/ AuNon-communicable disease care in Sierra Leona:
a mixed-methods study of the drivers and barriers to To assess self-care associated factors in hypertensive patients at a public health facility in Bule Hora Ethiopia Oromia.
Ethiopia Selatan To analyze the drivers hypertension care in Sierra Leona Sanju Bhattarai dkk, .
/ AuFacilitators and barriers to hypertension management in urban Nepal: findings from a qualitative study.
Ay Yingxian Sun.
Jianjun Mu.
Dao Wen Wang, dkk.
/ Au A Village doctor-led multifaceted intervention for blood pressure control in rural China: an open, cluster randomised trial.
Ay Chonticha Chantakeeree dkk, .
/ Au Understanding healthpromoting behaviors among older adults with hypertension Rose Clarke Nanyonga.
Lori Spies.
Florence Nakaggwa .
Au The effectiveness Methods Population & Sample an explanatory data through and qualitative in-depth Quantitative.
Crosectional design, using All 4,612 patients undergoing routine check-ups Sample: 370 hypertensive patients .
respondents, quantitative and 14 for qualitative, selected using purposive sampling Population :
Hypertensive patients at the Bule Hora Town Public Health Sample:
selected using systematic random sampling Kono District.
Sierra Leona Mixedmethods study:
data analysis and qualitative To explore factors that facilitate and hinder management in urban Nepal, interpersonal, health community factors.
intervention led by control blood pressure in rural communities Kathmand u.
Nepal Quasiexperimental pre- and posttest Population :
Hypertensive patients at the NCD Clinic Sample :
1,628 patients .
ualitative: 13 adherent patients, 8 LTFU, 7 staf.
Population :
HIV patients in two tertiary hospitals in Kaduna State.
Nigeria Sample:
226 HIV patients .
in the intervention group, 113 in the control grou.
District Kasungu.
Malawi Population :
Village Health Workers in Kasungu Sample:
35 Village health workers who met the inclusion criteria experiences of elderly hypertension regarding nurse-led Chonburi.
Thailand Quasiexperimental pre- and posttest Qualitative with Mixed methods Population :
Kumpala.
Uganda Population :
Elderly .
ged Ou 60 year.
Sample:
40 elderly individuals who met the following inclusion criteria https://doi.
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Desember 2025 Study Locations Author.
/Year/Title Objective Methods Population & Sample nurse-led interventions on hypertension management: A mixed method studyAy:
intervention on lifestyle and qualitative Hypertensive undergoing treatment at an outpatient clinic.
Sample:
attendend Ou 3 intervention 16 participants for focus groups.
2 nurse educator for interviews Population :
Patients essential hypertension for at least 1 year and undergoing antihypertensive therapy for at least 6 months Sample:
581 hypertensive patients .
from PHC and 251 from SHC Population :
Outpatients with a diagnosis of hypertension Sample:
A total of 849 outpatients with hypertension were recruited by simple random sampling during the clinic visit.
Population :
Hypertensive patients aged Sample :
25 hypertensive patients IDIs 16 hypertensive FGDs 5 Family members, 11 health workers, and 4 key informants Horvat O.
Halgato T.
StojiNMilosavljeviN A, dkk .
/ Au Identification of patient-related, healthcarerelated knowledgerelated factors associated outpatients: a cross-sectional study in Serbia Pedro Pallangyo dkk .
/ Au Medication Adherence and Blood Pressure Control Among Hypertensive Outpatients Attending Tertiary Cardiovascular Hospital in Tanzania: A Cross-sectional study Buna Bhandari dkk .
/ Au Barriers and facilitators for treatment and control of high blood pressure among Kathmandu.
Nepal:
qualitative study informed by the COM-B model of behavior Khairulnissa Ajani.
Ambreen Gowani.
Raisa Gul.
Pamela Petrucka .
/ Au Levels and predictors of self-care hypertension in Pakistan To identify patient, health system, and pressure control.
Vojvodin.
Serbia Utara Crosectional study using a semistructured To explore the level of medication adherence and associated factors tertiary-level hospital in Tanzania.
Dar Salaam.
Tanzania Hospital-based cross-sectional To explore the barriers and supporting factors in the treatment and control of hypertension patients in Nepal.
Kathmand u.
Nepal Qualitative research using in-depth (IDI.
Focus group (FGD.
To assess the level of self-care behavior and hypertensive patients in Karachi.
Pakistan Karachi.
Pakistan Crosectional survey in a mixed-method .
Population :
Patient hypertension Sample:
A total of 21 articles published between 2020 and 2025 were reviewed, consisting of eight articles from developed countries .
he United States.
Canada, and the United Kingdo.
and three articles from developing countries (Thailand.
Turkey, and Brazi.
Seven articles employed qualitative methods, two used mixed methods, and two utilized quantitative approaches .
ross-sectional and cohort studie.
Nine articles were rated as high quality .
rade A), while two were rated as moderate quality .
rade B).
These articles provide a comprehensive understanding of hypertension management, including patient experiences, treatment adherence, and influencing factors across countries (Table .
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Desember 2025 Barriers to Adherence to Hypertension Therapy Table 2.
Data Charting Barriers to Adherence to Hypertension Therapy Obstacle Categories Patient Factors Therapeutic Factors Sub-Obstacles Medical Factors Low knowledge Low Health Literacy Low motivation Therapy fatigue Physical/cognitive limitations Belief in traditional medicine Drug side effects Complexity of the regimen Medicine is not available Evaluation of low blood Preference Comorbidities .
iabetes, kidney, etc.
Hypertension Not regularly monitoring blood pressure Low income Limited access to facilities Transportation costs Low education Job does not support Socioeconomic Factors Health System Factors Short consultation time Poor Lack of further education Medications consistently available Lack of primary care Results Patients often stop therapy when they feel well or believe in alternative treatments.
Low health literacy and lack of motivation worsen adherence.
Long-term medication fatigue and physical/cognitive impairments also contribute .
, .
, .
, .
Side effects such as dizziness or digestive problems cause patients to discontinue their medications.
Complicated medication schedules are confusing.
Inconsistent drug availability in healthcare facilities, and some patients consider traditional medicine safer .
, .
, .
, .
, .
Patients with comorbidities often struggle with Because hypertension is often asymptomatic, many patients fail to take their medication regularly.
Lack of home blood pressure monitoring is also a challenge .
, .
, .
, .
High medical and transportation costs are barriers, especially for those without insurance or living in remote Low levels of education contribute to a lack of understanding of the importance of therapy.
Busy work schedules also hinder access to healthcare .
, .
, .
, .
, .
Patients receive inadequate information due to short consultations and high workloads among medical staff.
Continuing health education is lacking.
The quality of primary care is low and uneven across many regions.
Logistical barriers force patients to purchase medications outside of healthcare facilities .
, .
, .
, .
, .
DISCUSSION This review aimed to identify key barriers affecting adherence in hypertensive patients, both to treatment and lifestyle changes, and to explore contributing social, psychological, economic, cultural, and health system factors.
The results indicate that these barriers are complex and interconnected.
Patient Barrier Factors This review shows that individual factors play a significant role in poor adherence to hypertension therapy.
Many patients lack an understanding of hypertension as a chronic disease and the importance of regular blood pressure monitoring .
, .
, so they stop the medication when they feel well .
Low health literacy, especially in patients with low education, makes it difficult for them to understand medical instructions .
, .
Low health literacy, especially in patients with low education, makes it difficult for them to understand medical instructions .
, .
Low motivation and lack of self-efficacy cause patients to be reluctant to make lifestyle changes such as a low-salt diet and exercise .
, .
Fatigue from taking long-term medication is also an obstacle .
, .
In addition, comorbidity and polypharmacy cause confusion regarding medication https://doi.
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, .
, physical and cognitive limitations hinder compliance .
, .
, as well as belief in traditional medicine or prayer causes inconsistency in therapy .
, .
Factors Inhibiting Therapy Side effects of antihypertensive drugs, such as dizziness, fatigue, and digestive disorders, often cause patients to stop or reduce the dose of the drug .
, .
The complexity of the regimen, especially for patients with comorbidities, causes confusion and reluctance to take medication regularly .
, .
Inconsistent drug availability in healthcare facilities also disrupts therapy, as patients must purchase them from pharmacies at higher prices .
, .
Lack of blood pressure monitoring and compliance evaluation leads patients to stop therapy when they feel well .
, .
In addition, the use of traditional or herbal medicines is considered safer .
, .
, as well as a lack of understanding of the long-term goals of treatment .
, .
, also reduces compliance.
Barrier Factors to Medical Conditions Many hypertensive patients have comorbidities such as diabetes, dyslipidemia, or kidney disease, which add to the complexity of therapy and increase the risk of side effects, thus reducing compliance .
, .
Side effects of the drug, such as dizziness, headaches, and digestive disorders, also make patients reluctant to continue therapy .
, .
Because hypertension is often asymptomatic, patients only take medication when symptoms occur .
, .
In addition, the use of traditional medicines without standard doses makes patients ignore medical drugs .
, .
Lack of home blood pressure monitoring and limited routine check-ups result in patients not understanding their blood pressure status .
, .
Socioeconomic Factors Low-income patients often cannot afford antihypertensive drugs, especially if they are not available free of charge at health facilities .
, .
, .
, leading to discontinuation of therapy or seeking alternatives.
Lack of health insurance also reduces compliance because the costs are borne out-of-pocket .
Rural patients have difficulty accessing healthcare services due to long distances, high transportation costs, and limited facilities .
, .
Low education levels result in low patient health literacy, making it difficult to understand the importance of treatment .
, .
In addition, in some cultures, health care expenses are not a priority compared to family needs .
Transportation barriers .
and job instability also make it difficult for patients to have regular check-ups or buy medication .
Factors Inhibiting the Health System Health system barriers include structural and service constraints, including inconsistent drug availability that requires patients to purchase from pharmacies at high prices .
, .
, .
Short consultation times due to high workloads reduce education about hypertension therapy .
, .
Ineffective communication makes patients reluctant to ask questions .
, .
, and a lack of ongoing education reduces patient understanding .
, .
During the COVID-19 pandemic, primary health care services were suboptimal, resulting in patients losing access to blood pressure monitoring .
Geographical barriers such as distance and high transportation costs also hamper routine check-ups .
, as well as infrastructure limitations, such as blood pressure measuring devices in primary facilities limit therapy evaluation .
This scoping review excels in comprehensively mapping barriers to adherence to hypertension therapy from individual, social, economic, cultural, and health system perspectives.
The methodology follows the Arksey and O'Malley framework, with literature sources from reputable databases and diverse study contexts.
However, its limitation is that it only includes English-language articles from 2020Ae2025 without an in-depth methodological quality Consequently, the results of this review are crucial for designing evidence- https://doi.
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Desember 2025 e-ISSN: 2338-3445 p-ISSN: 0853-9987 based interventions with a holistic approach to improve adherence and access to services in resource-limited populations.
CONCLUSION
The review results indicate that adherence in hypertensive patients is influenced by various multidimensional barriers.
Individual factors such as understanding, health literacy, motivation, therapy fatigue, comorbidities, and physical or cognitive limitations are key challenges.
Therapeutic factors include medication side effects, regimen complexity, inconsistent medication availability, and the use of traditional medicine.
Other barriers include medical conditions, socioeconomic factors such as income, access to healthcare, education, transportation, and employment, and health system factors such as ineffective communication, limited ongoing education, and low-quality primary care.
Therefore, a comprehensive approach is needed through effective education, increased health literacy, improved services and communication, and socioeconomic support to improve patient adherence and quality of life and prevent
ACKNOWLEDGEMENT
The authors would like to thank all those who assisted in the preparation of this review, particularly the review team for their valuable input, and the institutions and universities that supported this research.
Appreciation is also extended to the authors of the articles used as reference sources.
REFERENCES