A study has shown numerous deficiencies in the quality of hypertension and diabetes primary care in Barbados, despite distribution of regional guidelines.

Current hypertension and diabetes guidelines were considered by some primary health care providers to be outdated, unavailable, difficult to remember and lacking in advice to tackle barriers. Practitioners thought that guidelines should be circulated widely, promoted with repeated educational sessions and kept short. Patient-oriented versions of the guidelines were welcomed.

Patient factors causing barriers to ideal outcome included denial and fear of stigma; financial resources to access an appropriate diet, exercise and monitoring equipment; confusion over medication regimens, not valuing free medication, belief in alternative medicines and being unable to change habits.

System barriers included lack of access to blood investigations, clinic equipment and medication; lack of human resources in polyclinics; and an uncoordinated team approach.

Patients faced cultural barriers with regards to meals, exercise, appropriate body size, footwear, medication taking and taking responsibility for one’s health; and difficulty getting time off work to attend a clinic.

Suggestions for how the health care system could help providers improve the health of those with diabetes and hypertension included educating both the public and persons with the condition, screening programs, providing free home monitors and adequate staffing.

Suggestions for how the wider society could help providers improve the health of those with diabetes and hypertension involved educational outreach to promote family support in managing the condition (cooking, encouraging exercise, giving insulin); a greater role for volunteer groups and retired persons in providing education, support, exercise groups and screening programs; starting associations for hypertension, hyperlipidemia and diabetes; the provision by the government of sidewalks and bicycle lanes for safe exercise; healthy food choices at schools and work places; a tax on unhealthy fast food and an attempt to bring down the cost of healthy food by the government; a requirement that fast food outlets provide healthy alternatives; labeling of all food to include fat, salt and calorie content; encouraging a kitchen garden program; time off by employers to attend appointments; and prominent persons with the disease should speak out to reduce stigma, and give hope that a good life can be had while living with chronic disease.

1. Adams OP, Carter AO. Diabetes and hypertension guidelines and the primary health care practitioner in Barbados: knowledge, attitudes, practices and barriers-a focus group study. BMC Family Practice 2010; 11: 96. (open access)