Cultural and Contextual Barriers to Sustained Home Blood Pressure Monitoring Practices Among Indigenous People in Northern Thailand: A Qualitative Study.

Background: Hypertension is a global health concern and a leading cause of unexpected death, especially among vulnerable populations. Although home blood pressure monitoring (HBPM) is effective for self-management and prevention, adherence remains suboptimal, particularly in ethnic minority communities where socio-cultural factors influence behavior. This study explored cultural and contextual barriers to sustained HBPM among the Indigenous Akha population in Chiang Rai, Thailand. Methods: A descriptive qualitative design was used from February to April 2023. Three focus group discussions were conducted among ten purposively sampled Akha individuals at risk for hypertension in Chiang Rai Province, Thailand. Researchers analyzed the data using inductive thematic analysis based on the six-phase framework outlined by Braun and Clarke, a manual approach conducted without the use of qualitative data analysis software. Results: Participants included ten Akha individuals aged 47-62 years. Three themes and seven sub-themes were identified as barriers: "cultural beliefs and illness perception" (symptom-based recognition, fear of lifelong medication use, traditional beliefs and community norms); "misalignment between national guidelines and local realities" (competing priorities of work and livelihood demands, lack of flexible, community-centered support); and "system-level obstacles to consistent monitoring" (lack of awareness and informational support, logistical and social barriers to accessing care). Conclusion: The complex barriers to HBPM among Indigenous populations emphasize the need for tailored health strategies that reflect unique social, cultural, and economic context of each community. Its findings are relevant not only in Thailand but also globally, offering guidance for improving health equity and chronic disease management in underserved groups.