Why Blood Pressure Remains Uncontrolled Among Working Adults in Thailand: A Qualitative Study

Background: Uncontrolled hypertension remains a major public health concern and a leading risk factor for stroke and other cardiovascular diseases. Despite effective treatments, blood pressure control among working adults remains suboptimal, particularly at the community level. Working adults often face challenges related to occupational demands, family responsibilities, and limited access to continuous care, which may hinder adherence to hypertension management and stroke prevention behaviors. Understanding these barriers may help guide interventions that are more appropriate for community settings. Objective: This qualitative descriptive study aimed to explore barriers to blood pressure control among working adults with uncontrolled hypertension receiving care at sub-district health promoting hospitals in Pathum Thani Province, Thailand, guided by the Ecological Model. Methods: Data were collected from 39 working adults with uncontrolled hypertension and 5 community health nurses through focus group discussions and semi-structured interviews. Audio-recorded interviews were transcribed verbatim and analyzed using thematic analysis. Results: Three main themes emerged across ecological levels. Individual-level barriers included knowledge gaps and low awareness, inconsistent medication adherence, and work–life imbalance. Family-level barriers involved caregiving responsibilities, financial and family obligations. Healthcare system and social-level barriers included workforce constraints, lack of social support and traditional education limitations. Conclusion: Improving health literacy, strengthening family support, and increasing access to flexible healthcare services may help working adults better manage their blood pressure.