Uncontrolled hypertension is a leading risk factor for mortality globally and affects 26% of adults in India. Underdiagnosis is a primary cause of poor hypertension control as only 37% of Indians with hypertension are diagnosed. To increase diagnosis, Indian guidelines recommend that clinicians opportunistically screen adults for hypertension at all points of care. This recommendation has substantial policy potential since Indian adults report frequent health care visits. Underdiagnosis despite guideline recommendations and frequent visits suggests that clinicians are not consistently screening for hypertension, leading to missed opportunities for increasing diagnosis. While there is evidence of poor guideline adherence in other care domains, there is limited research on clinician adherence to hypertension screening guidelines in India

This article presents findings from a study conducted in two primary health facilities in Chennai and Kolkata. The findings and the broader literature from India suggest that quality-improvement interventions need to directly target clinician behavior. Commonly used approaches for clinician behavior change, such as financial incentives and sanctions, may be challenging to implement in India due to limited resources, oversight, and regulation. In India, approaches such as clinical support systems, task-shifting, and nonfinancial incentives may be more practical. Changing clinician behavior is crucial to translating India’s ongoing primary care improvement efforts into increased hypertension control.