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Culhane-Pera KA, Vang KB, Ortega LM, Xiong T, Northuis CA, de la Parra P, Lakshminarayan K. Mobile health technology for hypertension management with Hmong and Latino adults: mixed-methods community-based participatory research. ETHNICITY & HEALTH 2023; 28:413-430. [PMID: 35387531 PMCID: PMC9535036 DOI: 10.1080/13557858.2022.2059451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 03/23/2022] [Indexed: 05/05/2023]
Abstract
OBJECTIVE To identify Hmong and Latino adults' perspectives about a mHealth-based care model for hypertension (HTN) management involving blood pressure (BP) self-monitoring, electronic transmission of BP readings, and responsive HTN medication adjustment by a provider team. DESIGN We conducted a mixed-methods formative study with 25 Hmong and 25 Latino participants with HTN at an urban federally-qualified health center. We used a tool to assess HTN knowledge and conducted open-ended interviews to identify perspectives about mHealth-based care model. RESULTS While most participants agreed that lowering high blood pressure decreased the risk of strokes, heart attacks, and kidney failure, there were gaps in medical knowledge. Three major themes emerged about the mHealth-based care model: (1) Using mHealth technology could be useful, especially if assistance was available to patients with technological challenges; (2) Knowing blood pressures could be helpful, especially to patients who agreed with doctors' medical diagnosis and prescribed treatment; (3) Transmitting blood pressures to the clinic and their responsive actions could feel empowering, and the sense of increased surveillance could feel entrapping. Some people may feel empowered since it could increase patient-provider communication without burden of clinic visits and could increase involvement in BP control for those who agree with the medical model of HTN. However, some people may feel entrapped as it could breach patient privacy, interfere with patients' lifestyle choices, and curtail patient autonomy. CONCLUSIONS In general, Hmong and Latino adults responded positively to the empowering aspects of the mHealth-based care model, but expressed caution for those who had limited technological knowledge, who did not agree with the medical model and who may feel entrapped. In a shared decision-making approach with patients and possibly their family members, health care systems and clinicians should explore barriers and potential issues of empowerment and entrapment when offering a mHealth care model in practice.
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Affiliation(s)
| | | | | | - Txia Xiong
- SoLaHmo Partnership for Health and Wellness, Minnesota Community Care, St Paul, MN, USA
| | - Carin A Northuis
- Division of Epidemiology & Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Pilar de la Parra
- SoLaHmo Partnership for Health and Wellness, Minnesota Community Care, St Paul, MN, USA
| | - Kamakshi Lakshminarayan
- Division of Epidemiology & Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, USA
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Trost C, Heisinger S, Funovics PT, Windhager R, Hobusch GM, Stamm T. Patients' perception of changes and consequences after tumor resection : A qualitative study in Austrian patients with musculoskeletal malignancies. Wien Klin Wochenschr 2023:10.1007/s00508-022-02136-6. [PMID: 36595059 DOI: 10.1007/s00508-022-02136-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 11/24/2022] [Indexed: 01/04/2023]
Abstract
OBJECTIVE The aim of this study was to investigate the effects and consequences of surgical treatment of patients with musculoskeletal malignancies on everyday life. METHODS A modified form of grounded theory was used for data collection and analysis. Data collection was systematic and analyzed simultaneously and 16 interviews were conducted: 2 narrative, 11 guided and 3 expert interviews (surgeon, physical therapist, support group). Data collection and analysis alternated until no new codes could be found. Once theoretical saturation was achieved, the main category was formed and described using the literature. RESULTS The main category results from the combination of all categories and leads to the core category. In the center is the affected person and in the immediate environment are the patient's relatives/partners. In the next instance the primary care physician is necessary to establish a sense of normalcy. This depends on the individuality of the person and the restored possibilities of movement. CONCLUSION Based on the results, the necessity of implementing psychosocial care involving the social environment is shown. The importance of relatives/partners for recovery is emphasized. Furthermore, the communication between the specialists and family physicians should be simplified.
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Affiliation(s)
- Carmen Trost
- Department of Orthopedics and Trauma Surgery, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.
| | - Stephan Heisinger
- Department of Orthopedics and Trauma Surgery, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Philipp T Funovics
- Department of Orthopedics and Trauma Surgery, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Reinhard Windhager
- Department of Orthopedics and Trauma Surgery, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Gerhard M Hobusch
- Department of Orthopedics and Trauma Surgery, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Tanja Stamm
- Institute for Outcomes Research, Medical University of Vienna, Vienna, Austria
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3
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Horne CE, Stayt LC, Schutz S, Smith CM, Haberstroh A, Bolin LP, Taylor CL, Moosavi SH, Bibbey A. Symptom experiences in hypertension: a mixed methods systematic review. J Hypertens 2023; 41:1-16. [PMID: 36250472 DOI: 10.1097/hjh.0000000000003306] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
AIM Understanding patients' hypertension (HTN) symptoms can assist healthcare professionals' awareness of individual, cultural, and behavioral responses and improve diagnostic accuracy to optimize treatment. The purpose of this review was to evaluate and synthesize current literature exploring HTN symptoms. METHODS Databases searched included MEDLINE (PubMed), CINAHL (EBSCO), Scopus, and Web of Science from January 2010 to January 2022. The search followed the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. The McMaster critical review forms were used to determine the quality of both qualitative and quantitative articles. Synthesis of the data was guided by the Joanna Briggs Institute Convergent Integrated Approach to Mixed Study Systematic Reviews. RESULTS In total, 41 articles were included, nine qualitative studies and 32 quantitative. The quality of the articles varied. Symptoms included commonly reported symptoms and some less prevalent, including some reporting absence of symptoms. Factors that affected symptoms included culture, beliefs, psychosocial factors, and knowledge. We also found that there may be a bidirectional relationship between symptoms and behaviors that may lead to self-management. CONCLUSION HTN is common and symptoms are frequently reported. HTN management is related to multiple factors. Symptoms continue in a number of individuals after initial diagnosis. Evaluating symptoms after initial diagnosis may help to optimally manage and meet blood pressure guidelines.
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Affiliation(s)
- Carolyn E Horne
- School of Nursing, University of North Carolina - Charlotte, Charlotte, North Carolina, USA
| | - Louise C Stayt
- Oxford School of Nursing and Midwifery, Oxford Brookes University, Oxford, UK
| | - Susan Schutz
- Oxford School of Nursing and Midwifery, Oxford Brookes University, Oxford, UK
| | | | | | - Linda P Bolin
- College of Nursing, East Carolina University, Greenville, North Carolina, USA
| | - Catherine L Taylor
- College of Nursing, East Carolina University, Greenville, North Carolina, USA
| | | | - Adam Bibbey
- Health and Life Sciences, Oxford Brookes University, Oxford, UK
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4
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Figueroa JC, Paniagua-Avila A, Sub Cuc I, Cardona S, Ramirez-Zea M, Irazola V, Fort MP. Explanatory models of hypertension in Guatemala: recognizing the perspectives of patients, family members, health care providers and administrators, and national-level health system stakeholders. BMC Public Health 2022; 22:2320. [PMID: 36510216 PMCID: PMC9743515 DOI: 10.1186/s12889-022-14668-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 11/18/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Uncontrolled hypertension is a major public health burden and the most common preventable risk factor for cardiovascular diseases in Guatemala and other low- and middle-income countries. Prior to an initial trial that evaluated a hypertension intervention in rural Guatemala, we collected qualitative information on the needs and knowledge gaps of hypertension care within Guatemala's public healthcare system. This analysis applied Kleinman's Explanatory Models of Illness to capture how patients, family members, community-, district-, and provincial-level health care providers and administrators, and national-level health system stakeholders understand hypertension. METHODS: We conducted in-depth interviews with three types of participants: 1) national-level health system stakeholders (n = 17), 2) local health providers and administrators from district, and health post levels (25), and 3) patients and family members (19) in the departments of Sololá and Zacapa in Guatemala. All interviews were conducted in Spanish except for 6 Maya-Kaqchikel interviews. We also conducted focus group discussions with auxiliary nurses (3) and patients (3), one in Maya-Tz'utujil and the rest in Spanish. Through framework and matrix analysis, we compared understandings of hypertension by participant type using the Explanatory Model of Illness domains -etiology, symptoms, pathophysiology, course of illness, and treatment. RESULTS Health providers and administrators, and patients described hypertension as an illness that spurs from emotional states like sadness, anger, and worry; is inherited and related to advanced age; and produces symptoms that include a weakened body, nerves, pain, and headaches. Patients expressed concerns about hypertension treatment's long-term consequences, despite trying to comply with treatment. Patients stated that they combine biomedical treatment (when available) with natural remedies (teas and plants). Health providers and administrators and family members stated that once patients feel better, they often disengage from treatment. National-level health system stakeholders referred to lifestyle factors as important causes, considered patients to typically be non-compliant, and identified budget limitations as a key barrier to hypertension care. The three groups of participants identified structural barriers to limited hypertension care (e.g., limited access to healthy food and unaffordability of medications). CONCLUSION As understandings of hypertension vary between types of participants, it is important to describe their similarities and differences considering the role each has in the health system. Considering different perceptions of hypertension will enable better informed program planning and implementation efforts.
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Affiliation(s)
- Juan Carlos Figueroa
- INCAP Research Center for the Prevention of Chronic Diseases, Institute of Nutrition of Central America and Panama, Calzada Roosevelt 6-25 Zona 11, 01011, Guatemala City, Guatemala.
- Dornsife School of Public Health, Department of Epidemiology and Biostatistics, Drexel University, Urban Health Collaborative, Philadelphia, PA, USA.
| | - Alejandra Paniagua-Avila
- INCAP Research Center for the Prevention of Chronic Diseases, Institute of Nutrition of Central America and Panama, Calzada Roosevelt 6-25 Zona 11, 01011, Guatemala City, Guatemala
- Mailman School of Public Health, Department of Epidemiology, Columbia University, New York City, New York, USA
| | - Ingrid Sub Cuc
- Department of Native American Studies, University of California, Davis, Davis, CA, , USA
| | - Sayra Cardona
- INCAP Research Center for the Prevention of Chronic Diseases, Institute of Nutrition of Central America and Panama, Calzada Roosevelt 6-25 Zona 11, 01011, Guatemala City, Guatemala
| | - Manuel Ramirez-Zea
- INCAP Research Center for the Prevention of Chronic Diseases, Institute of Nutrition of Central America and Panama, Calzada Roosevelt 6-25 Zona 11, 01011, Guatemala City, Guatemala
| | - Vilma Irazola
- Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina
| | - Meredith P Fort
- INCAP Research Center for the Prevention of Chronic Diseases, Institute of Nutrition of Central America and Panama, Calzada Roosevelt 6-25 Zona 11, 01011, Guatemala City, Guatemala
- Colorado School of Public Health, Anschutz Medical Campus, Aurora, CO, USA
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Lu SV, Leung BMY, Bruton AM, Millington E, Alexander E, Camden K, Hatsu I, Johnstone JM, Arnold LE. Parents' priorities and preferences for treatment of children with ADHD: Qualitative inquiry in the MADDY study. Child Care Health Dev 2022; 48:852-861. [PMID: 35244227 DOI: 10.1111/cch.12995] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 02/08/2022] [Accepted: 02/10/2022] [Indexed: 12/21/2022]
Abstract
BACKGROUND Parents' lived experiences of having a child with ADHD may shape their decision making regarding ADHD treatment options for their child. The aim of this study was to explore parents' experiences of living with a child with ADHD in the family and how their experiences influence their perspectives on treatment preferences and priorities. METHODS A phenomenological qualitative design was used. Semistructured interviews were conducted with parents of children with ADHD who were enrolled in a multisite randomized controlled trial. Interviews were transcribed verbatim, and transcripts at each site were double coded. Initial codes were derived directly from the text. Qualitative data were analysed with an inductive approach. RESULTS Twenty-three parents were interviewed: eight from Alberta, Canada; eight from Portland, Oregon, USA; and seven from Columbus, Ohio, USA. Among the parents, 69% were married, 86% completed college education and 52% reported household income over $80,000. Among the children, the mean age was 9.6 years (SD = 1.8 years), 78% were boys and 48% were never medicated for their ADHD. Two major themes emerged from the analysis. Theme 1 was 'impact of ADHD on families within and outside the home' with the following subthemes: 'reconfiguring the home life', 'trial-and-error of accommodations at school' and 'responding to social pressures to fit in'. Theme 2 was 'enabling appropriate and accessible treatments for families' with the following subthemes: 'finding the "right fit" with professionals and treatments' and 'factors influencing inequitable access to treatments'. CONCLUSIONS Parents described shared experiences and identified similar barriers, preferences and priorities for ADHD treatments regardless of demographic differences by site. Families desired access to family-centred, multimodal approaches to ADHD treatment. Further research is needed to identify the specific structural changes to healthcare, services and policies that will better support this approach.
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Affiliation(s)
- Stacy V Lu
- Department of Population, Family, and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Brenda M Y Leung
- Faculty of Health Sciences, University of Lethbridge, Lethbridge, Alberta, Canada
| | - Alisha M Bruton
- Department of Psychiatry, Oregon Health & Science University, Portland, Oregon, USA
| | - Elizabeth Millington
- Faculty of Health Sciences, University of Lethbridge, Lethbridge, Alberta, Canada
| | - E Alexander
- Department of Human Sciences, College of Education and Human Ecology, The Ohio State University, Columbus, Ohio, USA
| | - Kelsey Camden
- Department of Psychiatry, Oregon Health & Science University, Portland, Oregon, USA
| | - Irene Hatsu
- Department of Human Sciences, College of Education and Human Ecology, The Ohio State University, Columbus, Ohio, USA
| | - Jeanette M Johnstone
- Department of Psychiatry, Oregon Health & Science University, Portland, Oregon, USA
| | - L Eugene Arnold
- Department of Psychiatry and Behavioral Health, The Ohio State University, Columbus, Ohio, USA
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Gyuricza JV, Brodersen J, Machado LBM, D'Oliveira AFPL. ‘People say it is dangerous’. REVISTA BRASILEIRA DE MEDICINA DE FAMÍLIA E COMUNIDADE 2022. [DOI: 10.5712/rbmfc17(44)3052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Introduction: Mild hypertension is a common asymptomatic condition present in people at low risk of future cardiovascular events. These people represent approximately two-thirds of those diagnosed with hypertension. The best available evidence does not support pharmacological treatment for mild hypertension to reduce cardiovascular mortality. Additionally, overdetection of hypertension also occurs, and this practice is supported by public awareness campaigns, screening, easy access to testing, and poor clinical practice, enhancing the overdiagnosis potential. Moreover, sparse qualitative patient-oriented evidence that diagnosing hypertension has harmful consequences is observed. Therefore, evidence regarding the potential for unintended psychosocial effects of diagnosing mild hypertension is required. Objective: The aim of this study was to investigate if diagnosing low-risk people with mild hypertension has unintended psychosocial consequences. Methods: Eleven semi-structured single interviews and four focus groups were conducted in São Paulo, Brazil, among people diagnosed with mild hypertension without comorbidities. Informants were selected among the general population from a list of patients, a primary healthcare clinic, or a social network. The informants had a broad range of characteristics, including sex, age, education level, race/skin colour, and time from diagnosis. Data were subjected to qualitative thematic content analysis by three of the authors independently, followed by discussions, to generate categories and themes. Results: The informants confirmed that the hypertension diagnosis was a label for psychosomatic reactions to stress, medicalised illness experiences, and set a biographical milestone. We observed unintended consequences of the diagnosis in a broad range of psychosocial dimensions, for example, fear of death, disabilities, or ageing; pressure and control from significant others; and guilt, shame, and anxiety regarding work and leisure. Although informants had a broad range of characteristics, they shared similar stories, understandings, and labelling effects of the diagnosis. Conclusion: The diagnosis of hypertension is a significant event and affects daily life. Most of the impact is regarded as negative psychosocial consequences or harm; however, sometimes the impact might be ambiguous. Patients’ explanatory models are key elements in understanding and changing the psychosocial consequences of the diagnosis, and healthcare providers must be aware of explanatory models and psychosocial consequences when evaluating blood pressure elevations.
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DeLaughter KL, Fix GM, McDannold SE, Pope C, Bokhour BG, Shimada SL, Calloway R, Gordon HS, Long JA, Miano DA, Cutrona SL. Incorporating African American Veterans' Success Stories for Hypertension Management: Developing a Behavioral Support Texting Protocol. JMIR Res Protoc 2021; 10:e29423. [PMID: 34855617 PMCID: PMC8686408 DOI: 10.2196/29423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 08/24/2021] [Accepted: 09/13/2021] [Indexed: 11/29/2022] Open
Abstract
Background Peer narratives engage listeners through personally relevant content and have been shown to promote lifestyle change and effective self-management among patients with hypertension. Incorporating key quotations from these stories into follow-up text messages is a novel way to continue the conversation, providing reinforcement of health behaviors in the patients’ daily lives. Objective In our previous work, we developed and tested videos in which African American Veterans shared stories of challenges and success strategies related to hypertension self-management. This study aims to describe our process for developing a text-messaging protocol intended for use after viewing videos that incorporate the voices of these Veterans. Methods We used a multistep process, transforming video-recorded story excerpts from 5 Veterans into 160-character texts. We then integrated these into comprehensive 6-month texting protocols. We began with an iterative review of story transcripts to identify vernacular features and key self-management concepts emphasized by each storyteller. We worked with 2 Veteran consultants who guided our narrative text message development in substantive ways, as we sought to craft culturally sensitive content for texts. Informed by Veteran input on timing and integration, supplementary educational and 2-way interactive assessment text messages were also developed. Results Within the Veterans Affairs texting system Annie, we programmed five 6-month text-messaging protocols that included cycles of 3 text message types: narrative messages, nonnarrative educational messages, and 2-way interactive messages assessing self-efficacy and behavior related to hypertension self-management. Each protocol corresponds to a single Veteran storyteller, allowing Veterans to choose the story that most resonates with their own life experiences. Conclusions We crafted a culturally sensitive text-messaging protocol using narrative content referenced in Veteran stories to support effective hypertension self-management. Integrating narrative content into a mobile health texting intervention provides a low-cost way to support longitudinal behavior change. A randomized trial is underway to test its impact on the lifestyle changes and blood pressure of African American Veterans. Trial Registration ClinicalTrials.gov NCT03970590; https://clinicaltrials.gov/ct2/show/NCT03970590 International Registered Report Identifier (IRRID) DERR1-10.2196/29423
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Affiliation(s)
- Kathryn L DeLaughter
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, MA, United States
| | - Gemmae M Fix
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, MA, United States.,Boston University School of Medicine, Boston, MA, United States
| | - Sarah E McDannold
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, MA, United States
| | - Charlene Pope
- Nursing, Ralph H Johnson VA Medical Center, Charleston, SC, United States.,College of Medicine, Medical University of South Carolina, Charleston, SC, United States
| | - Barbara G Bokhour
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, MA, United States.,Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA, United States
| | - Stephanie L Shimada
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, MA, United States.,Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA, United States.,Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, MA, United States
| | - Rodney Calloway
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, MA, United States
| | - Howard S Gordon
- Jesse Brown Veterans Affairs Medical Center and VA Center of Innovation for Complex Chronic Healthcare, Chicago, IL, United States.,Section of Academic Internal Medicine, Department of Medicine, University of Illinois at Chicago, Chicago, IL, United States.,Institute for Health Research and Policy, University of Illinois at Chicago, Chicago, IL, United States
| | - Judith A Long
- Corporal Michael J Crescenz VA Medical Center, VA Center for Health Equity Research and Promotion (CHERP), Philadelphia, PA, United States.,Division of General Internal Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Danielle A Miano
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, MA, United States
| | - Sarah L Cutrona
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, MA, United States.,Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA, United States
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Lawless MT, Tieu M, Feo R, Kitson AL. Theories of self-care and self-management of long-term conditions by community-dwelling older adults: A systematic review and meta-ethnography. Soc Sci Med 2021; 287:114393. [PMID: 34534780 DOI: 10.1016/j.socscimed.2021.114393] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Revised: 09/02/2021] [Accepted: 09/08/2021] [Indexed: 02/03/2023]
Abstract
RATIONALE The proportion of older adults living with long-term conditions (LTCs) is increasing. Self-care and self-management approaches are seen as valuable in helping older people with LTCs to manage their health and care, yet the theoretical overlaps and divergences are not always clear. OBJECTIVES The objectives of this review were to: (1) systematically identify and appraise studies of self-care or self-management of LTCs by community-dwelling older adults (aged ≥60 years) either informed by, applying, creating, or testing theory; (2) explore similarities or points of convergence between the identified theories; and (3) use a meta-ethnographic approach to synthesise the theories and group related concepts into core constructs. METHODS We conducted a systematic theory synthesis, searching six electronic databases. Three reviewers independently screened titles and abstracts followed by full texts and two reviewers appraised study quality. Theoretical data were synthesised within and across individual theories using meta-ethnographic line-of-argument synthesis. RESULTS A total of 141 articles (138 studies) and 76 theories were included in the review. Seven core constructs were developed: (1) temporal and spatial context; (2) stressors; (3) personal resources; (4) informal social resources; (5) formal social resources; (6) behavioural adaptations; and (7) quality of life outcomes. A line of argument was developed that conceptualised older adults' self-care and self-management as a dynamic process of behavioural adaptation, enabled by personal resources and informal and formal social resources, aimed at alleviating the impacts of stressors and maintaining quality of life. CONCLUSION This synthesis provides an overview of theories used in research on older adults' LTC self-care and self-management. Our synthesis describes the complex interplay of intrinsic and extrinsic factors influencing self-care and self-management behaviours and provides considerations for future research, intervention design, and implementation. The utility of the constructs in research and practice requires further attention and empirical validation.
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Affiliation(s)
- Michael T Lawless
- College of Nursing and Health Sciences, Flinders University, Bedford Park, SA, 5042, Australia; Caring Futures Institute, Flinders University, Bedford Park, SA, 5042, Australia.
| | - Matthew Tieu
- College of Nursing and Health Sciences, Flinders University, Bedford Park, SA, 5042, Australia; College of Humanities, Arts, and Social Sciences, Flinders University, Bedford Park, SA, 5042, Australia
| | - Rebecca Feo
- College of Nursing and Health Sciences, Flinders University, Bedford Park, SA, 5042, Australia; Caring Futures Institute, Flinders University, Bedford Park, SA, 5042, Australia
| | - Alison L Kitson
- College of Nursing and Health Sciences, Flinders University, Bedford Park, SA, 5042, Australia; Caring Futures Institute, Flinders University, Bedford Park, SA, 5042, Australia
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Song T, Liu F, Deng N, Qian S, Cui T, Guan Y, Arnolda L, Zhang Z, Yu P. A Comprehensive 6A Framework for Improving Patient Self-Management of Hypertension Using mHealth Services: Qualitative Thematic Analysis. J Med Internet Res 2021; 23:e25522. [PMID: 34152272 PMCID: PMC8277389 DOI: 10.2196/25522] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 01/12/2021] [Accepted: 04/27/2021] [Indexed: 12/16/2022] Open
Abstract
Background Hypertension affects over 15% of the world’s population and is a significant global public health and socioeconomic challenge. Mobile health (mHealth) services have been increasingly introduced to support hypertensive patients to improve their self-management behaviors, such as adherence to pharmacotherapy and lifestyle modifications. Objective This study aims to explore patients’ perceptions of mHealth services and the mechanisms by which the services support them to self-manage their hypertension. Methods A semistructured, in-depth interview study was conducted with 22 outpatients of the General Hospital of Ningxia Medical University from March to May 2019. In 2015, the hospital introduced an mHealth service to support community-dwelling outpatients with self-management of hypertension. Content analysis was conducted by following a grounded theory approach for inductive thematic extraction. Constant comparison and categorization classified the first-level codes with similar meanings into higher-level themes. Results The patient-perceived mechanisms by which the mHealth service supported their self-management of hypertension were summarized as 6A: access, assessment, assistance, awareness, ability, and activation. With the portability of mobile phones and digitization of information, the mHealth service provided outpatients with easy access to assess their vital signs and self-management behaviors. The assessment results gave the patients real-time awareness of their health conditions and self-management performance, which activated their self-management behaviors. The mHealth service also gave outpatients access to assistance, which included health education and self-management reminders. Both types of assistance could also be activated by abnormal assessment results, that is, uncontrolled or deteriorating blood pressure values, discomfort symptoms, or not using the service for a long period. With its scalable use to handle any possible information and services, the mHealth service provided outpatients with educational materials to learn at their own pace. This led to an improvement in self-management awareness and ability, again activating their self-management behaviors. The patients would like to see further improvements in the service to provide more useful, personalized information and reliable services. Conclusions The mHealth service extended the traditional hypertension care model beyond the hospital and clinician’s office. It provided outpatients with easy access to otherwise inaccessible hypertension management services. This led to process improvement for outpatients to access health assessment and health care assistance and improved their awareness and self-management ability, which activated their hypertension self-management behaviors. Future studies can apply the 6A framework to guide the design, implementation, and evaluation of mHealth services for outpatients to self-manage chronic conditions.
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Affiliation(s)
- Ting Song
- Centre for Digital Transformation, School of Computing and Information Technology, Faculty of Engineering and Information Sciences, University of Wollongong, Wollongong, Australia.,Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, Australia
| | - Fang Liu
- Department of Health Examination, General Hospital of Ningxia Medical University, Yinchuan, China
| | - Ning Deng
- Key Laboratory for Biomedical Engineering of Ministry of Education, College of Biomedical Engineering and Instrument Science, Zhejiang University, Hangzhou, China
| | - Siyu Qian
- Centre for Digital Transformation, School of Computing and Information Technology, Faculty of Engineering and Information Sciences, University of Wollongong, Wollongong, Australia.,Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, Australia.,Drug and Alcohol Service, Illawarra Shoalhaven Local Health District, Wollongong, Australia
| | - Tingru Cui
- School of Computing and Information Systems, Faculty of Engineering and Information Technology, University of Melbourne, Melbourne, Australia
| | - Yingping Guan
- Department of Health Examination, General Hospital of Ningxia Medical University, Yinchuan, China
| | - Leonard Arnolda
- Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, Australia
| | - Zhenyu Zhang
- Centre for Digital Transformation, School of Computing and Information Technology, Faculty of Engineering and Information Sciences, University of Wollongong, Wollongong, Australia
| | - Ping Yu
- Centre for Digital Transformation, School of Computing and Information Technology, Faculty of Engineering and Information Sciences, University of Wollongong, Wollongong, Australia.,Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, Australia
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Schalet BD, Reise SP, Zulman DM, Lewis ET, Kimerling R. Psychometric evaluation of a patient-reported item bank for healthcare engagement. Qual Life Res 2021; 30:2363-2374. [PMID: 33835412 DOI: 10.1007/s11136-021-02824-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/12/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE Healthcare engagement is a core measurement target for efforts to improve healthcare systems. This construct is broadly defined as the extent to which healthcare services represent collaborative partnerships with patients. Previous qualitative work operationalized healthcare engagement as generalized self-efficacy in four related subdomains: self-management, collaborative communication, health information use, and healthcare navigation. Building on this work, our objective was to establish a healthcare engagement instrument that is sufficiently unidimensional to yield a single score. METHOD We conducted cognitive interviews followed by a nation-wide mail survey of US Veteran Administration (VA) healthcare users. Data were collected on 49 candidate healthcare engagement items, as well as measures of self-efficacy for managing symptoms, provider communication, and perceived access. Items were subjected to exploratory bifactor, statistical learning, and IRT analyses. RESULTS Cognitive interviews were completed by 56 patients and 9552 VA healthcare users with chronic conditions completed the mail survey. Participants were mostly white and male but with sizable minority participation. Psychometric analyses and content considerations reduced the item pool to 23 items, which demonstrated a strong general factor (OmegaH of .89). IRT analyses revealed a high level of reliability across the trait range and little DIF across groups. Most health information use items were removed during analyses, suggesting a more independent role for this domain. CONCLUSION We provide quantitative evidence for a relatively unidimensional measure of healthcare engagement. Despite developed with VA healthcare users, the measure is intended for general use. Future work includes short-form development and validation with other patient groups.
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Affiliation(s)
- Benjamin D Schalet
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, USA.
| | - Steven P Reise
- Department of Psychology, University of California, San Diego, USA
| | - Donna M Zulman
- Center for Innovation to Implementation, VA Palo Alto Health Care System, Menlo Park, USA.,Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, USA
| | - Eleanor T Lewis
- Center for Innovation to Implementation, VA Palo Alto Health Care System, Menlo Park, USA
| | - Rachel Kimerling
- National Center for PTSD, VA Palo Alto Health Care System, Menlo Park, USA.,Center for Innovation to Implementation, VA Palo Alto Health Care System, Menlo Park, USA
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11
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Ragavan RS, Joshi R, Evans RG, Riddell MA, Thankappan KR, Chow CK, Oldenburg B, Mahal AS, Kalyanram K, Kartik K, Suresh O, Thomas N, Mini GK, Srikanth VK, Maulik PK, Alim M, Guggilla RK, Busingye D, Thrift AG. Additive association of knowledge and awareness on control of hypertension: a cross-sectional survey in rural India. J Hypertens 2021; 39:107-116. [PMID: 32833918 DOI: 10.1097/hjh.0000000000002594] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To determine whether there is an interaction between knowledge about hypertension and awareness of hypertension on the treatment and control of hypertension in three regions of South India at different stages of epidemiological transition (see Video, Supplemental Digital Content 1, http://links.lww.com/HJH/B426). METHODS Using a cross-sectional design, we randomly selected villages within each of rural Trivandrum, West Godavari, and Chittoor. Sampling was stratified by age group and sex. We measured blood pressure and administered a questionnaire to determine knowledge and awareness of hypertension. Logistic regression was used to assess associations of awareness and knowledge about hypertension with its treatment and control in participants with hypertension, while examining for statistical interaction. RESULTS Among a total of 11 657 participants (50% male; median age 45 years), 3455 had hypertension. In analyses adjusted for age and sex, both knowledge score [adjusted odds ratio (aOR) 1.14 [95% confidence interval (CI) 1.12--1.17)] and awareness [aOR 104 (95% CI 82--134)] were associated with treatment for hypertension. Similarly, both knowledge score [aOR 1.10; 95% CI (1.08--1.12)] and awareness [aOR 13.4; 95% CI (10.7--16.7)], were positively associated with control of blood pressure in those with hypertension, independent of age and sex. There was an interaction between knowledge and awareness on both treatment and control of hypertension (P of attributable proportion <0.001 for each). CONCLUSION Health education to improve knowledge about hypertension and screening programs to improve awareness of hypertension may act in an additive fashion to improve management of hypertension in rural Indian populations.
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Affiliation(s)
| | - Rohina Joshi
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
- George Institute for Global Health, Delhi, India
| | - Roger G Evans
- Cardiovascular Disease Program, Biomedicine Discovery Institute and Department of Physiology, Monash University, Melbourne, Australia
| | - Michaela A Riddell
- School of Clinical Sciences at Monash Health, Monash University, Melbourne
| | - Kavumpurathu R Thankappan
- Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum
- Department of Public Health & Community Medicine, Central University of Kerala, Kasaragod, Kerala, India
| | - Clara K Chow
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
- Westmead Applied Research Centre, The University of Sydney, Sydney, New South Wales
- Department of Cardiology, Westmead Hospital, Sydney
| | - Brian Oldenburg
- Melbourne School of Population and Global Health, University of Melbourne
| | - Ajay S Mahal
- School of Public Health and Preventive Medicine, Monash University
- Nossal Institute for Global Health, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - Kartik Kalyanram
- Rishi Valley Rural Health Centre, Chittoor District, Andhra Pradesh
| | - Kamakshi Kartik
- Rishi Valley Rural Health Centre, Chittoor District, Andhra Pradesh
| | - Oduru Suresh
- School of Clinical Sciences at Monash Health, Monash University, Melbourne
- Rishi Valley Rural Health Centre, Chittoor District, Andhra Pradesh
| | - Nihal Thomas
- Department of Endocrinology, Diabetes & Metabolism, Christian Medical College, Vellore, Tamil Nadu
| | - Gomathyamma K Mini
- Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum
- Global Institute of Public Health, Ananthapuri Hospitals and Research Institute, Trivandrum, Kerala, India
| | - Velandai K Srikanth
- School of Clinical Sciences at Monash Health, Monash University, Melbourne
- Peninsula Clinical School, Central Clinical School, Monash University, Frankston, Australia
| | - Pallab K Maulik
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
- George Institute for Global Health, Delhi, India
- George Institute for Global Health -- Oxford University, Oxford, UK
| | - Mohammed Alim
- George Institute for Global Health, Delhi, India
- Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Rama K Guggilla
- Department of Population Medicine and Civilization Diseases Prevention, Faculty of Medicine with the Division of Dentistry and Division of Medical Education in English, Medical University of Bialystok, Bialystok, Poland
| | - Doreen Busingye
- School of Clinical Sciences at Monash Health, Monash University, Melbourne
| | - Amanda G Thrift
- School of Clinical Sciences at Monash Health, Monash University, Melbourne
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12
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McBride CM, Morrissey EC, Molloy GJ. Patients' Experiences of Using Smartphone Apps to Support Self-Management and Improve Medication Adherence in Hypertension: Qualitative Study. JMIR Mhealth Uhealth 2020; 8:e17470. [PMID: 33112251 PMCID: PMC7657730 DOI: 10.2196/17470] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2019] [Revised: 06/05/2020] [Accepted: 06/21/2020] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Worldwide, hypertension control rates remain suboptimal despite clinically effective antihypertensive drug therapy. Patient failure to take medication as prescribed (ie, nonadherence) is the most important factor contributing to poor control. Smartphone apps can facilitate the delivery of evidence-based behavior change techniques to improve adherence and may provide a scalable, usable, and feasible method to deliver self-management support. OBJECTIVE The aim of this study is to explore patients' experiences of the usability and feasibility of smartphone apps to support self-management and improve medication adherence in hypertension. METHODS A qualitative descriptive study was conducted. A total of 11 people living with hypertension from the West of Ireland were sampled purposively and interviewed about their experience of using a self-management app for a 4-week period, which included two key functionalities: self-monitoring of blood pressure (BP) and medication reminders. Thematic analysis was carried out on the semistructured interview data. RESULTS Participants' age ranged from 43 to 74 years (mean 62 years, SD 9.13). Three themes were identified: digital empowerment of self-management, human versus digital systems, and digital sustainability. Although patients' experience of using the technology to self-monitor BP was one of empowerment, characterized by an enhanced insight and understanding into their condition, control, and personal responsibility, the reminder function was only feasible for patients who reported unintentional nonadherence to treatment. Patients experienced the app as a sustainable tool to support self-management and found it easy to use, including those with limited technological competence. CONCLUSIONS The study's findings provide new insights into the experience of using apps to support medication adherence in hypertension. Overall, the data support apps as a usable and feasible method to aid self-management of hypertension and highlight the need for personalized functionality, particularly with regard to medication adherence reminder strategies. The study's findings challenge the perspective that the use of these technologies to support self-management can inevitably add to the burden of treatment experienced by patients.
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Affiliation(s)
- Ciara M McBride
- School of Psychology, National Univeristy of Ireland Galway, Galway, Ireland
| | - Eimear C Morrissey
- Health Behaviour Change Research Group, National Univiersity of Ireland Galway, Galway, Ireland
| | - Gerard J Molloy
- Medication Adherence Across the Lifespan Research Group, National University of Ireland Galway, Galway, Ireland
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13
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Seguin ML, Rangnekar A, Renedo A, Palafox B, McKee M, Balabanova D. Systematic review of frameworks used to conceptualise health pathways of individuals diagnosed with cardiovascular diseases. BMJ Glob Health 2020; 5:e002464. [PMID: 32928800 PMCID: PMC7490945 DOI: 10.1136/bmjgh-2020-002464] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 07/03/2020] [Accepted: 07/14/2020] [Indexed: 11/04/2022] Open
Abstract
The treatment of cardiovascular disease (CVD) is managed inadequately globally. Theoretically informed frameworks have the potential to account for the multiple elements which constitute the CVD patient pathway, and capture their inter-relationships and processes of change. However, a review and critique of such frameworks is currently lacking. This systematic review aims to identify and critically assess frameworks of access to and utilisation of care which capture the pathways of patients diagnosed with one or more CVDs. The specific objectives are to (1) review how existing frameworks have been used and adapted to capture CVD patient pathways and (2) draw on elements of Strong Structuration Theory to critically appraise them, in terms of their ability to capture the dynamics of the patient journey and the factors that influence it. Five bibliographic databases were searched in January 2019. We included qualitative and quantitative studies containing frameworks used to capture the patient pathway of individuals with CVD, encompassing symptoms, diagnosis, treatment and long-term management. Data on patient behaviour and structural factors were interpreted according to elements of Strong Structuration Theory to assess frameworks on their ability to capture a holistic patient journey. The search yielded 15 articles. The majority were quantitative and all focused on management of CVDs, primarily hypertension. Commonly used frameworks included the common-sense self-regulation model, transtheoretical model and theory of planned behaviour. A critique drawing on elements of Strong Structuration Theory revealed these frameworks narrowly focused on patient attributes (patient beliefs/attitudes) and resulting patient action, but neglected external structures that interacted with these to produce particular outcomes, which results in an individualistic and linear view of the patient pathway. We suggest that a framework informed by Strong Structuration Theory is sufficiently flexible to examine the patient pathway, while avoiding a strict linear view facilitated by other frameworks.
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Affiliation(s)
- Maureen L Seguin
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine Faculty of Public Health and Policy, London, UK
| | - Avanti Rangnekar
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine Faculty of Public Health and Policy, London, UK
| | - Alicia Renedo
- Social and Environmental Health Research, London School of Hygiene and Tropical Medicine Faculty of Public Health and Policy, London, UK
| | - Benjamin Palafox
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine Faculty of Public Health and Policy, London, UK
| | - Martin McKee
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine Faculty of Public Health and Policy, London, UK
| | - Dina Balabanova
- Global Health and Development, London School of Hygiene and Tropical Medicine Faculty of Public Health and Policy, London, UK
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14
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Faronbi JO, Ademuyiwa IY, Olaogun AA. Patterns of chronic illness among older patients attending a university hospital in Nigeria. Ghana Med J 2020; 54:42-47. [PMID: 32863412 PMCID: PMC7445699 DOI: 10.4314/gmj.v54i1.7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Background The rising burden of chronic diseases has attracted the attention of public health researchers and policymakers worldwide. Objectives To assess the demographic, morbidity and outcome patterns of chronic illness among the older patients at Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria. Design Retrospective study Setting Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria. Participants Seven hundred and eighty-eight (788) adults (60 years and over) hospitalized between 2010 and 2014 in the hospital. Interventions None Results The age of the selected study population ranged from 60 to 99 years with a mean of 76.08(±10.42). More than half (53.0%) were between 60–69 years, with a subsequent decline. Male patients accounted for 64.0%, but females were more frequent among patients 80 years and older. The most common health conditions were heart diseases (22.5%), neoplasm (13.2%), cerebrovascular accident (12.4%), and gastrointestinal diseases (14.5%). The records showed that 14.9% were referred to other institution for various reasons (including further management, lack of space, industrial action by workers, discharged against medical advice or dead). Conclusion Heart diseases were the major chronic illnesses among the older adults followed by neoplasm conditions, while musculoskeletal conditions were the least. It also found that there was a poor outcome of conditions among older adults in this setting. Therefore, efforts should be made towards the prevention and reduction of chronic illnesses, as well as improving the outcome of care. Funding Doctoral Fellowship from Consortium for Advanced Research Training in Africa
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Affiliation(s)
- Joel O Faronbi
- Department of Nursing Science, College of Health Sciences, Obafemi Awolowo University, Ile-Ife, Nigeria.,The Frail Elderly Research Support Group (FRESH), Institute of Neuroscience and Physiology, The Sahlgrenska Academy at Gothenburg University, Gothenburg, Sweden
| | - Iyabo Y Ademuyiwa
- Department of Nursing Science, Faculty of Clinical Sciences, University of Lagos, Idi-Araba Lagos, Nigeria
| | - Adenike A Olaogun
- Department of Nursing Science, College of Health Sciences, Obafemi Awolowo University, Ile-Ife, Nigeria
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15
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Gorbani F, Mahmoodi H, Sarbakhsh P, Shaghaghi A. Predictive Performance of Pender's Health Promotion Model for Hypertension Control in Iranian Patients. Vasc Health Risk Manag 2020; 16:299-305. [PMID: 32764950 PMCID: PMC7381821 DOI: 10.2147/vhrm.s258458] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 07/05/2020] [Indexed: 11/26/2022] Open
Abstract
Objective The main aim of this study was to investigate predictive factors of adherence to the hypertension control therapeutic and lifestyle recommendations in a sample of Iranian patients based on the constructs of Pender’s health promotion model. Patients and Methods The cross-sectional study was performed on the 380 hypertensive patients who were referred to the health centers, the emergency and internal diseases departments of the Bagheralolom Hospital, and the cardiologists’ offices in the city of Ahar, North West of Iran. Data were collected using a researcher designed questionnaire based on the Pender’s health promotion model. The Pearson correlation test, multivariate linear regression, and independent t-test were used for data analysis. Results Mean age of the recruited patients was 52.94 (SD=12.8). Perceived benefits, perceived barriers, situational influences, and interpersonal influences (adjusted R2= 0.525) explained 52.5% of the observed variation in adherence to hypertension control recommendations. Conclusion Successful hypertension control in patients with chronic morbidity need to be based on sound data about major determinants of the relevant health/illness behaviors. The study findings revealed that the Pender’s health promotion model could be applicable as a theoretical framework to identify major determinants of adherence to hypertension control recommendations. Future cross-cultural validation of the study findings in more representative and larger sample sizes could add to the legitimacy of the evidence surrounding self-care practices in hypertensive patients.
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Affiliation(s)
- Fatemeh Gorbani
- Department of Health Education and Promotion, Faculty of Health, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Hassan Mahmoodi
- Social Determinant of Health Research Center, Research Institute for Health Development, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Parvin Sarbakhsh
- Department of Biostatistics and Epidemiology, Faculty of Health, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Abdolreza Shaghaghi
- Department of Health Education and Promotion, Faculty of Health, Tabriz University of Medical Sciences, Tabriz, Iran
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16
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Ayub S, Marsh V, Reed S. An Exploration of Chronic Disease Perception, Management, and Barriers to Care in Liberian Refugees Resettled in Charlottesville, Virginia. J Natl Med Assoc 2020; 112:654-667. [PMID: 32693979 DOI: 10.1016/j.jnma.2020.06.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Revised: 05/29/2020] [Accepted: 06/22/2020] [Indexed: 10/23/2022]
Abstract
Charlottesville is a resettlement site for Liberian refugees. Many receive care at the International Family Medicine Clinic (IFMC). IFMC physicians note reduced adherence to chronic disease medications among refugee patients. This study aims to understand the Liberian refugee populations' model of chronic disease. In 2014, twelve one-on-one interviews were conducted. Topics included concept of disease, health care access, disease burden, acculturation, and socioeconomic factors. Transcripts were analyzed according to the explanatory model of disease and Krueger's framework analysis. This study can assist providers in tailoring their practices to meet the needs of refugee patients and inform future public health interventions.
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Affiliation(s)
- Suniah Ayub
- University of Florida, College of Medicine, Department of Surgery, Gainesville, FL, USA.
| | - Vickie Marsh
- University of Virginia, School of Medicine, Department of Family Medicine, Charlottesville, VA, USA
| | - Sean Reed
- University of Virginia, School of Medicine, Department of Family Medicine, Charlottesville, VA, USA
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17
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Cairns AE, Tucker KL, Crawford C, McManus RJ, Powell J. Implementing self-management: a mixed methods study of women's experiences of a postpartum hypertension intervention (SNAP-HT). Trials 2020; 21:508. [PMID: 32517785 PMCID: PMC7282057 DOI: 10.1186/s13063-020-04394-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Accepted: 05/08/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Self-management strategies are effective in a number of medical conditions; however, implementation studies have demonstrated adoption into clinical practice can be problematic. The process of implementation was explored during a pilot randomised controlled trial evaluating postpartum blood pressure self-management in women with medicated hypertensive disorders of pregnancy. METHODS A mixed methods study using semi-structured interviews with a qualitative and a scored (quantitative) component were undertaken as part of a pilot randomised controlled trial (SNAP-HT) in postnatal women with medicated gestational hypertension or pre-eclampsia. Women were randomised to usual care or blood pressure self-management. Self-management entailed daily home blood pressure monitoring and automated medication reduction via telemonitoring. Women from both groups optionally consented to participate in audio-recorded interviews at 4 weeks and 6 months postpartum. Interview questions were developed to explore the proposed benefits of self-management and the constructs of normalisation process theory. Participants provided a score (Likert scale 1-5) for each question and were encouraged to expand upon these answers through further discussion. The interviews were transcribed and analysed using the framework approach. RESULTS Sixty-eight women, 34 from each randomised group, completed at least one audio-recorded interview. Several overarching themes emerged from analysis of 126 interview transcripts: control; convenience; confidence, communication and knowledge; concern; constraints; and components of the intervention. In the scored component of the analysis, both groups reported feeling more in control of their condition postpartum compared to during pregnancy, more so in those self-managing at both 4 weeks and 6 months: adjusted differences 0.6 (95% confidence interval [CI] 0.2 to 1.1) and 0.7 (95% CI 0.3 to 1.2) respectively. CONCLUSIONS Interviews and quantitative data showed that self-management enhanced women's sense of control and improved their blood pressure-related anxiety. Prior to taking part, a few women anticipated that home monitoring might increase anxiety, but stated that it had the opposite effect. Self-management was perceived as more flexible and reactive and as enabling more targeted down-titration of medication. These data provide considerable support for blood pressure self-management postpartum and reinforce the effectiveness of the intervention used in this study. TRIAL REGISTRATION ClinicalTrials.gov: NCT02333240. Prospectively registered on 7 January 2015.
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Affiliation(s)
- Alexandra E Cairns
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Primary Care, Radcliffe Observatory Quarter, Woodstock Road, Oxford, OX2 6GG, UK.
| | - Katherine L Tucker
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Primary Care, Radcliffe Observatory Quarter, Woodstock Road, Oxford, OX2 6GG, UK
| | - Carole Crawford
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Primary Care, Radcliffe Observatory Quarter, Woodstock Road, Oxford, OX2 6GG, UK
| | - Richard J McManus
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Primary Care, Radcliffe Observatory Quarter, Woodstock Road, Oxford, OX2 6GG, UK
| | - John Powell
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Primary Care, Radcliffe Observatory Quarter, Woodstock Road, Oxford, OX2 6GG, UK
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18
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Gunn CM, Bokhour B, Parker VA, Parker PA, Blakeslee S, Bandos H, Holmberg C. Exploring Explanatory Models of Risk in Breast Cancer Risk Counseling Discussions: NSABP/NRG Oncology Decision-Making Project 1. Cancer Nurs 2020; 42:3-11. [PMID: 28661894 PMCID: PMC5745305 DOI: 10.1097/ncc.0000000000000517] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Explanatory models represent patient understanding of etiology, pathophysiology, illness, symptoms, and treatments, but little attention has been paid to how they are used by patients "at risk" for future disease. OBJECTIVE The aims of this study were to elucidate what constitutes an explanatory model of risk and to describe explanatory models of risk related to developing breast cancer. METHODS Thirty qualitative interviews with women identified as at an increased risk for breast cancer were conducted. Interviews were coded to identify domains of explanatory models of risk using a priori codes derived from the explanatory model of illness framework. Within each domain, a grounded thematic analysis described participants' explanatory models related to breast cancer risk. RESULTS The domains of treatment and etiology remained similar in a risk context compared with illness, whereas course of illness, symptoms, and pathophysiology differed. We identified a new, integrative concept relative to other domains within explanatory models of risk: social comparisons, which was dominant in risk perhaps due to the lack of physical experiences associated with being "at risk." CONCLUSIONS Developing inclusive understandings of risk and its treatment is key to developing a framework for the care of high-risk patients that is both evidence based and sensitive to patient preferences. IMPLICATIONS FOR PRACTICE The concept of "social comparisons" can assist healthcare providers in understanding women's decision making under conditions of risk. Ensuring that healthcare providers understand patient perceptions of risk is important because it relates to patient decision making, particularly due to an increasing focus on risk assessment in cancer.
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Affiliation(s)
- Christine M Gunn
- Author Affiliations: Women's Health Unit, Section of General Internal Medicine, Boston University School of Medicine (Dr Gunn); Department of Health Law, Policy and Management, Boston University School of Public Health (Drs Gunn, Bokhour, and V.A. Parker), Massachusetts; Psychiatry & Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, New York (Dr P.A. Parker); NRG Oncology, and The University of Pittsburgh, Pittsburgh, Pennsylvania (Dr Bandos); and Institute of Public Health, Charité-Universitätsmedizin, Berlin, Germany (Dr Holmberg and Ms Blakeslee)
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19
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Lynch HM, Green AS, Clarke Nanyonga R, Gadikota-Klumpers DD, Squires A, Schwartz JI, Heller DJ. Exploring patient experiences with and attitudes towards hypertension at a private hospital in Uganda: a qualitative study. Int J Equity Health 2019; 18:206. [PMID: 31888767 PMCID: PMC6937689 DOI: 10.1186/s12939-019-1109-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Accepted: 12/10/2019] [Indexed: 11/29/2022] Open
Abstract
Background Hypertension is the leading risk factor for mortality worldwide and is more common in sub-Saharan Africa than any other region. Work to date confirms that a lack of human and material resources for healthcare access contributes to this gap. The ways in which patients’ knowledge and attitudes toward hypertension determine their engagement with and adherence to available care, however, remains unclear. Methods We conducted an exploratory, qualitative descriptive study to assess awareness, knowledge, and attitudes towards hypertension and its management at a large private hospital in Kampala. We interviewed 64 participants (29 with hypertension and 34 without, 1 excluded) in English. General thematic analysis using the Integrated Conceptual Health Literacy Model was used to iteratively generate themes and categories. Results We identified three main themes: Timing of Hypertension Diagnosis, Aiming for Health Literacy, and the Influence of Knowledge on Behavior. Most participants with hypertension learned of their condition incidentally, speaking to the lack of awareness of hypertension as an asymptomatic condition. Drove nearly all participants to desire more information. However, many struggled to translate knowledge into self-management behaviors due to incomplete information and conflicting desires of participants regarding lifestyle and treatment. Conclusions Internal patient factors had a substantial impact on adherence, calling attention to the need for educational interventions. Systemic barriers such as cost still existed even for those with insurance and need to be recognized by treating providers.
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Affiliation(s)
- Hayley M Lynch
- Arnhold Institute for Global Health, Icahn School of Medicine at Mount Sinai, 1216 5th Avenue, New York, NY, 10029, USA
| | - Aliza S Green
- Arnhold Institute for Global Health, Icahn School of Medicine at Mount Sinai, 1216 5th Avenue, New York, NY, 10029, USA
| | | | - Darinka D Gadikota-Klumpers
- Arnhold Institute for Global Health, Icahn School of Medicine at Mount Sinai, 1216 5th Avenue, New York, NY, 10029, USA
| | | | - Jeremy I Schwartz
- Section of General Internal Medicine, Yale School of Medicine, New Haven, USA
| | - David J Heller
- Arnhold Institute for Global Health, Icahn School of Medicine at Mount Sinai, 1216 5th Avenue, New York, NY, 10029, USA.
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20
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Kressin NR, Elwy AR, Glickman M, Orner MB, Fix GM, Borzecki AM, Katz LA, Cortés DE, Cohn ES, Barker A, Bokhour BG. Beyond Medication Adherence: The Role of Patients' Beliefs and Life Context in Blood Pressure Control. Ethn Dis 2019; 29:567-576. [PMID: 31641324 DOI: 10.18865/ed.29.4.567] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Objective Despite numerous interventions to address adherence to antihypertensive medications, continued high rates of uncontrolled blood pressure (BP) suggest a need to better understand patient factors beyond adherence associated with BP control. We examined how patients' BP-related beliefs, and aspects of life context affect BP control, beyond medication adherence. Methods We conducted a cross-sectional telephone survey of primary care patients with hypertension between 2010 and 2011 (N=103; 93 had complete data on all variables and were included in the regression analyses). We assessed patient sociodemographics (including race/ethnicity), medication adherence, BP-related beliefs, aspects of life context, and used clinical BP assessments. Results Regression models including sociodemographics, medication adherence, and either beliefs or context consistently predicted BP control. Adding context after beliefs added no predictive value while adding beliefs after context significantly predicted BP control. Practical Implications Results suggest that when clinicians must choose a dimension on which to intervene, focusing on beliefs would be the most fruitful approach to effecting change in BP control.
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Affiliation(s)
- Nancy R Kressin
- Center for Healthcare Organization and Implementation Research (CHOIR), a VA HSR&D Center of Innovation, VA Boston Healthcare System and Edith Nourse Rogers Memorial Veterans Hospital; Bedford, MA.,Section of General Internal Medicine, Boston University School of Medicine; Boston, MA
| | - A Rani Elwy
- Center for Healthcare Organization and Implementation Research (CHOIR), a VA HSR&D Center of Innovation, VA Boston Healthcare System and Edith Nourse Rogers Memorial Veterans Hospital; Bedford, MA.,Department of Psychiatry and Human Behavior, Warren Alpert Medical School, Brown University; Providence, RI
| | - Mark Glickman
- Center for Healthcare Organization and Implementation Research (CHOIR), a VA HSR&D Center of Innovation, VA Boston Healthcare System and Edith Nourse Rogers Memorial Veterans Hospital; Bedford, MA.,Department of Statistics, Harvard University; Boston, MA
| | - Michelle B Orner
- Center for Healthcare Organization and Implementation Research (CHOIR), a VA HSR&D Center of Innovation, VA Boston Healthcare System and Edith Nourse Rogers Memorial Veterans Hospital; Bedford, MA
| | - Gemmae M Fix
- Center for Healthcare Organization and Implementation Research (CHOIR), a VA HSR&D Center of Innovation, VA Boston Healthcare System and Edith Nourse Rogers Memorial Veterans Hospital; Bedford, MA.,Boston University School of Public Health; Boston, MA
| | - Ann M Borzecki
- Center for Healthcare Organization and Implementation Research (CHOIR), a VA HSR&D Center of Innovation, VA Boston Healthcare System and Edith Nourse Rogers Memorial Veterans Hospital; Bedford, MA.,Section of General Internal Medicine, Boston University School of Medicine; Boston, MA.,Boston University School of Public Health; Boston, MA
| | - Lois A Katz
- VA New York Harbor Healthcare System; New, York, NY.,New York University School of Medicine; New York, NY
| | - Dharma E Cortés
- Cambridge Health Alliance; Cambridge, MA.,Harvard Medical School; Cambridge, MA
| | - Ellen S Cohn
- Boston University, Sargent College of Health and Rehabilitation Sciences; Boston, MA
| | - Anna Barker
- Center for Healthcare Organization and Implementation Research (CHOIR), a VA HSR&D Center of Innovation, VA Boston Healthcare System and Edith Nourse Rogers Memorial Veterans Hospital; Bedford, MA
| | - Barbara G Bokhour
- Center for Healthcare Organization and Implementation Research (CHOIR), a VA HSR&D Center of Innovation, VA Boston Healthcare System and Edith Nourse Rogers Memorial Veterans Hospital; Bedford, MA.,Boston University School of Public Health; Boston, MA
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Tiffe T, Morbach C, Rücker V, Gelbrich G, Wagner M, Faller H, Störk S, Heuschmann PU. Impact of Patient Beliefs on Blood Pressure Control in the General Population: Findings from the Population-Based STAAB Cohort Study. Int J Hypertens 2019; 2019:9385397. [PMID: 31467700 PMCID: PMC6699330 DOI: 10.1155/2019/9385397] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Revised: 06/19/2019] [Accepted: 07/07/2019] [Indexed: 01/15/2023] Open
Abstract
Background. Effective antihypertensive treatment depends on patient compliance regarding prescribed medications. We assessed the impact of beliefs related towards antihypertensive medication on blood pressure control in a population-based sample treated for hypertension. Methods. We used data from the Characteristics and Course of Heart Failure Stages A-B and Determinants of Progression (STAAB) study investigating 5000 inhabitants aged 30 to 79 years from the general population of Würzburg, Germany. The Beliefs about Medicines Questionnaire German Version (BMQ-D) was provided in a subsample without established cardiovascular diseases (CVD) treated for hypertension. We evaluated the association between inadequately controlled hypertension (systolic RR >140/90 mmHg; >140/85 mmHg in diabetics) and reported concerns about and necessity of antihypertensive medication. Results. Data from 293 participants (49.5% women, median age 64 years [quartiles 56.0; 69.0]) entered the analysis. Despite medication, half of the participants (49.8%) were above the recommended blood pressure target. Stratified for sex, inadequately controlled hypertension was less frequent in women reporting higher levels of concerns (OR 0.36; 95%CI 0.17-0.74), whereas no such association was apparent in men. We found no association for specific-necessity in any model. Conclusion. Beliefs regarding the necessity of prescribed medication did not affect hypertension control. An inverse association between concerns about medication and inappropriately controlled hypertension was found for women only. Our findings highlight that medication-related beliefs constitute a serious barrier of successful implementation of treatment guidelines and underline the role of educational interventions taking into account sex-related differences.
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Affiliation(s)
- Theresa Tiffe
- Institute of Clinical Epidemiology and Biometry, University of Würzburg, Germany
- Comprehensive Heart Failure Center, University of Würzburg, Germany
| | - Caroline Morbach
- Comprehensive Heart Failure Center, University of Würzburg, Germany
- Department of Medicine I, University Hospital Würzburg, Germany
| | - Viktoria Rücker
- Institute of Clinical Epidemiology and Biometry, University of Würzburg, Germany
| | - Götz Gelbrich
- Institute of Clinical Epidemiology and Biometry, University of Würzburg, Germany
- Clinical Trial Unit, University Hospital Würzburg, Germany
| | - Martin Wagner
- Institute of Clinical Epidemiology and Biometry, University of Würzburg, Germany
| | - Hermann Faller
- Institute of Clinical Epidemiology and Biometry, University of Würzburg, Germany
| | - Stefan Störk
- Comprehensive Heart Failure Center, University of Würzburg, Germany
- Department of Medicine I, University Hospital Würzburg, Germany
| | - Peter U. Heuschmann
- Institute of Clinical Epidemiology and Biometry, University of Würzburg, Germany
- Comprehensive Heart Failure Center, University of Würzburg, Germany
- Clinical Trial Unit, University Hospital Würzburg, Germany
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The Connectedness of Mental Health Providers Referring Patients to a Treatment Study for Post-Traumatic Stress: A Social Network Study. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2019; 47:197-209. [DOI: 10.1007/s10488-019-00945-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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23
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Self-management and psychological resilience moderate the relationships between symptoms and health-related quality of life among patients with hypertension in China. Qual Life Res 2019; 28:2585-2595. [PMID: 31049824 DOI: 10.1007/s11136-019-02191-z] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/24/2019] [Indexed: 02/08/2023]
Abstract
PURPOSE To examine whether and how self-management and psychological resilience could moderate the relationships between symptoms and health-related quality of life (HRQoL) among hypertensive patients in China. METHODS This was a cross-sectional study of 220 participants recruited from January to May, 2018. Demographic and clinical information were obtained from medical records and by patient interview. The Chinese version of 17-item Hypertension-specific Symptom Scale, 21-item Self-Management Scale, and 10-item Connor-Davidson Resilience Scale (CD-RISC-10) as well as Short Form 12 Health Survey (SF-12) were used to collect information in this research. The moderation effects of self-management and psychological resilience were explored using the PROCESS macro for SPSS. RESULTS Among all patients, 128 (58.2%) were female, 106 (48.2%) had a bachelor degree or higher, and 133 (60.5%) had moderate to severe Charlson Comorbidity Index. Both self-management and psychological resilience were negatively correlated to symptoms (r = - 0.259, p < 0.001; r = - 0.282, p < 0.001) but positively correlated to physical (r = 0.316, p < 0.001; r = 0.344, p < 0.001) and mental (r = 0.273, p < 0.001; r = 0.309, p < 0.001) HRQoL. After controlling for potential covariates, self-management could moderate the associations between symptoms and physical HRQoL (p = 0.041, ΔR2 = 0.010), while psychological resilience could moderate the relationships between symptoms and mental HRQoL (p = 0.02, ΔR2 = 0.010). CONCLUSIONS For hypertension patients, HRQoL is dependent on the severity of symptoms, engagement of self-management behaviors, and psychological resilience, which should be carefully considered when to improve patients' HRQoL by health care providers.
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Johnson HM, Sullivan-Vedder L, Kim K, McBride PE, Smith MA, LaMantia JN, Fink JT, Knutson Sinaise MR, Zeller LM, Lauver DR. Rationale and study design of the MyHEART study: A young adult hypertension self-management randomized controlled trial. Contemp Clin Trials 2019; 78:88-100. [PMID: 30677485 PMCID: PMC6387836 DOI: 10.1016/j.cct.2019.01.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Revised: 01/11/2019] [Accepted: 01/16/2019] [Indexed: 12/25/2022]
Abstract
Young adults (18-39 year-olds) with hypertension have a higher lifetime risk for cardiovascular disease. However, less than 50% of young adults achieve hypertension control in the United States. Hypertension self-management programs are recommended to improve control, but have been targeted to middle-aged and older populations. Young adults need hypertension self-management programs (i.e., home blood pressure monitoring and lifestyle modifications) tailored to their unique needs to lower blood pressure and reduce the risks and medication burden they may face over a lifetime. To address the unmet need in hypertensive care for young adults, we developed MyHEART (My Hypertension Education And Reaching Target), a multi-component, theoretically-based intervention designed to achieve self-management among young adults with uncontrolled hypertension. MyHEART is a patient-centered program, based upon the Self-Determination Theory, that uses evidence-based health behavior approaches to lower blood pressure. Therefore, the objective of this study is to evaluate MyHEART's impact on changes in systolic and diastolic blood pressure compared to usual care after 6 and 12 months in 310 geographically and racially/ethnically diverse young adults with uncontrolled hypertension. Secondary outcomes include MyHEART's impact on behavioral outcomes at 6 and 12 months, compared to usual clinical care (increased physical activity, decreased sodium intake) and to examine whether MyHEART's effects on self-management behavior are mediated through variables of perceived competence, autonomy, motivation, and activation (mediation outcomes). MyHEART is one of the first multicenter, randomized controlled hypertension trials tailored to young adults with primary care. The design and methodology will maximize the generalizability of this study. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT03158051.
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Affiliation(s)
- Heather M Johnson
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, 1685 Highland Avenue, 5158 Medical Foundation Centennial Building, Madison, WI 53705-2281, USA; Health Innovation Program, University of Wisconsin School of Medicine and Public Health, 800 University Bay Drive, Suite 210, Madison, WI 53705, USA.
| | - Lisa Sullivan-Vedder
- Aurora Health Care Department of Family Medicine, Family Care Center, 1020 N 12(th) Street, Milwaukee, WI 53233, USA.
| | - KyungMann Kim
- Department of Biostatistics and Medical Informatics, University of Wisconsin School of Medicine and Public Health, K6/420 Clinical Sciences Center, 600 Highland Avenue, Madison, WI 53792-4675, USA.
| | - Patrick E McBride
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, 1685 Highland Avenue, 5158 Medical Foundation Centennial Building, Madison, WI 53705-2281, USA.
| | - Maureen A Smith
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, 1685 Highland Avenue, 5158 Medical Foundation Centennial Building, Madison, WI 53705-2281, USA; Health Innovation Program, University of Wisconsin School of Medicine and Public Health, 800 University Bay Drive, Suite 210, Madison, WI 53705, USA; Department of Population Health Sciences, University of Wisconsin School of Medicine and Public Health, 610 Walnut Street, 707 WARF Building, Madison, WI 53726, USA; Department of Family Medicine and Community Health, University of Wisconsin School of Medicine and Public Health, 1100 Delaplaine Court, Madison, WI 53715-1896, USA.
| | - Jamie N LaMantia
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, 1685 Highland Avenue, 5158 Medical Foundation Centennial Building, Madison, WI 53705-2281, USA; Health Innovation Program, University of Wisconsin School of Medicine and Public Health, 800 University Bay Drive, Suite 210, Madison, WI 53705, USA.
| | - Jennifer T Fink
- Department of Health Informatics and Administration, University of Wisconsin-Milwaukee College of Health Sciences, NWQ Building B, Suite #6455, 2025 E. Newport Avenue, Milwaukee, WI 53211-2906, USA.
| | - Megan R Knutson Sinaise
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, 1685 Highland Avenue, 5158 Medical Foundation Centennial Building, Madison, WI 53705-2281, USA; Health Innovation Program, University of Wisconsin School of Medicine and Public Health, 800 University Bay Drive, Suite 210, Madison, WI 53705, USA.
| | - Laura M Zeller
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, 1685 Highland Avenue, 5158 Medical Foundation Centennial Building, Madison, WI 53705-2281, USA; Health Innovation Program, University of Wisconsin School of Medicine and Public Health, 800 University Bay Drive, Suite 210, Madison, WI 53705, USA.
| | - Diane R Lauver
- School of Nursing, University of Wisconsin, Signe Skott Cooper Hall, 701 Highland Avenue, Madison, WI 53705, USA.
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Izzo JL. Barriers to blood pressure control initiatives: Regional diversity, inadequate measurement techniques, guideline inconsistencies, and health disparities. J Clin Hypertens (Greenwich) 2019; 21:204-207. [PMID: 30609230 DOI: 10.1111/jch.13466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Joseph L Izzo
- Departments of Medicine and Pharmacology, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, New York.,Department of Medicine, Erie County Medical Center, Buffalo, New York
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Alefan Q, Huwari D, Alshogran OY, Jarrah MI. Factors affecting hypertensive patients' compliance with healthy lifestyle. Patient Prefer Adherence 2019; 13:577-585. [PMID: 31114171 PMCID: PMC6497893 DOI: 10.2147/ppa.s198446] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2018] [Accepted: 03/12/2019] [Indexed: 11/23/2022] Open
Abstract
Purpose: This study aimed to identify factors correlating with hypertensive patients' compliance with lifestyle recommendations in north of Jordan. Patients and methods: A cross-sectional survey and face-to-face interview methods were used to collect the data from 1000 adult Jordanian hypertensive patients (>18 years old). A questionnaire was developed based on previous literature and professional consultation. Results: Only 23% of the patients were fully compliant with healthy lifestyle behaviors. About 95% were knowledgeable on hypertension and 86% had positive beliefs about the management protocols of their disease. Gender, physician counseling on a healthy lifestyle, patients' beliefs about hypertension management, and their knowledge on hypertension and its management have an independent effect on compliance with lifestyle recommendations. Conclusion: Patients' compliance with lifestyle recommendations was low. Receiving counseling from physicians about healthy lifestyle and self-care; being informed about hypertension and its management; and having positive beliefs about managing this disease are significant predictors of patients' compliance with lifestyle recommendations.
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Affiliation(s)
- Qais Alefan
- Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology, Irbid, Jordan
- Correspondence: Qais AlefanDepartment of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology, P.O. Box 3030, Irbid22110, JordanTel +962 7 7214 8171Fax +9 622 720 1075Email
| | - Dima Huwari
- Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology, Irbid, Jordan
| | - Osama Y Alshogran
- Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology, Irbid, Jordan
| | - Mohamad I Jarrah
- Department of Internal Medicine, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
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Fix GM, Hyde JK, Bolton RE, Parker VA, Dvorin K, Wu J, Skolnik AA, McInnes DK, Midboe AM, Asch SM, Gifford AL, Bokhour BG. The moral discourse of HIV providers within their organizational context: An ethnographic case study. PATIENT EDUCATION AND COUNSELING 2018; 101:2226-2232. [PMID: 30131263 PMCID: PMC7819576 DOI: 10.1016/j.pec.2018.08.018] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Revised: 08/09/2018] [Accepted: 08/11/2018] [Indexed: 05/22/2023]
Abstract
OBJECTIVE Providers make judgments to inform treatment planning, especially when adherence is crucial, as in HIV. We examined the extent these judgments may become intertwined with moral ones, extraneous to patient care, and how these in turn are situated within specific organizational contexts. METHODS Our ethnographic case study included interviews and observations. Data were analyzed for linguistic markers indexing how providers conceptualized patients and clinic organizational structures and processes. RESULTS We interviewed 30 providers, observed 43 clinical encounters, and recorded fieldnotes of 30 clinic observations, across 8 geographically-diverse HIV clinics. We found variation, and identified two distinct judgment paradigms: 1) Behavior as individual responsibility: patients were characterized as "good," "behaving," or "socio-paths," and "flakes." Clinical encounters focused on medication reconciliation; 2) Behaviors as socio-culturally embedded: patients were characterized as struggling with housing, work, or relationships. Encounters broadened to problem-solving within patients' life-contexts. In sites with individualized conceptualizations, providers worked independently with limited support services. Sites with socio-culturally embedded conceptualizations had multidisciplinary teams with resources to address patients' life challenges. CONCLUSIONS AND PRACTICE IMPLICATIONS When self-management is viewed as an individual's responsibility, nonadherence may be seen as a moral failing. Multidisciplinary teams may foster perceptions of patients' behaviors as socially embedded.
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Affiliation(s)
- Gemmae M Fix
- Center for Healthcare Organization and Implementation Research (CHOIR), ENRM Veterans Affairs Medical Center and VA Boston Healthcare System, Bedford/Boston, MA, USA; Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, MA, USA.
| | - Justeen K Hyde
- Center for Healthcare Organization and Implementation Research (CHOIR), ENRM Veterans Affairs Medical Center and VA Boston Healthcare System, Bedford/Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Rendelle E Bolton
- Center for Healthcare Organization and Implementation Research (CHOIR), ENRM Veterans Affairs Medical Center and VA Boston Healthcare System, Bedford/Boston, MA, USA; Brandeis University, The Heller School for Social Policy and Management, Waltham, MA, USA
| | - Victoria A Parker
- Center for Healthcare Organization and Implementation Research (CHOIR), ENRM Veterans Affairs Medical Center and VA Boston Healthcare System, Bedford/Boston, MA, USA; Peter T. Paul College of Business & Economics, University of New Hampshire, Durham, NH, USA
| | - Kelly Dvorin
- Center for Healthcare Organization and Implementation Research (CHOIR), ENRM Veterans Affairs Medical Center and VA Boston Healthcare System, Bedford/Boston, MA, USA
| | - Juliet Wu
- Center for Healthcare Organization and Implementation Research (CHOIR), ENRM Veterans Affairs Medical Center and VA Boston Healthcare System, Bedford/Boston, MA, USA
| | - Avy A Skolnik
- Center for Healthcare Organization and Implementation Research (CHOIR), ENRM Veterans Affairs Medical Center and VA Boston Healthcare System, Bedford/Boston, MA, USA
| | - D Keith McInnes
- Center for Healthcare Organization and Implementation Research (CHOIR), ENRM Veterans Affairs Medical Center and VA Boston Healthcare System, Bedford/Boston, MA, USA; Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, MA, USA
| | - Amanda M Midboe
- Center for Innovation to Implementation (ci2i), VA Palo Alto HCS, Palo Alto, CA, USA
| | - Steven M Asch
- Center for Innovation to Implementation (ci2i), VA Palo Alto HCS, Palo Alto, CA, USA; Division of Primary Care and Population Health, Stanford University, Stanford, CA, USA
| | - Allen L Gifford
- Center for Healthcare Organization and Implementation Research (CHOIR), ENRM Veterans Affairs Medical Center and VA Boston Healthcare System, Bedford/Boston, MA, USA; Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine, Boston, MA, USA
| | - Barbara G Bokhour
- Center for Healthcare Organization and Implementation Research (CHOIR), ENRM Veterans Affairs Medical Center and VA Boston Healthcare System, Bedford/Boston, MA, USA; Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, MA, USA
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Pringle J. Health mind mapping has the potential to facilitate patient engagement in self-management of long-term conditions. Evid Based Nurs 2018; 22:23. [PMID: 30478187 DOI: 10.1136/ebnurs-2018-103011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/29/2018] [Indexed: 11/03/2022]
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Buitron de la Vega P, Coe C, Paasche-Orlow MK, Clark JA, Waite K, Sanchez MJ, Armstrong E, Bokhour BG. "It's like a mirror image of my illness": Exploring Patient Perceptions About Illness Using Health Mind Mapping-a Qualitative Study. J Gen Intern Med 2018; 33:1692-1699. [PMID: 29992428 PMCID: PMC6153235 DOI: 10.1007/s11606-018-4557-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Revised: 02/06/2018] [Accepted: 06/18/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND A patient's self-management of chronic disease is influenced in part by their explanatory model of illness (EMI) and daily lived experiences (DLE). Unfortunately, assessing patient's EMI and using this information to engage patients in chronic illness self-management continues to be a challenge. OBJECTIVE "Health mind mapping" (HMM) is a novel process that captures a patient's EMI and DLE through the use of a graphic representation of ideas. We aimed to explore patient's experiences using HMM. DESIGN Qualitative study utilizing semi-structured interviews. PARTICIPANTS Adult patients with uncontrolled type 2 diabetes from a primary care clinic. APPROACH A facilitator guided 20 participants through the process of developing a health mind map. Subsequently, each participant completed a semi-structured interview about their experience with the process and perceptions about how their maps could be used. The process and interviews were video and audio recorded. We conducted a content analysis of the maps and a thematic analysis, using an inductive approach, of the interview data. RESULTS Participants explored a wide range of EMs and DLEs in their HMM process. Participants reported that the HMM process (1) helped to develop insight about self and illness; (2) was a catalyst for wanting to take actions to improve illness; and (3) represented an opportunity to actively share illness experiences. They reported potential uses of the map: (1) to communicate about their illness to others in their social network; (2) to communicate about their illness to providers; (3) to help others with diabetes manage their illness; and (4) to encourage ongoing engagement in diabetes self-care. CONCLUSIONS Participants reported that HMM helped them develop new insight about their illness and was a catalyst for encouraging them to take control of their illness. HMM has the potential to facilitate communication with providers and engage patients in collaborative goal setting to improve self-care in chronic illness.
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Affiliation(s)
- Pablo Buitron de la Vega
- General Internal Medicine, Boston Medical Center, Boston, MA, USA.
- Boston University School of Medicine, Boston, MA, USA.
| | | | - Michael K Paasche-Orlow
- General Internal Medicine, Boston Medical Center, Boston, MA, USA
- Boston University School of Medicine, Boston, MA, USA
| | - Jack A Clark
- Boston University School of Public Health, Boston, MA, USA
| | - Katherine Waite
- General Internal Medicine, Boston Medical Center, Boston, MA, USA
| | | | - Emily Armstrong
- General Internal Medicine, Boston Medical Center, Boston, MA, USA
| | - Barbara G Bokhour
- Boston University School of Public Health, Boston, MA, USA
- Center for Healthcare Organizations and Implementation Research, Edith Nourse Rogers VA Medical Center, Bedford, MA, USA
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Taft C, Hallberg I, Bengtsson U, Manhem K, Kjellgren K. Links between blood pressure and medication intake, well-being, stress, physical activity and symptoms reported via a mobile phone-based self-management support system: a cohort study in primary care. BMJ Open 2018; 8:e020849. [PMID: 30139897 PMCID: PMC6112389 DOI: 10.1136/bmjopen-2017-020849] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Revised: 06/12/2018] [Accepted: 07/19/2018] [Indexed: 01/10/2023] Open
Abstract
OBJECTIVES To explore relationships between patients' self-monitoring of blood pressure (BP) and their concurrent self-reports of medication intake, well-being, stress, physical activity and symptoms. DESIGN This study is a secondary analysis of a prospective study exploring the 8-week effectiveness of a mobile phone-based self-management support system for patients with hypertension. SETTING Four primary healthcare centres situated in urban and suburban communities in Sweden. PARTICIPANTS 50 patients undergoing treatment for hypertension. PRIMARY AND SECONDARY OUTCOME MEASURES Associations between systolic (SBP) and diastolic blood pressure (DBP) and 10 self-report lifestyle-related variables were analysed using linear mixed effects modelling. RESULTS Medication intake, better well-being, less stress and greater physical activity were associated variously with lower same-day SBP and DBP. The single strongest association was found between medication intake and SBP, where failure to take medications was associated with an estimated 7.44 mm Hg higher SBP. To a lesser degree, medication intake was also associated with DBP, where DBP was 4.70 mm Hg higher in cases where medications were not taken. Well-being and stress were consistently associated with SBP and DBP, whereas physical activity was associated with only SBP. None of the symptoms-dizziness, headache, restlessness, fatigue or palpitations-were significantly associated with BP. CONCLUSIONS Our findings that BP was associated with patients' BP management behaviours and experiences of well-being and stress, but not symptoms suggest that enabling persons with hypertension to monitor and track their BP in relation to medication intake, physical activity, well-being, stress and symptoms may be a fruitful way to help them gain first-hand understanding of the importance of adherence and persistence to treatment recommendations. TRIAL REGISTRATION NUMBER NCT01510301; Pre-results.
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Affiliation(s)
- Charles Taft
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Centre for Person-Centred Care (GPCC), Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Inger Hallberg
- Centre for Person-Centred Care (GPCC), Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Ulrika Bengtsson
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Centre for Person-Centred Care (GPCC), Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Karin Manhem
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Internal Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Karin Kjellgren
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Centre for Person-Centred Care (GPCC), Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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African American Veterans Storytelling: A Multisite Randomized Trial to Improve Hypertension. Med Care 2017; 55 Suppl 9 Suppl 2:S50-S58. [PMID: 28806366 DOI: 10.1097/mlr.0000000000000766] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND Disparities in hypertension control persist for African American Veterans. OBJECTIVE To enhance cultural relevance of hypertension control self-management education, in a multisite, stratified randomized trial, we tested an interactive Veteran-to-Veteran storytelling digital video disk (DVD) intervention created with Veteran partners, versus an education-only DVD comparison. METHODS At 3 VA facilities, African American Veterans with uncontrolled hypertension were randomized to storytelling DVD intervention or didactic comparison DVD and followed for 6 months. We hypothesized that follow-up blood pressure (BP) would be lower among Veterans in the intervention group. RESULTS African American Veterans (N=619) were 92% male, 39% over age 65, most had a high-school education, over 50% of both the intervention and comparison group reported a household income of <$20,000, and 40% had less than adequate health literacy. At baseline, mean intervention and comparison group BPs were 138/80 and 139/81 mm Hg, respectively; at 6 months, mean systolic BP (SBP) increased by 0.1 in the intervention group and by 1.9 for the comparison group; diastolic BP fell by 0.1 in the intervention group and rose by 0.2 in the comparison group. No differences between the intervention and control groups were statistically significant (all P>0.3). Site differences were large; at one, the intervention group improved while the comparison groups deteriorated, resulting in 6.3 and 3.9 mm Hg more improvement for the intervention group in SBP and diastolic BP (P=0.06 and 0.04), respectively; at the other 2 sites, there were positive and negative changes, all small, in the 2 measures, with minimal differences-one site favored the comparison group and the other, the intervention (these comparisons did not approach statistical significance (all P>0.20). In a secondary analysis stratified by baseline BP, there was no intervention effect among those with uncontrolled BP, but intervention patients who were in control at baseline were more likely to stay in control, compared with comparison [SBP increase by 6.3 mm Hg (SD=14.4) among intervention, and by 10.9 mm Hg (SD=16.9) in comparison, P=0.02]. CONCLUSIONS In this multisite trial, we did not find a significant overall storytelling intervention effect (Clinicaltrials.gov Reg. #NCT01276197).
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Kressin NR, Chapman SE, Magnani JW. A Tale of Two Patients: Patient-Centered Approaches to Adherence as a Gateway to Reducing Disparities. Circulation 2017; 133:2583-92. [PMID: 27297350 DOI: 10.1161/circulationaha.116.015361] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The disparate effects of social determinants of health on cardiovascular health status and health care have been extensively documented by epidemiology. Yet, very little attention has been paid to how understanding and addressing social determinants of health might improve the quality of clinical interactions, especially by improving patients' adherence to recommended therapies. We present a case and suggested approach to illustrate how cardiovascular clinicians can use patient-centered approaches to identify and address social determinants of health barriers to adherence and reduce the impact of unconscious clinician biases. We propose that cardiovascular clinicians (1) recognize that patients may have different belief systems about illnesses' cause and treatment, which may influence their actions, and not assume they share one's experiences or explanatory model; (2) Endeavor to understand the individual patient before you; (3) based on that understanding, tailor your approach to that individual. We suggest a previously-developed mnemonic for an approach to RESPECT the patient: First, show Respect; then elicit patients' understandings of their illness by asking about their Explanatory model. Ask about the patient's Social context, share Power in the interaction, show Empathy, ask about Concerns or fears, and work to develop Trust by building the relationship over time. We provide additional clinical resources to support these efforts, including lay descriptions of cardiovascular conditions, challenges to adherence, and suggested strategies to address them.
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Affiliation(s)
- Nancy R Kressin
- From VA Boston Healthcare System, Jamaica Plain, MA (N.R.K.); Department of Medicine, Boston University School of Medicine and Boston Medical Center, MA (N.R.K., S.E.C.); and Department of Medicine, Division of Cardiology, UPMC Heart & Vascular Institute, University of Pittsburgh, PA (J.W.M.).
| | - Sheila E Chapman
- From VA Boston Healthcare System, Jamaica Plain, MA (N.R.K.); Department of Medicine, Boston University School of Medicine and Boston Medical Center, MA (N.R.K., S.E.C.); and Department of Medicine, Division of Cardiology, UPMC Heart & Vascular Institute, University of Pittsburgh, PA (J.W.M.)
| | - Jared W Magnani
- From VA Boston Healthcare System, Jamaica Plain, MA (N.R.K.); Department of Medicine, Boston University School of Medicine and Boston Medical Center, MA (N.R.K., S.E.C.); and Department of Medicine, Division of Cardiology, UPMC Heart & Vascular Institute, University of Pittsburgh, PA (J.W.M.)
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Hsieh JG, Hsu M, Wang YW. An anthropological approach to teach and evaluate cultural competence in medical students - the application of mini-ethnography in medical history taking. MEDICAL EDUCATION ONLINE 2016; 21:32561. [PMID: 27662824 PMCID: PMC5035505 DOI: 10.3402/meo.v21.32561] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/11/2016] [Revised: 08/10/2016] [Accepted: 08/10/2016] [Indexed: 05/25/2023]
Abstract
PURPOSE To use mini-ethnographies narrating patient illness to improve the cultural competence of the medical students. METHODS Between September 2013 and June 2015, all sixth-year medical students doing their internship at a medical center in eastern Taiwan were trained to write mini-ethnographies for one of the patients in their care. The mini-ethnographies were analyzed by authors with focus on the various aspects of cultural sensitivity and a holistic care approach. RESULTS Ninety-one students handed in mini-ethnographies, of whom 56 were male (61.5%) and 35 were female (38.5%). From the mini-ethnographies, three core aspects were derived: 1) the explanatory models and perceptions of illness, 2) culture and health care, and 3) society, resources, and health care. Based on the qualities of each aspect, nine secondary nodes were classified: expectations and attitude about illness/treatment, perceptions about their own prognosis in particular, knowledge and feelings regarding illness, cause of illness, choice of treatment method (including traditional medical treatments), prejudice and discrimination, influences of traditional culture and language, social support and resources, and inequality in health care. CONCLUSIONS Mini-ethnography is an effective teaching method that can help students to develop cultural competence. It also serves as an effective instrument to assess the cultural competence of medical students.
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Affiliation(s)
- Jyh-Gang Hsieh
- Department of Family Medicine, Hualien Tzu Chi Hospital, Hualien, Taiwan
| | - Mutsu Hsu
- Department of Human Development and Psychology, Tzu Chi University, Hualien, Taiwan
| | - Ying-Wei Wang
- Department of Family Medicine, Hualien Tzu Chi Hospital, Hualien, Taiwan
- Department of Medical Humanities, School of Medicine, Tzu Chi University, Hualien, Taiwan;
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Bokhour BG, Fix GM, Gordon HS, Long JA, DeLaughter K, Orner MB, Pope C, Houston TK. Can stories influence African-American patients' intentions to change hypertension management behaviors? A randomized control trial. PATIENT EDUCATION AND COUNSELING 2016; 99:1482-1488. [PMID: 27387121 DOI: 10.1016/j.pec.2016.06.024] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Revised: 06/17/2016] [Accepted: 06/21/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVES Information-only interventions for hypertension management have limited effectiveness, particularly among disadvantaged populations. We assessed the impact of viewing African-American patients' stories of successfully controlling hypertension on intention to change hypertension management behaviors and engagement with educational materials. METHODS In a three-site randomized trial, 618 African-American Veterans with uncontrolled hypertension viewed an information-only DVD about hypertension (control) or a DVD adding videos of African-American Veterans telling stories about successful hypertension management (intervention). After viewing, patients were asked about their engagement with the DVD, and their intentions to change behavior. Mean scores were compared with two-sided t-tests. RESULTS Results favored the Stories intervention, with significantly higher emotional engagement versus control (4.3 vs. 2.2 p<0.0001). Intervention patients reported significantly greater intentions to become more physically active (4.6 vs. 4.4, p=0.018), use salt substitutes (3.9 vs. 3.4, p=0.006), talk openly with their doctor about hypertension (4.6 vs. 4.5, p=0.049), and remember to take hypertension medication (4.8 vs. 4.6, p=0.04). CONCLUSION Patients were more emotionally engaged and reported intentions to change behavior when watching real patient hypertension management success stories. PRACTICE IMPLICATIONS Stories may be more influential than information alone, and represent a scalable approach to modifying behavioral intention.
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Affiliation(s)
- Barbara G Bokhour
- Center for Healthcare Organization and Implementation Research, ENRM Veterans Affairs Medical Center, United States; Department of Health Law Policy and Management, Boston University School of Public Health, United States.
| | - Gemmae M Fix
- Center for Healthcare Organization and Implementation Research, ENRM Veterans Affairs Medical Center, United States; Department of Health Law Policy and Management, Boston University School of Public Health, United States.
| | - Howard S Gordon
- Center of Innovation for Complex Chronic Healthcare, Jesse Brown Veterans Affairs Medical Center, United States; Section of Academic Internal Medicine, Department of Medicine, University of Illinois at Chicago College of Medicine, United States.
| | - Judith A Long
- Center for Health Equity Research and Promotion, Corporal Michael J. Crescenz/Philadelphia VA Medical Center, United States; Division of General Internal Medicine, University of Pennsylvania School of Medicine, United States.
| | - Kathryn DeLaughter
- Center for Healthcare Organization and Implementation Research, ENRM Veterans Affairs Medical Center, United States.
| | - Michelle B Orner
- Center for Healthcare Organization and Implementation Research, ENRM Veterans Affairs Medical Center, United States.
| | - Charlene Pope
- Ralph H. Johnson VA Medical Center, United States; Medical University of South Carolina College of Nursing, United States.
| | - Thomas K Houston
- Center for Healthcare Organization and Implementation Research, ENRM Veterans Affairs Medical Center, United States; Division of Health Informatics and Implementation Science, Quantitative Health Sciences, University of Massachusetts Medical School, United States.
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The Comparison of Dietary Behaviors among Rural Controlled and Uncontrolled Hypertensive Patients. Adv Prev Med 2016; 2016:7086418. [PMID: 27516908 PMCID: PMC4969533 DOI: 10.1155/2016/7086418] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2016] [Accepted: 05/26/2016] [Indexed: 02/07/2023] Open
Abstract
Nutrition is a dominant peripheral factor in increasing blood pressure; however, little information is available about the nutritional status of hypertensive patients in Iran. This study aimed to compare nutritional behaviors of the rural controlled and uncontrolled hypertensive patients and to determine the predictive power of nutritional behaviors from blood pressure. This cross-sectional study was conducted on 671 rural hypertensive patients, using multistage random sampling method in Ardabil city in 2013. Data were collected by a 3-day food record questionnaire. Nutritional data were extracted by Nutritionist 4 software and analyzed by the SPSS 18 software using Pearson correlation, multiple linear regression, ANOVA, and independent t-test. A significant difference was observed in the means of fat intake, cholesterol, saturated fat, sodium, energy, calcium, vitamin C, fiber, and nutritional knowledge between controlled and uncontrolled groups. In the controlled group, sodium, saturated fats, vitamin C, calcium, and energy intake explained 30.6% of the variations in blood pressure and, in the uncontrolled group, sodium, carbohydrate, fiber intake, and nutritional knowledge explained 83% of the variations in blood pressure. There was a significant difference in the nutritional behavior between the two groups and changes in blood pressure could be explained significantly by nutritional behaviors.
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Hallberg I, Ranerup A, Kjellgren K. Supporting the self-management of hypertension: Patients' experiences of using a mobile phone-based system. J Hum Hypertens 2016; 30:141-6. [PMID: 25903164 PMCID: PMC4705419 DOI: 10.1038/jhh.2015.37] [Citation(s) in RCA: 61] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2015] [Revised: 03/13/2015] [Accepted: 03/18/2015] [Indexed: 11/09/2022]
Abstract
Globally, hypertension is poorly controlled and its treatment consists mainly of preventive behavior, adherence to treatment and risk-factor management. The aim of this study was to explore patients' experiences of an interactive mobile phone-based system designed to support the self-management of hypertension. Forty-nine patients were interviewed about their experiences of using the self-management system for 8 weeks regarding: (i) daily answers on self-report questions concerning lifestyle, well-being, symptoms, medication intake and side effects; (ii) results of home blood-pressure measurements; (iii) reminders and motivational messages; and (iv) access to a web-based platform for visualization of the self-reports. The audio-recorded interviews were analyzed using qualitative thematic analysis. The patients considered the self-management system relevant for the follow-up of hypertension and found it easy to use, but some provided insight into issues for improvement. They felt that using the system offered benefits, for example, increasing their participation during follow-up consultations; they further perceived that it helped them gain understanding of the interplay between blood pressure and daily life, which resulted in increased motivation to follow treatment. Increased awareness of the importance of adhering to prescribed treatment may be a way to minimize the cardiovascular risks of hypertension.
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Affiliation(s)
- I Hallberg
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Centre for Person-Centred Care (GPCC), Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - A Ranerup
- Centre for Person-Centred Care (GPCC), Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Applied IT, University of Gothenburg, Gothenburg, Sweden
| | - K Kjellgren
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Centre for Person-Centred Care (GPCC), Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Abstract
Refugees share a common experience of displacement from their country of origin, migration, and resettlement in an unfamiliar country. More than 17 million people have fled their home countries due to war, generalized violence, and persecution. US primary care physicians must care for their immediate and long-term medical needs. Challenges include (1) language and cultural barriers, (2) high rates of mental health disorders, (3) higher prevalence of latent infections, and (4) different explanatory models for chronic diseases. This article discusses management strategies for common challenges that arise in the primary care of refugees.
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Affiliation(s)
- Genji Terasaki
- Section of General Internal Medicine, Department of Medicine, Harborview Medical Center, University of Washington, Box 359780, 325 Ninth Avenue, Seattle, WA 98104, USA.
| | - Nicole Chow Ahrenholz
- Section of General Internal Medicine, Department of Medicine, Harborview Medical Center, University of Washington, Box 359780, 325 Ninth Avenue, Seattle, WA 98104, USA
| | - Mahri Z Haider
- Section of General Internal Medicine, Department of Medicine, Harborview Medical Center, University of Washington, Box 359780, 325 Ninth Avenue, Seattle, WA 98104, USA
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Rimando M. Perceived Barriers to and Facilitators of Hypertension Management among Underserved African American Older Adults. Ethn Dis 2015; 25:329-36. [PMID: 26675535 DOI: 10.18865/ed.25.3.329] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE To understand the perceived barriers to and facilitators of hypertension self-management among underserved African American older adults in a southeastern clinic. DESIGN Qualitative descriptive. SETTING Urban cardiovascular health clinic in a southeastern state. PARTICIPANTS 28 African Americans diagnosed with hypertension. METHODS Interview questions were focused on knowledge of hypertension management and barriers and facilitators to hypertension self-management. Thematic content analysis was applied. RESULTS Patients reported increased hypertension knowledge after attending the clinic. All patients reported knowledge of the severe consequences of uncontrolled hypertension. Perceived barriers to hypertension management included lack of money, lack of motivation to exercise, and fear of injury from exercising. Perceived facilitators of hypertension management included weight loss, unexpected diagnosis of hypertension, family members with hypertension and diabetes, and social support. CONCLUSIONS Findings suggest that perceived barriers and facilitators influence a patient's decision to manage hypertension. Findings suggest the importance of health literacy and patient-provider communication at this particular clinic. Possible factors in the social environment may influence hypertension management. This study adds to the literature by understanding the perceived barriers to and facilitators of hypertension management of an underserved sample in a southeastern clinic. The results suggest a need for the redesign and transformation of future hypertension education strategies aimed at this clinic sample.
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Affiliation(s)
- Marylen Rimando
- 1. Rural Health Research Institute, Georgia Southern University
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Holmberg C, Waters EA, Whitehouse K, Daly M, McCaskill-Stevens W. My Lived Experiences Are More Important Than Your Probabilities: The Role of Individualized Risk Estimates for Decision Making about Participation in the Study of Tamoxifen and Raloxifene (STAR). Med Decis Making 2015; 35:1010-22. [PMID: 26183166 DOI: 10.1177/0272989x15594382] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2014] [Accepted: 06/07/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND Decision-making experts emphasize that understanding and using probabilistic information are important for making informed decisions about medical treatments involving complex risk-benefit tradeoffs. Yet empirical research demonstrates that individuals may not use probabilities when making decisions. OBJECTIVES To explore decision making and the use of probabilities for decision making from the perspective of women who were risk-eligible to enroll in the Study of Tamoxifen and Raloxifene (STAR). METHODS We conducted narrative interviews with 20 women who agreed to participate in STAR and 20 women who declined. The project was based on a narrative approach. Analysis included the development of summaries of each narrative, and thematic analysis with developing a coding scheme inductively to code all transcripts to identify emerging themes. RESULTS Interviewees explained and embedded their STAR decisions within experiences encountered throughout their lives. Such lived experiences included but were not limited to breast cancer family history, a personal history of breast biopsies, and experiences or assumptions about taking tamoxifen or medicines more generally. CONCLUSIONS Women's explanations of their decisions about participating in a breast cancer chemoprevention trial were more complex than decision strategies that rely solely on a quantitative risk-benefit analysis of probabilities derived from populations In addition to precise risk information, clinicians and risk communicators should recognize the importance and legitimacy of lived experience in individual decision making.
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Affiliation(s)
- Christine Holmberg
- Berlin School of Public Health, Charité - Universitätsmedizin Berlin, Berlin, Germany (CH, KW)
| | - Erika A Waters
- Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA (EAW)
| | - Katie Whitehouse
- Berlin School of Public Health, Charité - Universitätsmedizin Berlin, Berlin, Germany (CH, KW)
| | - Mary Daly
- Fox Chase Cancer Center, Philadelphia, PA, USA (MD)
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Affiliation(s)
- Barbara G. Bokhour
- From the Center for Healthcare Organization and Implementation Research (CHOIR)-VA HSR&D Center of Innovation, VA Boston Healthcare System and Edith Nourse Rogers Memorial VA Medical Center, Bedford, MA (B.G.B., N.R.K.); Department of Health Policy and Management, Boston University School of Public Health, Boston, MA (B.G.B.); and Section of General Internal Medicine, Boston University School of Medicine, Boston, MA (N.R.K.)
| | - Nancy R. Kressin
- From the Center for Healthcare Organization and Implementation Research (CHOIR)-VA HSR&D Center of Innovation, VA Boston Healthcare System and Edith Nourse Rogers Memorial VA Medical Center, Bedford, MA (B.G.B., N.R.K.); Department of Health Policy and Management, Boston University School of Public Health, Boston, MA (B.G.B.); and Section of General Internal Medicine, Boston University School of Medicine, Boston, MA (N.R.K.)
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Supporting patients to self-monitor their oral anticoagulation therapy: recommendations based on a qualitative study of patients' experiences. Br J Gen Pract 2015; 65:e438-46. [PMID: 26077266 PMCID: PMC4484944 DOI: 10.3399/bjgp15x685645] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2014] [Accepted: 02/18/2015] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Clinical trials suggest that oral anticoagulation therapy (OAT) self-monitoring is safe and effective, however little is known about the patient experience of this process. There is a lack of understanding about how best to train and support patients embarking on OAT self-monitoring. AIM To collect in-depth information about patients' experiences of OAT self-monitoring outside of clinical trial conditions and to produce a set of recommendations on how best to support such patients. DESIGN AND SETTING Semi-structured qualitative interviews with patients who self-monitor and live in England. METHOD In total, 26 of the 267 (9.7%) who participated in the Cohort study of Anticoagulation Self-Monitoring (CASM) and were still self-monitoring after 12 months' follow-up were interviewed. Topics discussed included experiences of OAT self-monitoring, healthcare support, training, and decision making. Framework analysis was used. RESULTS Following initial problems using the monitoring device, interviewees described a mostly positive experience. Although less effort was expended attending monitoring appointments with health professionals, effort was required to conduct self-monitoring tests and to interpret and act on the results. Desire to self-manage was variable, especially when dosing advice systems worked promptly and reliably. Interviewees overcame patchy healthcare system knowledge and support of self-monitoring by educating themselves. Family and friends provided support with learning to use the monitor and managing OAT dosage adjustments. CONCLUSION Better, more-consistent training and health-service support would have alleviated a number of problems encountered by these patients who were self-monitoring. This training and support will become even more important if self-monitoring becomes more accessible to the general population of people on OAT.
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Kamran A, Azadbakht L, Sharifirad G, Mahaki B, Mohebi S. The relationship between blood pressure and the structures of Pender's health promotion model in rural hypertensive patients. JOURNAL OF EDUCATION AND HEALTH PROMOTION 2015; 4:29. [PMID: 25883999 PMCID: PMC4392569 DOI: 10.4103/2277-9531.154124] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
INTRODUCTION AND OBJECTIVE Perception is the most important predictor of behavior and there is a strong relation and correlation between behavior and believes. Thus, to improve self-care behaviors of patients, it is required to fully understand their perceptions about behavior. This paper aimed to assess the prediction power of health promotion model of systolic blood pressure (SBP) as the result of self-care behavior in rural hypertensive. METHODS This cross-sectional study has been carried out through random multistage sampling on 671 rural patients under the coverage of health center of Ardebil city in 2013. Data were collected through reliable and valid questionnaire based on the health promotion model in eight sectors. For data analysis, Pearson correlation statistical tests, multivariate linear regression, ANOVA and independent t-test were used and for confirmatory factor analysis, SPSS 18 and AMOS 18 (SPSS Inc., Chicago, IL, USA) were used. RESULTS The results showed significant negative correlation between self-efficacy, perceived benefits, situational influences, affects related to behavior and commitment to action structures with SBP and showed a positive significant correlation between perceived barriers and SBP. Furthermore, age and body mass had direct significant relation with SBP. The age of patients showed inverse significant correlation with self-efficacy, perceived benefits, affects related to behavior, interpersonal influences and commitment and showed a direct significant correlation with perceived barriers, means that by increase of age, the perceived barriers also increased. The structures of health promotion model have in overall the prediction power of 71.4% of SBP changes. CONCLUSION The diet perceptions of patients, the same as health promotion model, has good predictive power of SBP, especially the structures of perceived benefits and self-efficacy have inverse meaningful relation with systole blood pressure and predicted a higher percentage of this variable.
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Affiliation(s)
- Aziz Kamran
- Department of Public Health, School of Health, Ardabil University of Medical Sciences, Ardabil, Iran
| | - Leila Azadbakht
- Food Security Research Center, Department of Community Nutrition, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Gholamreza Sharifirad
- Department of Public Health, School of Health, Qom University of Medical Sciences, Qom, Iran
| | - Behzad Mahaki
- Department of Biostatistics and Epidemiology, School of Health, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Siamak Mohebi
- Health Policy and Promotion Research Center, Qom University of Medical Sciences, Qom, Iran
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Abstract
BACKGROUND In the United States, nearly 25% of all women older than 20 years have hypertension (HTN). Nearly 30% to 50% of persons with HTN experience symptoms attributed to high blood pressure (BP). Women with hypertensive symptoms may connect their symptoms to perceived BP changes and may be using their perceptions about BP changes to guide their HTN self-management. There is limited research about perceived BP changes or their use in self-management. OBJECTIVE The purpose of this qualitative study is to describe the experiences of women with HTN self-managing their perceived BP changes. METHODS van Manen's phenomenology methodology and method guided the inquiry. Women with HTN who believed they could tell when their BP changed based on their symptoms were recruited from community settings and were interviewed once with a semistructured guide. Interviews were digitally recorded and professionally transcribed. Textual data were analyzed using thematic analysis to identify major themes. RESULTS Seven black and 6 white women comprised the study sample. Participants were middle aged (mean [SD], 50.5 [9.62] years), were experienced in living with HTN (mean [SD],10.76 [9.50] years), had at least a high school education, and had a limited annual income (93% <$24 000). One central theme ("getting to normal") and 4 subthemes (i.e., "I can tell," "tending to it," "the wake-up call," and "doing it right") were discovered in the data. The themes depict a process of episodic symptom-driven and day-to-day actions that the participants used to get their BP to normal. CONCLUSIONS The study is significant as new knowledge was discovered about how women perceive their BP changes and use them to guide self-management. This study contributes to clinical practice through suggestions for improving patient assessments. Results serve as a foundation for further research of the self-management of BP changes and developing belief-based interventions with the potential to improve BP control.
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Differences and similarities in explanatory models of hypertension in the United States of america, Tanzania and Jamaica. W INDIAN MED J 2014; 63:238-46. [PMID: 25314281 DOI: 10.7727/wimj.2013.302] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2013] [Accepted: 04/22/2014] [Indexed: 11/18/2022]
Abstract
BACKGROUND Misperceptions detract from effective disease management in a number of conditions but the nature of underlying illness beliefs and their relative consistency in patients with chronic hypertension (cHTN) who present to the Emergency Department (ED) with poor blood pressure control is not known. OBJECTIVES 1) To explore disease knowledge in ED patients with cHTN using explanatory modelling; and 2) to compare gaps in cHTN knowledge across racially similar but geographically divergent ED patients. METHODS Emergency department patients of African origin with cHTN were recruited from three sites: Detroit Receiving Hospital (DRH - Detroit, MI), the Tanzanian Training Center for International Health (TTCIH - Ifakara, TZ) and the University Hospital of the West Indies (UHWI - Kingston, JA). Demographic and baseline data were collected along with open-ended responses to a series of questions related to cHTN. Qualitative responses were coded into predefined, disease-relevant quantitative domains by two separate, blinded reviewers and multilevel comparisons were performed using Kruskal-Wallis or analysis of variance (ANOVA) tests, where appropriate. RESULTS One hundred and ninety-seven patients were enrolled; mean age (50.5 years vs 51.6 years vs 50.8 years; p = 0.86) and gender distribution (% male: 49.5 vs 44 vs 40; p = 0.53) were similar across sites but patients at DRH (vs TTCIH vs UHWI) were more hypertensive at presentation (mean systolic BP in mmHg: 166.8 vs 153 vs 152.7; p = 0.003), had a longer mean duration of cHTN (12.1 years vs 4.6 years vs 9.1; p < 0.0001), and were less likely to be on antihypertensive therapy (84.5% vs 92% vs 100%, p = 0.001). Explanatory models revealed limited recognition of cHTN as a "disease" (19.6% vs 28% vs 16%; p = 0.31) and consistency in the belief that cHTN was curable (44.3% vs 36% vs 42%; p = 0.62). Stress (48.4% vs 60% vs 50%; p = 0.31) and, especially at DRH, diet (62.2% vs 22% vs 36%; p < 0.0001) were identified most frequently as causes of cHTN and an association with symptoms was common (83.5% vs 98% vs 78%; p = 0.15). Clear differences existed for perceived benefits of treatment and consequences of poor control by site, but in general, both were under-appreciated. CONCLUSIONS Misperceptions related to cHTN are common in ED patients. While specific areas of disconnect exist by geographic region, failure to recognize cHTN as a dire and fixed disease state is consistent, suggesting that a uniform educational intervention may be of benefit in this setting.
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Fix GM, Cohn ES, Solomon JL, Cortés DE, Mueller N, Kressin NR, Borzecki A, Katz LA, Bokhour BG. The role of comorbidities in patients' hypertension self-management. Chronic Illn 2014; 10:81-92. [PMID: 23892774 PMCID: PMC8887829 DOI: 10.1177/1742395313496591] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
OBJECTIVE We sought to understand barriers to hypertension self-management in patients with hypertension and comorbidities. METHODS We conducted semi-structured, qualitative interviews with 48 patients with uncontrolled hypertension and at least one comorbidity to learn about beliefs and behaviors that might affect hypertension self-management. Using a grounded theory strategy, we analyzed interview transcripts detailing patients' hypertension self-management behaviors vis-à-vis a framework including Explanatory Models-a patient's understanding of the pathophysiology, cause, course, treatment, and severity of an illness, such as hypertension. RESULTS We identified four factors that interfered with hypertension self-management. (1) Interdependence: Participants saw hypertension as interconnected to their comorbidities and subsequently had difficulty separating information about their illnesses. (2) Low priority: Compared to other conditions, participants assigned hypertension a lower priority. (3) Conflicts: Participants struggled with conflicts between hypertension self-management practices and those for comorbidities. (4) Managing multiple medications: Polypharmacy led to patients' confusion and concern about taking medications as prescribed. DISCUSSION Participants did not experience hypertension as a discreet clinical condition; rather, they self-managed hypertension concurrently with other conditions, leading to a breakdown in hypertension self-management. We provide strategies to address each of the four barriers to better equip providers in addressing their clinically salient concerns.
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Affiliation(s)
- Gemmae M Fix
- Center for Healthcare Organization and Implementation Research (CHOIR), a VA HSR&D Center of Innovation, VA Boston Healthcare System and Edith Nourse Rogers Memorial VA Medical Center, MA, USA
- Department of Health Policy and Management, Boston University School of Public Health, MA, USA
| | - Ellen S Cohn
- Boston University, Sargent College of Health and Rehabilitation Sciences, MA, USA
| | - Jeffrey L Solomon
- Center for Healthcare Organization and Implementation Research (CHOIR), a VA HSR&D Center of Innovation, VA Boston Healthcare System and Edith Nourse Rogers Memorial VA Medical Center, MA, USA
| | | | - Nora Mueller
- Center for Healthcare Organization and Implementation Research (CHOIR), a VA HSR&D Center of Innovation, VA Boston Healthcare System and Edith Nourse Rogers Memorial VA Medical Center, MA, USA
| | - Nancy R Kressin
- Center for Healthcare Organization and Implementation Research (CHOIR), a VA HSR&D Center of Innovation, VA Boston Healthcare System and Edith Nourse Rogers Memorial VA Medical Center, MA, USA
- Section of General Internal Medicine, Boston University School of Medicine, MA, USA
- VA Boston Healthcare System, MA, USA
| | - Ann Borzecki
- Center for Healthcare Organization and Implementation Research (CHOIR), a VA HSR&D Center of Innovation, VA Boston Healthcare System and Edith Nourse Rogers Memorial VA Medical Center, MA, USA
- Department of Health Policy and Management, Boston University School of Public Health, MA, USA
- Section of General Internal Medicine, Boston University School of Medicine, MA, USA
| | - Lois A Katz
- VA New York Harbor Healthcare System, NY, USA
| | - Barbara G Bokhour
- Center for Healthcare Organization and Implementation Research (CHOIR), a VA HSR&D Center of Innovation, VA Boston Healthcare System and Edith Nourse Rogers Memorial VA Medical Center, MA, USA
- Department of Health Policy and Management, Boston University School of Public Health, MA, USA
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47
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Hallberg I, Taft C, Ranerup A, Bengtsson U, Hoffmann M, Höfer S, Kasperowski D, Mäkitalo A, Lundin M, Ring L, Rosenqvist U, Kjellgren K. Phases in development of an interactive mobile phone-based system to support self-management of hypertension. Integr Blood Press Control 2014; 7:19-28. [PMID: 24910510 PMCID: PMC4046514 DOI: 10.2147/ibpc.s59030] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Hypertension is a significant risk factor for heart disease and stroke worldwide. Effective treatment regimens exist; however, treatment adherence rates are poor (30%-50%). Improving self-management may be a way to increase adherence to treatment. The purpose of this paper is to describe the phases in the development and preliminary evaluation of an interactive mobile phone-based system aimed at supporting patients in self-managing their hypertension. A person-centered and participatory framework emphasizing patient involvement was used. An interdisciplinary group of researchers, patients with hypertension, and health care professionals who were specialized in hypertension care designed and developed a set of questions and motivational messages for use in an interactive mobile phone-based system. Guided by the US Food and Drug Administration framework for the development of patient-reported outcome measures, the development and evaluation process comprised three major development phases (1, defining; 2, adjusting; 3, confirming the conceptual framework and delivery system) and two evaluation and refinement phases (4, collecting, analyzing, interpreting data; 5, evaluating the self-management system in clinical practice). Evaluation of new mobile health systems in a structured manner is important to understand how various factors affect the development process from both a technical and human perspective. Forthcoming analyses will evaluate the effectiveness and utility of the mobile phone-based system in supporting the self-management of hypertension.
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Affiliation(s)
- Inger Hallberg
- Institute of Health and Care Sciences, University of Gothenburg, Gothenburg, Linköping, Sweden ; Centre for Person-Centred Care, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Charles Taft
- Institute of Health and Care Sciences, University of Gothenburg, Gothenburg, Linköping, Sweden ; Centre for Person-Centred Care, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Agneta Ranerup
- Department of Applied Information Technology, University of Gothenburg, Gothenburg, Linköping, Sweden ; Centre for Person-Centred Care, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Ulrika Bengtsson
- Institute of Health and Care Sciences, University of Gothenburg, Gothenburg, Linköping, Sweden ; Centre for Person-Centred Care, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Mikael Hoffmann
- The NEPI Foundation, Linköping, Sweden ; Department of Medical and Health Sciences, Linköping University, Linköping
| | - Stefan Höfer
- Department of Medical Psychology, Innsbruck Medical University, Innsbruck, Austria
| | | | - Asa Mäkitalo
- Department of Education, Communication and Learning, University of Gothenburg, Gothenburg
| | - Mona Lundin
- Department of Education, Communication and Learning, University of Gothenburg, Gothenburg
| | - Lena Ring
- Centre for Research Ethics and Bioethics, Uppsala University ; Department of Use of Medical Products, Medical Products Agency, Uppsala
| | - Ulf Rosenqvist
- Department of Medical Specialist and Department of Medical and Health Sciences, Linköping University, Motala
| | - Karin Kjellgren
- Institute of Health and Care Sciences, University of Gothenburg, Gothenburg, Linköping, Sweden ; Department of Medical and Health Sciences, Linköping University, Linköping ; Centre for Person-Centred Care, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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48
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Frankel RM, Sherman HB. The secret of the care of the patient is in knowing and applying the evidence about effective clinical communication. Oral Dis 2014; 21:919-26. [PMID: 24725164 DOI: 10.1111/odi.12250] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2014] [Accepted: 03/27/2014] [Indexed: 11/30/2022]
Abstract
American physicians and dentists conduct approximately 140 000-160 000 patient interviews in a practice lifetime, making the interview the most frequently performed medical procedure. Over the past 75 years, a steadily growing stream of scientific research has confirmed the fact that patient-clinician communication affects the course, direction, and both biomedical and functional outcomes of care. The field of clinical communication research has matured from anecdotes and aphorisms about 'bedside manner' to sophisticated randomized control trials and evidence-based outcomes that have been translated into reliable practice guidelines. Several key skills or habits of practice have been identified and studied in terms of their efficacy and effectiveness. These include the importance of agenda-setting, eliciting patients' perspectives about the nature of their ailments, communicating caring and concern, and testing for patient comprehension and agreement with proposed treatments. In addition to being effective, interpersonal communication can be deeply satisfying as well as offering a lower probability of law suits in the event of an adverse outcome.
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Affiliation(s)
- R M Frankel
- Department of Medicine and Geriatrics, Indiana University School of Medicine, Indianapolis, IN, USA
| | - H B Sherman
- Center for Courage and Renewal, Seattle, WA, USA
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49
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Burla MJ, Brody AM, Ference BA, Flack JM, Mahn JJ, Marinica AL, Carroll JA, Nasser SA, Zhang S, Levy PD. Blood pressure control and perceived health status in African Americans with subclinical hypertensive heart disease. JOURNAL OF THE AMERICAN SOCIETY OF HYPERTENSION : JASH 2014; 8:321-9. [PMID: 24726098 DOI: 10.1016/j.jash.2014.02.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/23/2013] [Revised: 02/22/2014] [Accepted: 02/23/2014] [Indexed: 11/22/2022]
Abstract
The role of antihypertensive therapy in reducing the risk of cardiovascular complications such as heart failure is well established, but the effects of different blood pressure goals on patient-perceived health status has not been well defined. We sought to determine if adverse effects on perceived health status will occur with lower blood pressure goals or more intensive antihypertensive therapy. Data were prospectively collected as a part of a single center, randomized controlled trial designed to evaluate standard (Seventh Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure-compliant) versus intense (<120/80 mm Hg) blood pressure goals for patients with uncontrolled hypertension and subclinical hypertensive heart disease. Blood pressure management was open label, and health status was measured at 3-month intervals over 1 year of follow-up using the short-form (SF)-36. Mixed linear models were constructed for each of the SF-36 summary scores. One hundred twenty-three (mean age 49.4 ± 8.2; 65% female; 95.1% African American) patients were randomized, 88 of whom completed the protocol. With the exception of a decrease in perceived health transition, health status did not change significantly on repeat measurement. Lower blood pressure goals and more intensive antihypertensive therapy appear to be well tolerated with limited effects on patients' perception of health status.
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Affiliation(s)
- Michael J Burla
- Department of Emergency Medicine, Wayne State University, Detroit, MI, USA; College of Osteopathic Medicine, Michigan State University, East Lansing, MI, USA.
| | - Aaron M Brody
- Department of Emergency Medicine, Wayne State University, Detroit, MI, USA
| | - Brian A Ference
- Division of Translational Research and Clinical Epidemiology and Department of Medicine, Wayne State University, Detroit, MI, USA
| | - John M Flack
- Division of Translational Research and Clinical Epidemiology and Department of Medicine, Wayne State University, Detroit, MI, USA; Cardiovascular Research Institute, Wayne State University, Detroit, MI, USA
| | - James J Mahn
- Department of Emergency Medicine, Wayne State University, Detroit, MI, USA; School of Medicine, Wayne State University, Detroit, MI, USA
| | - Alexander L Marinica
- Department of Emergency Medicine, Wayne State University, Detroit, MI, USA; College of Osteopathic Medicine, Michigan State University, East Lansing, MI, USA
| | - Justin A Carroll
- Department of Emergency Medicine, Wayne State University, Detroit, MI, USA; School of Medicine, Wayne State University, Detroit, MI, USA
| | - Samar A Nasser
- College of Education, Health, and Human Services, University of Michigan-Dearborn, Dearborn, MI, USA
| | - Shiling Zhang
- Division of Translational Research and Clinical Epidemiology and Department of Medicine, Wayne State University, Detroit, MI, USA
| | - Phillip D Levy
- Department of Emergency Medicine, Wayne State University, Detroit, MI, USA; Cardiovascular Research Institute, Wayne State University, Detroit, MI, USA
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50
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e-Care for heart wellness: a feasibility trial to decrease blood pressure and cardiovascular risk. Am J Prev Med 2014; 46:368-77. [PMID: 24650839 PMCID: PMC3978093 DOI: 10.1016/j.amepre.2013.11.009] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2013] [Revised: 11/07/2013] [Accepted: 11/14/2013] [Indexed: 02/07/2023]
Abstract
BACKGROUND Pharmacist- or nurse-led team care decreases patient blood pressure (BP) and cardiovascular disease (CVD) risk. PURPOSE To evaluate whether a Web-based dietitian-led (WD) team care intervention was feasible and resulted in decreased BP, CVD risk, and weight compared to usual care (UC). METHODS Electronic health record (EHR) data identified patients aged 30-69 years with BMI >26, elevated BP, and 10%-25% 10-year Framingham CVD risk who were registered patient website users. Patients with uncontrolled BP at screening were randomized to UC or WD, which included a home BP monitor, scale, and dietitian team care. WD participants had a single in-person dietitian visit to obtain baseline information and create a plan to reduce CVD risk. Planned follow-up occurred via secure messaging to report BP, weight, and fruit and vegetable intake and receive ongoing feedback. If needed, dietitians encouraged patients and their physicians to intensify antihypertensive and lipid-lowering medications. Primary outcomes were change in systolic BP and weight loss ≥4 kg at 6 months. Feasibility outcomes included intervention utilization and satisfaction. RESULTS Between 2010 and 2011, a total of 90 of 101 participants completed 6-month follow-ups. The WD group had higher rates of secure messaging utilization and patient satisfaction. The WD group lost significantly more weight than the UC group (adjusted net difference=-3.2 kg, 95% CI=-5.0, -1.5, p<0.001) and was more likely to lose ≥4 kg (adjusted relative risk [RRadj]=2.96, 95% CI=1.16, 7.53). BP control and CVD risk reduction were greater in WD than UC, but differences were not statistically significant. CONCLUSIONS WD intervention was feasible and resulted in decreased weight, BP, and CVD risk. A larger trial is justified. TRIAL REGISTRATION NUMBER Trial Registration Number: NCT01077388.
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