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Heinert SW, Guzman-Baez K, Aamir A, Penugonda A, Crabtree BF, Greene K, Heckman CJ, Levy P, Strickland PO, Hudson SV. Developing a Youth-Led Digital Hypertension Education Intervention for Adults With Hypertension: Qualitative Study on Refinement and Acceptability. JMIR Form Res 2024; 8:e54909. [PMID: 39240662 PMCID: PMC11415718 DOI: 10.2196/54909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 04/09/2024] [Accepted: 05/13/2024] [Indexed: 09/07/2024] Open
Abstract
BACKGROUND Hypertension affects one-third of adults in the United States and is the leading risk factor for death. Underserved populations are seen disproportionately in the emergency department (ED) and tend to have worse blood pressure (BP) control. For adults, a lack of hypertension knowledge is a common barrier to hypertension control, while social support is a strong facilitator, and providing information that is culturally sensitive and relevant is especially important in this context. The youth experience increased confidence when given the responsibility to provide health education and care navigation to others. As such, we planned a randomized controlled trial (RCT) for the effectiveness of a digital youth-led hypertension education intervention for adult patients in the ED with hypertension, focusing on change in BP and hypertension knowledge. OBJECTIVE In preparation for an RCT, we conducted a formative study to determine acceptable and easily comprehensible ways to present hypertension information to adults with hypertension and optimal ways to engage youth to support adults on how to achieve better hypertension control. METHODS After creating an intervention prototype with 6 weekly self-guided hypertension online modules, we recruited 12 youth (adolescents, aged 15-18 years) for 3 focus groups and 10 adult ED patients with hypertension for individual online interviews to garner feedback on the prototype. After completing a brief questionnaire, participants were asked about experiences with hypertension, preferences for a hypertension education intervention, and acceptability, feasibility, obstacles, and solutions for intervention implementation with youth and adults. The moderator described and showed participants the prototyped intervention process and materials and asked for feedback. Questionnaire data were descriptively summarized, and qualitative data were analyzed using the template organizing style of analysis by 3 study team members. RESULTS Participants showed great interest in the intervention prototype, thought their peers would find it acceptable, and appreciated its involvement of youth. Youth with family members with hypertension reported that their family members need more support for their hypertension. Youth suggested adding more nutrition education activities to the intervention, such as a sodium tracker and examples of high-sodium foods. Adults discussed the need for a hypertension support intervention for themselves and the expected benefits to youth. They mentioned the overwhelming amount of hypertension information available and appreciated the intervention's concise content presentation. They suggested adding more mental health and smoking cessation resources, information about specific hypertension medications, and adding active links for health care information. CONCLUSIONS Based on focus groups and interviews with participants, a youth-led digital hypertension intervention is an acceptable strategy to engage both adults with hypertension and youth. Incorporating participant suggestions into the intervention may improve its clarity, engagement, and impact when used in a subsequent RCT.
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Affiliation(s)
- Sara W Heinert
- Department of Emergency Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, United States
| | | | - Affan Aamir
- Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, United States
| | | | - Benjamin F Crabtree
- Department of Family Medicine and Community Health, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, United States
| | - Kathryn Greene
- Department of Communication, Rutgers University, New Brunswick, NJ, United States
| | - Carolyn J Heckman
- Rutgers Cancer Institute, Rutgers University, New Brunswick, NJ, United States
| | - Phillip Levy
- Department of Emergency Medicine, Wayne State University, Detroit, MI, United States
| | - Pamela Ohman Strickland
- Department of Biostatistics and Epidemiology, Rutgers School of Public Health, Piscataway, NJ, United States
| | - Shawna V Hudson
- Department of Family Medicine and Community Health, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, United States
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Woods SB, Udezi V, Roberson PNE, Arnold EM, Nesbitt S, Hiefner A. "A cuff is not enough": A community-based participatory research approach to soliciting perspectives of African Americans with hypertension and their family members on self-management intervention features. FAMILY PROCESS 2024; 63:731-748. [PMID: 37718711 PMCID: PMC10947536 DOI: 10.1111/famp.12935] [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: 02/09/2023] [Revised: 06/20/2023] [Accepted: 08/07/2023] [Indexed: 09/19/2023]
Abstract
We aimed to solicit the perspectives of African Americans with hypertension and their family members on the desired features of a behavioral hypertension self-management intervention. Using a community-based participatory approach to intervention design, we conducted four dyadic focus groups, including African American community members with hypertension (n = 23) and their family members (n = 23), recruited from African American-serving Christian churches in a large, southern metropolitan area. We used open-ended questions to elicit participants' perspectives regarding program features they would recommend, intervention delivery, and barriers necessary to address. Our grounded theory analysis identified themes reflecting participants' recommendations for hypertension self-management interventions to enhance health literacy and provide communication training via an accessible, population-tailored, family-based approach, which they believed has the potential to create family-level impact on health across generations. Participants also recommended intervention researchers engage in advocacy (i.e., via physician education and policy change) as part of a broader impact on structural inequities driving worse hypertension and health outcomes for African Americans. The perceptions and recommendations of African Americans with a lived experience of hypertension, as well as their family members, aid in shaping acceptable and efficacious behavioral interventions aiming to promote hypertension self-management behavior while leveraging the unique power of family relationships to create sustained behavior change.
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Affiliation(s)
- Sarah B. Woods
- University of Texas Southwestern Medical Center, Department of Family and Community Medicine, Dallas TX, USA
| | - Victoria Udezi
- University of Texas Southwestern Medical Center, Department of Family and Community Medicine, Dallas TX, USA
| | | | - Elizabeth Mayfield Arnold
- University of Texas Southwestern Medical Center, Department of Family and Community Medicine, Dallas TX, USA
| | - Shawna Nesbitt
- University of Texas Southwestern Medical Center, Departments of Internal Medicine and Cardiology, Dallas TX, USA
| | - Angela Hiefner
- University of Texas Southwestern Medical Center, Department of Family and Community Medicine, Dallas TX, USA
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Akinyelure OP, Jaeger BC, Safford MM, Oparil S, Carson AP, Sims A, Hannon L, Howard G, Muntner P, Hardy ST. Social Determinants of Health and Incident Apparent Treatment-Resistant Hypertension Among White and Black US Adults: The REGARDS Study. J Am Heart Assoc 2024; 13:e031695. [PMID: 38752519 PMCID: PMC11179800 DOI: 10.1161/jaha.123.031695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 01/26/2024] [Indexed: 05/19/2024]
Abstract
BACKGROUND We examined the association of multilevel social determinants of health with incident apparent treatment-resistant hypertension (aTRH). METHODS AND RESULTS We analyzed data from 2774 White and 2257 Black US adults from the REGARDS (Reasons for Geographic and Racial Differences in Stroke) study taking antihypertensive medication without aTRH at baseline to estimate the association of social determinants of health with incident aTRH. Selection of social determinants of health was guided by the Healthy People 2030 domains of education, economic stability, social context, neighborhood environment, and health care access. Blood pressure (BP) was measured during study visits, and antihypertensive medication classes were identified through a pill bottle review. Incident aTRH was defined as (1) systolic BP ≥140 mm Hg or diastolic BP ≥90 mm Hg, or systolic BP ≥130 mm Hg or diastolic BP ≥80 mm Hg for those with diabetes or chronic kidney disease while taking ≥3 classes of antihypertensive medication or (2) taking ≥4 classes of antihypertensive medication regardless of BP level, at the follow-up visit. Over a median 9.5 years of follow-up, 15.9% of White and 24.0% of Black adults developed aTRH. A percent of the excess aTRH risk among Black versus White adults was mediated by low education (14.2%), low income (16.0%), not seeing a friend or relative in the past month (8.1%), not having someone to care for them if ill or disabled (7.6%), lack of health insurance (10.6%), living in a disadvantaged neighborhood (18.0%), and living in states with poor public health infrastructure (6.0%). CONCLUSIONS Part of the association between race and incident aTRH risk was mediated by social determinants of health.
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Affiliation(s)
| | - Byron C. Jaeger
- Department of Biostatistics and Data ScienceWake Forest University School of MedicineWinston‐SalemNCUSA
| | | | - Suzanne Oparil
- Department of MedicineUniversity of Alabama at BirminghamBirminghamALUSA
| | - April P. Carson
- Departments of Medicine and Population Health ScienceUniversity of Mississippi Medical CenterJacksonMSUSA
| | - Andrew Sims
- Department of BiostatisticsUniversity of Alabama at BirminghamBirminghamALUSA
| | - Lonnie Hannon
- Department of Health BehaviorUniversity of Alabama at BirminghamBirminghamALUSA
| | - George Howard
- Department of BiostatisticsUniversity of Alabama at BirminghamBirminghamALUSA
| | - Paul Muntner
- Department of EpidemiologyUniversity of Alabama at BirminghamBirminghamALUSA
| | - Shakia T. Hardy
- Department of EpidemiologyUniversity of North Carolina at Chapel HillChapel HillNCUSA
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Acharya S, Neupane G, Seals A, KC M, Giustini D, Sharma S, Taylor YJ, Palakshappa D, Williamson JD, Moore JB, Bosworth HB, Pokharel Y. Self-Measured Blood Pressure-Guided Pharmacotherapy: A Systematic Review and Meta-Analysis of United States-Based Telemedicine Trials. Hypertension 2024; 81:648-657. [PMID: 38189139 PMCID: PMC11213974 DOI: 10.1161/hypertensionaha.123.22109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 12/25/2023] [Indexed: 01/09/2024]
Abstract
BACKGROUND The optimal approach to implementing telemedicine hypertension management in the United States is unknown. METHODS We examined telemedicine hypertension management versus the effect of usual clinic-based care on blood pressure (BP) and patient/clinician-related heterogeneity in a systematic review/meta-analysis. We searched United States-based randomized trials from Medline, Embase, CENTRAL, CINAHL, PsycINFO, Compendex, Web of Science Core Collection, Scopus, and 2 trial registries. We used trial-level differences in BP and its control rate at ≥6 months using random-effects models. We examined heterogeneity in univariable metaregression and in prespecified subgroups (clinicians leading pharmacotherapy [physician/nonphysician], self-management support [pharmacist/nurse], White versus non-White patient predominant trials [>50% patients/trial], diabetes predominant trials [≥25% patients/trial], and White patient predominant but not diabetes predominant trials versus both non-White and diabetes patient predominant trials]. RESULTS Thirteen, 11, and 7 trials were eligible for systolic and diastolic BP difference and BP control, respectively. Differences in systolic and diastolic BP and BP control rate were -7.3 mm Hg (95% CI, -9.4 to -5.2), -2.7 mm Hg (-4.0 to -1.5), and 10.1% (0.4%-19.9%), respectively, favoring telemedicine. Greater BP reduction occurred in trials where nonphysicians led pharmacotherapy, pharmacists provided self-management support, White patient predominant trials, and White patient predominant but not diabetes predominant trials, with no difference by diabetes predominant trials. CONCLUSIONS Telemedicine hypertension management is more effective than clinic-based care in the United States, particularly when nonphysicians lead pharmacotherapy and pharmacists provide self-management support. Non-White patient predominant trials achieved less BP reduction. Equity-conscious, locally informed adaptation of telemedicine interventions is needed before wider implementation.
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Affiliation(s)
- Sameer Acharya
- Department of Internal Medicine, Cayuga Medical Center, Ithaca, New York, USA
| | - Gagan Neupane
- Department of Internal Medicine, Florida Atlantic University, Boca Raton, Florida, USA
| | - Austin Seals
- Department of Internal Medicine, Atrium Health Wake Forest Baptist, Winston-Salem, North Carolina, USA
| | - Madhav KC
- Yale University, School of Medicine, New Haven, Connecticut, USA
| | - Dean Giustini
- University of British Columbia, Vancouver, British Columbia, Canada
| | - Sharan Sharma
- SCL Heart and Vascular Institute, Brighton, Colorado, USA
| | - Yhenneko J. Taylor
- Center for Health System Sciences, Atrium Health, Charlotte, North Carolina, USA
| | - Deepak Palakshappa
- Department of Internal Medicine, Atrium Health Wake Forest Baptist, Winston-Salem, North Carolina, USA
| | - Jeff D. Williamson
- Department of Internal Medicine, Atrium Health Wake Forest Baptist, Winston-Salem, North Carolina, USA
| | - Justin B. Moore
- Department of Implementation Science, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Hayden B. Bosworth
- Department of Population Health Sciences, Duke University, Durham, North Carolina, USA
| | - Yashashwi Pokharel
- Department of Internal Medicine, Atrium Health Wake Forest Baptist, Winston-Salem, North Carolina, USA
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Peralta-Garcia A, Laurent J, Bazzano AN, Payne MJ, Anderson A, Alvarado F, Ferdinand KC, He J, Mills KT. Barriers and Facilitators to Improving Cardiovascular Health in Churches with Predominantly Black Congregations. Ethn Dis 2023; DECIPHeR:96-104. [PMID: 38846733 PMCID: PMC11099528 DOI: 10.18865/ed.decipher.96] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2024] Open
Abstract
Objective Black communities bear a disproportionate burden of cardiovascular disease (CVD). Barriers and facilitators for improving cardiovascular health (CVH) in churches with predominantly black congregations were explored through a qualitative needs assessment. Methods Four focus groups with church members (n=21), 1 with wellness coordinators (n=5), and 1 with primary care providers (n=4) and 7 individual interviews with church leaders were completed in New Orleans and Bogalusa, Louisiana. Virtual, semistructured interviews and focus groups were held between October 2021 and April 2022. The Theorical Domains Framework (TDF) guided a framework analysis of transcribed data based on inductive and deductive coding to identify themes related to determinants of CVH. Results The following four domains according to the TDF were identified as the most relevant for improving CVH: knowledge, professional role, environmental context, and emotions. Within these domains, barriers expressed by church leadership and members were a lack of knowledge of CVD, provider distrust, and little time and resources for lifestyle changes; facilitators included existing church wellness programs and social support, community resources, and willingness to improve patient-provider relationships. Primary care providers recognized a lack of effective communication and busy schedules as obstacles and the need to strengthen communication through increased patient autonomy and trust. Potential strategies to improve CVH informed by the Expert Recommendation for Implementing Change compilation of implementation strategies include education and training, task shifting, dissemination of information, culturally tailored counselling, and linkage to existing resources. Conclusions These findings can inform the implementation of interventions for improving cardiovascular health and reducing disparities in black church communities.
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Affiliation(s)
- Ana Peralta-Garcia
- School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA
| | - Jodie Laurent
- School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA
| | | | - Marilyn J. Payne
- Payne & Associates Counseling & Consulting Services, New Orleans, LA
| | - Andrew Anderson
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD
| | - Flor Alvarado
- School of Medicine, Tulane University, New Orleans, LA
- Translational Science Institute, Tulane University, New Orleans, LA
| | - Keith C. Ferdinand
- School of Medicine, Tulane University, New Orleans, LA
- Translational Science Institute, Tulane University, New Orleans, LA
| | - Jiang He
- School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA
- School of Medicine, Tulane University, New Orleans, LA
- Translational Science Institute, Tulane University, New Orleans, LA
| | - Katherine T. Mills
- School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA
- Translational Science Institute, Tulane University, New Orleans, LA
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Smith JD, Carroll AJ, Sanuade OA, Johnson R, Abramsohn EM, Abbas H, Ahmad FS, Eggleston A, Lazar D, Lindau ST, McHugh M, Mohanty N, Philbin S, Pinkerton EA, Rosul LL, Merle JL, Tedla YG, Walunas TL, Davis P, Kho A. Process of Engaging Community and Scientific Partners in the Development of the CIRCL-Chicago Study Protocol. Ethn Dis 2023; DECIPHeR:18-26. [PMID: 38846735 PMCID: PMC11099531 DOI: 10.18865/ed.decipher.18] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2024] Open
Abstract
Objectives Hypertension affects 1 in 3 adults in the United States and disproportionately affects African Americans. Kaiser Permanente demonstrated that a "bundle" of evidence-based interventions significantly increased blood pressure control rates. This paper describes a multiyear process of developing the protocol for a trial of the Kaiser bundle for implementation in under-resourced urban communities experiencing cardiovascular health disparities during the planning phase of this biphasic award (UG3/UH3). Methods The protocol was developed by a collaboration of faith-based community members, representatives from community health center practice-based research networks, and academic scientists with expertise in health disparities, implementation science, community-engaged research, social care interventions, and health informatics. Scientists from the National Institutes of Health and the other grantees of the Disparities Elimination through Coordinated Interventions to Prevent and Control Heart and Lung Disease Risk (DECIPHeR) Alliance also contributed to developing our protocol. Results The protocol is a hybrid type 3 effectiveness-implementation study using a parallel cluster randomized trial to test the impact of practice facilitation on implementation of the Kaiser bundle in community health centers compared with implementation without facilitation. A central strategy to the Kaiser bundle is to coordinate implementation via faith-based and other community organizations for recruitment and navigation of resources for health-related social risks. Conclusions The proposed research has the potential to improve identification, diagnosis, and control of blood pressure among under-resourced communities by connecting community entities and healthcare organizations in new ways. Faith-based organizations are a trusted voice in African American communities that could be instrumental for eliminating disparities.
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Affiliation(s)
- Justin D. Smith
- Spencer Fox Eccles School of Medicine, University of Utah, Salt Lake City, UT
| | | | - Olutobi A. Sanuade
- Spencer Fox Eccles School of Medicine, University of Utah, Salt Lake City, UT
| | | | | | | | - Faraz S. Ahmad
- Northwestern University Feinberg School of Medicine, Chicago, IL
| | | | | | | | - Megan McHugh
- Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Nivedita Mohanty
- Northwestern University Feinberg School of Medicine, Chicago, IL
- AllianceChicago, Chicago, IL
| | - Sarah Philbin
- Northwestern University Feinberg School of Medicine, Chicago, IL
| | - El A. Pinkerton
- University of Chicago Biological Sciences Division, Chicago, IL
| | | | - James L. Merle
- Spencer Fox Eccles School of Medicine, University of Utah, Salt Lake City, UT
| | | | | | - Paris Davis
- Total Resource Community Development Organization, Chicago, IL
| | - Abel Kho
- Northwestern University Feinberg School of Medicine, Chicago, IL
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Philbin S, Johnson RE, Pedamallu H, Carroll AJ, Ekong A, Lazar D, Mohanty N, McHugh M, Tedla Y, Davis P, Kho A, Smith JD. Planning the Implementation of a Multilevel Blood Pressure Control Intervention in Chicago: Community and Clinical Perspectives. Ethn Dis 2023; DECIPHeR:60-67. [PMID: 38846723 PMCID: PMC11099518 DOI: 10.18865/ed.decipher.60] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2024] Open
Abstract
Objectives Hypertension is associated with high morbidity and mortality. The complications of hypertension disproportionately impact African American residents in Chicago's South Side neighborhood. To inform the implementation of an evidence-based multilevel hypertension management intervention, we sought to identify community member- and clinician-level barriers to diagnosing and treating hypertension, and strategies for addressing those barriers. Methods We conducted 5 focus groups with members of faith-based organizations (FBOs) (n=40) and 8 focus groups with clinicians and administrators (n=26) employed by community health centers (CHCs) located in Chicago's South Side. Results Participants across groups identified the physical environment, including lack of access to clinics and healthy food, as a risk factor for hypertension. Participants also identified inconsistent results from home blood pressure monitoring and medication side effects as barriers to seeking diagnosis and treatment. Potential strategies raised by participants to address these barriers included (1) addressing patients' unmet social needs, such as food security and transportation; (2) offering education that meaningfully engages patients in discussions about managing hypertension (eg, medication adherence, diet, follow-up care); (3) coordinating referrals via community-based organizations (including FBOs) to CHCs for hypertension management; and (4) establishing a setting where community members managing hypertension diagnosis can support one another. Conclusions Clinic-level barriers to the diagnosis and treatment of hypertension, such as competing priorities and resource constraints, are exacerbated by community-level stressors. Community members and clinicians agreed that it is important to select implementation strategies that leverage and enhance both community- and clinic-based resources.
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Affiliation(s)
- Sarah Philbin
- Northwestern University Feinberg School of Medicine, Chicago, IL
| | | | | | | | | | | | - Nivedita Mohanty
- Northwestern University Feinberg School of Medicine, Chicago, IL
- AllianceChicago, Chicago, IL
| | - Megan McHugh
- Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Yacob Tedla
- Vanderbilt University Medical Center, Nashville, TN
| | - Paris Davis
- Total Resource Community Development Organization, Chicago, IL
| | - Abel Kho
- Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Justin D. Smith
- Spencer Fox Eccles School of Medicine at the University of Utah, Salt Lake City, UT
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Bhattarai S, Bajracharya S, Shrestha A, Skovlund E, Åsvold BO, Mjolstad BP, Sen A. Facilitators and barriers to hypertension management in urban Nepal: findings from a qualitative study. Open Heart 2023; 10:e002394. [PMID: 37899127 PMCID: PMC10618998 DOI: 10.1136/openhrt-2023-002394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 10/02/2023] [Indexed: 10/31/2023] Open
Abstract
INTRODUCTION In Nepal, one-fourth of the adult population has hypertension. Despite provision of comprehensive hypertension services through the primary healthcare system, huge gaps in treatment and control of hypertension exist. Our study explored the individual, interpersonal, health system and community-level barriers and facilitators affecting hypertension management in urban Nepal. METHODS We used a qualitative methodology informed by Kaufman's socioecological model, conducting focus group discussions with hypertension patients and their family members. In-depth interviews with hypertension patients, healthcare providers and municipal officials were also conducted. RESULTS We found that inadequate knowledge about hypertension and harmful cultural beliefs hindered effective treatment of hypertension. Interrupted medical supply and distrust in primary healthcare providers affected the poor's access to hypertension services. Poor communication between family members and gender norms affected adaptation of treatment measures. This study emphasised the role of family members in supporting patients in adhering to treatment measures and rebuilding community trust in primary healthcare providers for better access to hypertension services. The findings guided the development of a manual to be used by community health workers during home visits to support patients to control high blood pressure. CONCLUSION The study highlights the importance of integrating various aspects of care to overcome the multiple barriers to hypertension management in urban settings in low-resource countries. Participatory home visits have the potential to empower individuals and families to develop and implement feasible and acceptable actions for home management of hypertension through improved adherence to antihypertensive medication, and behaviour change.
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Affiliation(s)
- Sanju Bhattarai
- Institute for Implementation Science and Health, Kathmandu, Nepal
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | | | - Archana Shrestha
- Institute for Implementation Science and Health, Kathmandu, Nepal
- Department of Public Health, Kathmandu University School of Medical Sciences, Dhulikhel, Nepal
- Department of Chronic Disease Epidemiology, Center of Methods for Implementation and Prevention Science, Yale School of Public Health, New Haven, Connecticut, USA
| | - Eva Skovlund
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - Bjørn Olav Åsvold
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Endocrinology, Clinic of Medicine, St Olavs Hospital Trondheim University Hospital, Trondheim, Norway
| | - Bente Prytz Mjolstad
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
- General Practice Research Unit, Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - Abhijit Sen
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
- Center for Oral Health Services and Research (TkMidt), Trondheim, Norway
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Abdalla M, Bolen SD, Brettler J, Egan BM, Ferdinand KC, Ford CD, Lackland DT, Wall HK, Shimbo D. Implementation Strategies to Improve Blood Pressure Control in the United States: A Scientific Statement From the American Heart Association and American Medical Association. Hypertension 2023; 80:e143-e157. [PMID: 37650292 PMCID: PMC10578150 DOI: 10.1161/hyp.0000000000000232] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
Abstract
Hypertension is one of the most important risk factors that contribute to incident cardiovascular events. A multitude of US and international hypertension guidelines, scientific statements, and policy statements have recommended evidence-based approaches for hypertension management and improved blood pressure (BP) control. These recommendations are based largely on high-quality observational and randomized controlled trial data. However, recent published data demonstrate troubling temporal trends with declining BP control in the United States after decades of steady improvements. Therefore, there is a widening disconnect between what hypertension experts recommend and actual BP control in practice. This scientific statement provides information on the implementation strategies to optimize hypertension management and to improve BP control among adults in the United States. Key approaches include antiracism efforts, accurate BP measurement and increased use of self-measured BP monitoring, team-based care, implementation of policies and programs to facilitate lifestyle change, standardized treatment protocols using team-based care, improvement of medication acceptance and adherence, continuous quality improvement, financial strategies, and large-scale dissemination and implementation. Closing the gap between scientific evidence, expert recommendations, and achieving BP control, particularly among disproportionately affected populations, is urgently needed to improve cardiovascular health.
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Acharya S, Neupane G, Seals A, Madhav KC, Giustini D, Sharma S, Taylor YJ, Palakshappa D, Williamson JD, Moore JB, Bosworth HB, Pokharel Y. Heterogeneity of the Effect of Telemedicine Hypertension Management Approach on Blood Pressure: A Systematic Review and Meta-analysis of US-based Clinical Trials. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.09.14.23295587. [PMID: 37745417 PMCID: PMC10516092 DOI: 10.1101/2023.09.14.23295587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/26/2023]
Abstract
Background Telemedicine management of hypertension (TM-HTN) uses home blood pressure (BP) to guide pharmacotherapy and telemedicine-based self-management support (SMS). Optimal approach to implementing TM-HTN in the US is unknown. Methods We conducted a systematic review and a meta-analysis to examine the effect of TM-HTN vs. usual clinic-based care on BP and assessed heterogeneity by patient- and clinician-related factors. We searched US-based randomized clinical trials among adults from Medline, Embase, CENTRAL, CINAHL, PsycInfo, and Compendex, Web of Science Core Collection, Scopus, and two trial registries to 7/7/2023. Two authors extracted, and a third author confirmed data. We used trial-level differences in systolic BP (SBP), diastolic BP (DBP) and BP control rate at ≥6 months using random-effects models. We examined heterogeneity of effect in univariable meta-regression and in pre-specified subgroups [clinicians leading pharmacotherapy (physician vs. non-physician), SMS (pharmacist vs. nurse), White vs. non-White patient predominant trials (>50% patients/trial), diabetes predominant trials (≥25% patients/trial) and in trials that have majority of both non-White patients and patients with diabetes vs. White patient predominant but not diabetes predominant trials. Results Thirteen, 11 and 7 trials were eligible for SBP, DBP and BP control, respectively. Differences in SBP, DBP and BP control rate were -7.3 mmHg (95% CI: - 9.4, -5.2), -2.7 mmHg (-4.0, -1.5) and 10.1% (0.4%, 19.9%), respectively, favoring TM-HTN. More BP reduction occurred in trials with non-physician vs. physician led pharmacotherapy (9.3/4.0 mmHg vs. 4.9/1.1 mmHg, P<0.01 for both SBP/DBP), pharmacist vs. nurses provided SMS (9.3/4.1 mmHg vs. 5.6/1.0 mmHg, P=0.01 for SBP, P<0.01 for DBP), and White vs. non-White patient predominant trials (9.3/4.0 mmHg vs. 4.4/1.1 mmHg, P<0.01 for both SBP/DBP), with no difference by diabetes predominant trials. Lower BP reduction occurred in both diabetes and non-White patient predominant trials vs. White patient predominant but not diabetes predominant trials (4.5/0.9 mmHg vs. 9.5/4.2 mmHg, P<0.01 for both SBP/DBP). Conclusions TM-HTN is more effective than clinic-based care in the US, particularly when non-physician led pharmacotherapy and pharmacist provided SMS. Non-White patient predominant trials seemed to achieve lesser BP reduction. Equity conscious, locally informed adaptation of TM-HTN is needed before wider implementation. Clinical Perspective What Is New?: In this systematic review and meta-analysis of US-based clinical trials, we found that telemedicine management of hypertension (TM-HTN) was more effective in reducing and controlling blood pressure (BP) compared with clinic based hypertension (HTN) care.The BP reduction was more evident when pharmacotherapy was led by non-physician compared with physicians and HTN self-management support was provided by clinical pharmacists compared with nurses,Non-White patient predominant trials achieved lesser BP reductions than White patient predominant trials.What Are the Clinical Implications?: Before wider implementation of TM-HTN intervention in the US, locally informed adaptation, such as optimizing the team-based HTN care approach, can provide more effective BP control.Without equity focused tailoring, TM-HTN intervention implemented as such can exacerbate inequities in BP control among non-White patients in the US.
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11
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Woods SB, Hiefner AR, Udezi V, Slaughter G, Moore R, Arnold EM. 'They should walk with you': the perspectives of African Americans living with hypertension and their family members on disease self-management. ETHNICITY & HEALTH 2023; 28:373-398. [PMID: 35227154 DOI: 10.1080/13557858.2022.2040958] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
OBJECTIVES African Americans are at significantly greater risk for hypertension, as well as worse hypertension-related morbidity and mortality than other racial/ethnic groups. Prior research aiming to address these health disparities has focused on improving individual patient self-management, with few studies testing family-centered interventions. We aimed to explore the perspectives of African Americans with hypertension and their family members on hypertension, self-management, and reciprocal family-hypertension impacts to inform future intervention design. DESIGN We conducted four dyadic focus groups (90-120 minutes) of African American adults with hypertension (i.e. patients) and their family members. We recruited patients (n = 23) and their family members (n = 23) from four African American-serving Christian churches over a period of three months (69.6% female, M age = 60.73 years). Patient-family member dyads were interviewed conjointly (groups ranged from 4 to 6 dyads, each) by facilitators using open-ended questions to elicit perspectives regarding contributors to hypertension, self-management strategies, family influence on self-management, and the impact of hypertension on the family. A grounded theory approach was used for analysis. RESULTS Participants' responses highlighted themes of societal risk factors and barriers (e.g. racism-related stress worsens blood pressure), influences of African American culture (e.g. culturally-informed diet practices), the patient-physician relationship (e.g. proactive communication is beneficial), family-level influences on health (e.g. family monitoring patients' health behaviors), and patient-level risk factors and self-management strategies (e.g. prayer to cope with stress). Themes reflected a hierarchical, nested, ecological structure such that themes within unique levels of participants' social systems affected, and were affected by, stress, change, or behavior in the other levels. CONCLUSIONS African American adults with hypertension and their family members described multilevel influences on hypertension and disease self-management, with a strong emphasis on the value of family support. Developing culturally appropriate, family-centered interventions to improve hypertension self-management will be an important next step.
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Affiliation(s)
- Sarah B Woods
- Family and Community Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Angela R Hiefner
- Family and Community Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Victoria Udezi
- Family and Community Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Gabriele Slaughter
- Medical School, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Rachel Moore
- Family and Community Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
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12
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Woods SB, Hiefner A, Roberson PNE, Zahra N, Arnold EM, Udezi V. Depressed mood and environmental mastery as potential pathways linking family relationship quality and disease self-management for African Americans with hypertension. FAMILY PROCESS 2023; 62:230-253. [PMID: 35634971 DOI: 10.1111/famp.12789] [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: 07/28/2021] [Revised: 04/06/2022] [Accepted: 04/15/2022] [Indexed: 06/15/2023]
Abstract
African Americans are at significantly greater risk of hypertension and worse cardiovascular outcomes than other racialized groups, yet hypertension intervention effects remain limited. Thus, it is necessary to understand the potential mechanisms whereby interventions may be more effectively targeted to improve health. Supported by prior research evidence and guided by the Biobehavioral Family Model, this study examined associations between family relationship quality, psychological wellbeing, and self-management behaviors for African Americans with hypertension. Data were pooled from three Midlife Development in the U.S. projects, resulting in a sample of 317 African Americans (63.4% female, Mage = 53.32) with self-reported high blood pressure in the past 12 months. We tested four cross-sectional multiple mediator models, with depressed mood and environmental mastery mediating associations between family strain and exercise, smoking, problematic alcohol use, and stress-eating. Environmental mastery mediated the association between greater family strain and decreased odds of achieving recommended exercise levels; greater odds of reporting problematic alcohol use; and greater stress-eating. Though family strain was associated with depressed mood in each model, this variable did not serve as an indirect pathway to self-management behaviors. Family strain, and the potential pathway identified via environmental mastery, may be a meaningful predictor of disease self-management for African Americans with hypertension. Longitudinal studies are needed to examine directionality and to support intervention trials for improving self-management and hypertension outcomes.
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Affiliation(s)
- Sarah B Woods
- Department of Family and Community Medicine, UT Southwestern Medical Center, University of Texas Southwestern Medical School, Dallas, Texas, USA
| | - Angela Hiefner
- Department of Family and Community Medicine, UT Southwestern Medical Center, University of Texas Southwestern Medical School, Dallas, Texas, USA
| | | | - Nida Zahra
- Department of Family and Community Medicine, UT Southwestern Medical Center, University of Texas Southwestern Medical School, Dallas, Texas, USA
| | - Elizabeth Mayfield Arnold
- Department of Family and Community Medicine, UT Southwestern Medical Center, University of Texas Southwestern Medical School, Dallas, Texas, USA
| | - Victoria Udezi
- Department of Family and Community Medicine, UT Southwestern Medical Center, University of Texas Southwestern Medical School, Dallas, Texas, USA
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13
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Xue Q, Zhang X, Liu R, Guan X, Li G, Zhao L, Wang Q, Wang D, Shen X. Differentiated effects and determinants of home blood pressure telemonitoring: lessons from a three-year cohort in Anhui Jieshou, China. J Med Internet Res 2022; 24:e37648. [PMID: 36114000 DOI: 10.2196/37648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 08/29/2022] [Accepted: 09/16/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Home blood pressure telemonitoring (HBPT) is witnessing rapid diffusion worldwide. Contemporary studies documented mainly short-term (6-12 month) effects of HBPT with little data about its uptake. OBJECTIVE This study aims to explore 3-year use and determinants of HBPT and its interactions with systolic and diastolic blood pressure (SBP/DBP) and blood pressure (BP) control rate. METHODS The study used HBPT records from a 3-year cohort of 5658 hypertensive patients in Anhui Jieshou, China and data from a structured household survey of a random sample (n=3005) from the cohort. The data analysis comprised: calculation and presentation, in time-line trajectories, rates of monthly active HBPT and mean SBP/DBP for overall and subgroups of patients with varied start-month SBP/DBP; and multivariable linear, logistics and percentile regression analysis using SBP/DBP, BP control rate and yearly times of HBPT as the dependent variable respectively. RESULTS HBPT followed mixed changes in mean monthly SBP/DBP for varied patient groups. The magnitude of changes ranged from -43 to +39 mmHg for SBP and -27 to +15 mmHg for DBP. The monthly rates of active HBPT all manifested a rapid and then slower and slower decline. When controlled for commonly researched confounders, times of HBPT in the last year were found with decreasing correlation coefficients for SBP/DBP (being decreased from 0.10 to -0.35 and from 0.11 to -0.35 respectively) and for BP control rate (from 0.53 to -0.62). CONCLUSIONS HBPT had major and "target-converging" effects on SBP/DBP. The magnitude of changes was much greater than have commonly reported. BP, variation in BP and time were the most important determinants of HBPT uptake; while age, education, duration of hypertension, family history and diagnosis of hypertension complications were also linked to the uptake but at apparently weaker strength. There is a clear need for differentiated thinking over application and assessment of HBPT and for identifying and correcting/leveraging potential outdated/new opportunities or beliefs.
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Affiliation(s)
- Qun Xue
- Anhui Medical University, 81 Meishan Road, Hefei, China, Hefei, CN
| | | | - Rong Liu
- Anhui Medical University, 81 Meishan Road, Hefei, China, Hefei, CN
| | - Xiaoqin Guan
- Anhui Medical University, 81 Meishan Road, Hefei, China, Hefei, CN
| | - Guocheng Li
- Anhui Medical University, 81 Meishan Road, Hefei, China, Hefei, CN
| | - Linhai Zhao
- Anhui Medical University, 81 Meishan Road, Hefei, China, Hefei, CN
| | | | - Debin Wang
- Anhui Medical University, 81 Meishan Road, Hefei, China, Hefei, CN
| | - Xingrong Shen
- Anhui Medical University, 81 Meishan Road, Hefei, China, Hefei, CN
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14
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van der Gaag M, Heijmans M, Ballester M, Orrego C, Niño de Guzmán E, Ninov L, Rademakers J. Preferences Regarding Self-Management Intervention Outcomes of Dutch Chronically Ill Patients With Limited Health Literacy. Front Public Health 2022; 10:842462. [PMID: 35646791 PMCID: PMC9130718 DOI: 10.3389/fpubh.2022.842462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 04/19/2022] [Indexed: 11/13/2022] Open
Abstract
Background: For many chronically ill patients self-management of their disease is difficult. This may be especially true for people with limited health literacy as they are faced with additional challenges in the day-to-day management of their disease. Research has shown that self-management support is most effective when tailored to the needs and preferences of patients. Therefore, this study explores the preferences regarding self-management outcomes of chronically ill patients with limited health literacy. Methods A total of 35 patients with limited health literacy were invited to a concept-mapping procedure consisting of two card sorting tasks. Patients ranked 60 outcomes, which are often found in literature in relation to self-management, to the level that was important for themselves. Means were calculated for each outcome and domain, and differences within the group were analyzed. Results For patients with limited health literacy, satisfaction with care is the most important outcome domain. This domain includes overall satisfaction, the communication with health care providers, the provision of information and trust. At an outcome level, outcomes related to symptom management and improving competences to self-management scored very high. No differences between patient groups for age and sex were found. Conclusion Chronically ill patients with limited health literacy prefer a wide variety of outcomes for their self-management. Next to health related outcomes, patients mostly prefer to work on their competences for self-management. For health care professionals, acting on these patient preferences and building a solid relationship will enhance successful self-management.
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Affiliation(s)
| | - Monique Heijmans
- Netherlands Institute for Health Services Research, Utrecht, Netherlands
| | - Marta Ballester
- Red de investigación en servicios de salud en enfermedades crónicas, Madrid, Spain.,Avedis Donabedian Research Institute (FAD), Barcelona, Spain.,Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Carola Orrego
- Red de investigación en servicios de salud en enfermedades crónicas, Madrid, Spain.,Avedis Donabedian Research Institute (FAD), Barcelona, Spain.,Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Ena Niño de Guzmán
- Department of Clinical Epidemiology and Public Health, Sant Pau Institute for Biomedical Research, Barcelona, Spain.,Ibero-American Cochrane Center (CCIb), Barcelona, Spain
| | | | - Jany Rademakers
- Netherlands Institute for Health Services Research, Utrecht, Netherlands.,Department of Family Medicine, Care and Public Health Research Institute, Maastricht University, Maastricht, Netherlands
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15
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Zhang M, Liu Y, Zhang WY, Yang JG, Yang WM, Zhou J, Mao ZM. Exploring perceived challenges of self-management in low-income older people with hypertension: A qualitative study. Int J Nurs Pract 2022; 28:e13059. [PMID: 35437909 DOI: 10.1111/ijn.13059] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2020] [Revised: 03/19/2022] [Accepted: 03/22/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Hypertension is a public health problem globally. Understanding the perceived challenges of low-income older people populations with chronic disease is an obstacle the world is facing today. AIM To explore perceived challenges of self-management in low-income older people with hypertension. METHODS Data were collected in three communities from September 2019 to October 2019 by semi-structured interviews. Interviews were audio-taped by digital voice recorder and analysed according to Colaizzi's seven steps. RESULTS Participants demonstrated perceived challenges concerning hypertension self-management. Six themes were identified: hypertension belief bias, family dysfunction, deep-rooted habit, elder self-neglect, medical informatization and supportive health policy. Each theme was identified with several subthemes. CONCLUSIONS Findings implied that most of the low-income older people lacked self-management behaviours. Future research is needed to address perceived challenges related to self-management behaviour for patients with hypertension worldwide.
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Affiliation(s)
- Meng Zhang
- Tongji Hospital Affiliated to Tongji Medical College, Huzhong University of Science and Technology, Wuhan, China
| | - Yu Liu
- Tongji Hospital Affiliated to Tongji Medical College, Huzhong University of Science and Technology, Wuhan, China
| | - Wen-Yan Zhang
- Tongji Hospital Affiliated to Tongji Medical College, Huzhong University of Science and Technology, Wuhan, China
| | - Jiang-Guo Yang
- Tongji Hospital Affiliated to Tongji Medical College, Huzhong University of Science and Technology, Wuhan, China
| | - Wei-Mei Yang
- Tongji Hospital Affiliated to Tongji Medical College, Huzhong University of Science and Technology, Wuhan, China
| | - Jing Zhou
- Hanshui Bridge Street Community Health Center, Qiaokou District, Wuhan, China
| | - Zhong-Min Mao
- Gutian Street Community Health Center, Qiaokou District, Wuhan, China
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16
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Appiah EO, Agyekum SB, Ninon AP, Appiah C. Non-pharmacologic hypertension management barriers and recommendations by hypertensive patients at Pentecost Hospital, Madina. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0000085. [PMID: 36962265 PMCID: PMC10022142 DOI: 10.1371/journal.pgph.0000085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 11/15/2021] [Indexed: 06/18/2023]
Abstract
The number of hypertension cases keeps rising worldwide. Africa is not exempted from the prevalence of hypertension. The Sub-Saharan region over the years has been recording high numbers of hypertension cases due to low consciousness, poor management and lack of control of urbanization. However, it has been established that hypertension as a condition can be managed by controlling familiar risk factors such as alcohol consumption, tobacco use, physical inactivity and intake of an unhealthy diet. The researchers, therefore, intend to explore the non-pharmacologic hypertension management barriers and recommendations by hypertensive patients at Pentecost Hospital, Madina. The researchers employed the qualitative exploratory-descriptive design using a purposive sampling technique to select 20 participants between the ages of 35-65, who met the inclusion criteria. Using a semi-structured interview guide, participants were engaged in 30-60 minutes of face-to-face interviews. The demography of the participants revealed that 60% (12) were females, and 40% (8) were also males. Participants reported that they visit the clinic once a week with a budget of hundred Ghana Cedis to five hundred Ghana Cedis (100-500 GHS). Two main themes and 7 subthemes emerged from the study analysis. The barriers identified include financial constraints, difficulty adjusting to lifestyle changes, personal factors (laziness, forgetfulness, stress), lack of motivation, and busy work schedules and limited time. Recommendations were also made to overcome the barriers which include follow ups by health care professionals, and advice to hypertensive and non-hypertensive patients. In conclusion, the study found that adherence to non-pharmacologic management of hypertension is greatly influenced by one's finances, some personal factors and external influences. Hence, it is necessary address these factors and also to ensure effective follow-ups and reminders in order to improve adherence to the non-pharmacologic management of hypertension. Further studies can also be conducted to address other obstacles to non-pharmacologic hypertension management.
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Affiliation(s)
- Evans Osei Appiah
- School of Nursing and Midwifery, Department of Midwifery, Valley View University, Accra, Ghana
| | - Susana Boateng Agyekum
- Nursing Department, School of Nursing and Midwifery, Valley View University, Accra, Ghana
| | - Amertil P. Ninon
- Dean of Nursing Department, School of Nursing and Midwifery, Valley View University, Accra, Ghana
| | - Cyndi Appiah
- Assistant Lecturer, Ghana Christian University College, Accra, Ghana
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17
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Terada S, Doi S, Tani Y, Maeda Y, Isumi A, Sugawara J, Maeda K, Satoh S, Mitsuda N, Fujiwara T. Relationship trajectories of pregnant women with their parents and postpartum depression: A hospital-based prospective cohort study in Japan. Front Psychiatry 2022; 13:961707. [PMID: 36405917 PMCID: PMC9668856 DOI: 10.3389/fpsyt.2022.961707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Accepted: 10/17/2022] [Indexed: 11/05/2022] Open
Abstract
BACKGROUNDS A history of childhood abuse and subsequent poor relationship with parents in adulthood among pregnant women is a known risk factor for postpartum depression (PPD). Although parent-daughter relationship can change during pregnancy, little is known whether the trajectories have an impact on PPD. The aim of this study is to examine whether trajectories of parent-daughter relationship during pregnancy are associated with PPD in Japanese mothers. METHODS In a hospital-based prospective cohort study conducted in Japan, 4,772 women were followed from their first visit to their 1-month postpartum check-up (follow-up rate: 77.4%). Parent-daughter relationship was assessed whether participants were satisfied with their parents at first visit and after delivery. We defined four parent-daughter relationship trajectory categories: consistently satisfied, improving, deteriorating, and consistently unsatisfied. PPD was assessed by the Edinburgh Postnatal Depression Scale. Logistic regression model was applied to adjust covariates. RESULTS There were 129 (2.7%), 122 (2.6%), and 181 (3.8%) cases of improving, deteriorating, and consistently unsatisfied relationship, respectively. Compared to the group that was consistently satisfied, pregnant women of the deteriorating and consistently unsatisfied group showed 2.81 (95% CI: 1.73-4.55) and 2.39 (95% CI: 1.58-3.62) times, respectively, more likely to show PPD after adjustment for confounders. CONCLUSION Women who felt that their relationship with parents "deteriorated" or was "consistently unsatisfactory" during pregnancy showed significant risk of PPD. Paying attention to the pregnant women's feelings about the relationship with their parents and promoting positive change may help predict and prevent PPD.
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Affiliation(s)
- Shuhei Terada
- Department of Global Health Promotion, Tokyo Medical and Dental University, Bunkyo, Japan
| | - Satomi Doi
- Department of Global Health Promotion, Tokyo Medical and Dental University, Bunkyo, Japan.,Japan Society for the Promotion of Science (JSPS), Tokyo, Japan
| | - Yukako Tani
- Department of Global Health Promotion, Tokyo Medical and Dental University, Bunkyo, Japan
| | - Yuto Maeda
- Department of Global Health Promotion, Tokyo Medical and Dental University, Bunkyo, Japan
| | - Aya Isumi
- Department of Global Health Promotion, Tokyo Medical and Dental University, Bunkyo, Japan.,Japan Society for the Promotion of Science (JSPS), Tokyo, Japan
| | - Junichi Sugawara
- Division of Feto-Maternal Medical Science, Department of Community Medical Support, Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan
| | - Kazuhisa Maeda
- Department of Obstetrics and Gynecology, Shikoku Medical Center for Children and Adults, Zentsuji, Japan
| | - Shoji Satoh
- Maternal and Perinatal Care Center, Oita Prefectural Hospital, Oita, Japan
| | - Nobuaki Mitsuda
- Department of Maternal Fetal Medicine, Osaka Women's and Children's Hospital, Izumi, Japan
| | - Takeo Fujiwara
- Department of Global Health Promotion, Tokyo Medical and Dental University, Bunkyo, Japan
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Xu X, Guo T, Liu Z, Chen P, Zhang Y, Ji Q, Xie H. A Systematic Review of Patient Preferences, Expectations, and Values for the Management and Treatment of Hypertension. Patient Prefer Adherence 2022; 16:2867-2876. [PMID: 36299561 PMCID: PMC9590339 DOI: 10.2147/ppa.s388356] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 10/12/2022] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To comprehensively summarize the evidence on the preferences, expectations, and values of hypertension management and treatment in hypertensive patients. METHODS From inception through January 2022, PubMed, Embase, Web of Science, EBSCO, and China National Knowledge Infrastructure were searched for studies with hypertension value, preference, or expectation. A qualitative retrospective analysis was performed. RESULTS A total of 24 studies involving 8701 participants were included. Although studies on the preferences of hypertensive patients are difficult to standardize, considerable convergence has occurred: 1) Patients preferred treatment regimens with lower incidence of comorbidities, faster response, lower cost, more frequent blood pressure monitoring, fewer side effects, and more convenient medication. 2) Patients have a crucial role in the treatment, and their physicians are expected to develop a shared patient-centered decision-making model. CONCLUSION The results of this systematic review demonstrated that side effects, cost, and convenience are important factors for patients when selecting a treatment regimen for hypertension. Patients often obtain hypertension information from their physicians and prefer shared patient-centered decision-making.
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Affiliation(s)
- Xianpeng Xu
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, People’s Republic of China
| | - Tao Guo
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, People’s Republic of China
| | - Zifeng Liu
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, People’s Republic of China
| | - Peng Chen
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, People’s Republic of China
| | - Ying Zhang
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, People’s Republic of China
| | - Qingjie Ji
- Quzhou Hospital of Traditional Chinese Medicine, Quzhou, People’s Republic of China
| | - Hui Xie
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, People’s Republic of China
- Correspondence: Hui Xie, Hospital of Chengdu University of Traditional Chinese Medicine, No. 39 Shi-er-qiao Road, Chengdu, 610072, Sichuan Province, People’s Republic of China, Email
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Tan FCJH, Oka P, Dambha-Miller H, Tan NC. The association between self-efficacy and self-care in essential hypertension: a systematic review. BMC FAMILY PRACTICE 2021; 22:44. [PMID: 33618661 PMCID: PMC7901221 DOI: 10.1186/s12875-021-01391-2] [Citation(s) in RCA: 47] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 02/09/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND The successful management of hypertension requires sustained engagement in self-care behaviour such as adhering to medication regimens and diet. Bandura's Social Cognitive Theory suggests that self-efficacy is a major determinant of engagement in self-care behaviour. Self-efficacy refers to an individual's belief in their capacity to execute behaviours necessary to produce specific performance attainments. This systematic review of observational studies aims to summarise and evaluate the quality of evidence available to support the association between self-efficacy and engagement in self-care behaviour in hypertension. METHODS Searches were performed of the Pubmed, MEDLINE, CINAHL and OpenSIGLE databases from database inception to January 2020. Reference lists and individual journals were also hand searched. Observational studies in English quantifying self-efficacy and self-care behaviour in hypertensive adults were included. The quality of included articles was assessed with the National Institute of Health Quality Assessment Tool for observational studies. RESULTS The literature search identified 102 studies, of which 22 met the inclusion criteria for full-text review. There were 21 studies which reported that higher self-efficacy was associated with engagement in self-care behaviours including medication adherence (n = 9), physical activity (n = 2) and dietary changes (n = 1). Of these, 12 studies were rated as 'good' on the quality assessment tool and 10 were 'fair'. A common limitation in these studies was a lack of objectivity due to their reliance on self-reporting of engagement in self-care behaviour. CONCLUSION Our review suggests an association between self-efficacy and self-care. However, the evidence supporting this association is of low to medium quality and is limited by heterogeneity. Our findings suggest the need for further well-designed interventional studies to investigate this association.
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Affiliation(s)
- Felicia Clara Jun Hui Tan
- Ministry of Health Holdings, 1 Maritime Square, #11-25 HarbourFront Centre, Singapore, 099253, Singapore.,SingHealth Polyclinics, 167 Jalan Bukit Merah Connection One (Tower 5), #15-10, Singapore, 150167, Singapore
| | - Prawira Oka
- Ministry of Health Holdings, 1 Maritime Square, #11-25 HarbourFront Centre, Singapore, 099253, Singapore.,SingHealth Polyclinics, 167 Jalan Bukit Merah Connection One (Tower 5), #15-10, Singapore, 150167, Singapore
| | | | - Ngiap Chuan Tan
- SingHealth Polyclinics, 167 Jalan Bukit Merah Connection One (Tower 5), #15-10, Singapore, 150167, Singapore. .,SingHealth-Duke NUS Family Medicine Academic Clinical Programme, Singapore, Singapore.
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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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21
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Schober DJ, Tate M, Rodriguez D, Ruppar TM, Williams J, Lynch E. High Blood Pressure Medication Adherence Among Urban, African Americans in the Midwest United States. J Racial Ethn Health Disparities 2020; 8:607-617. [PMID: 32651883 DOI: 10.1007/s40615-020-00819-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 06/29/2020] [Accepted: 07/05/2020] [Indexed: 01/25/2023]
Abstract
Hypertension is a chronic condition that disproportionately affects African Americans. Managing high blood pressure (HBP) requires adherence to daily medication. However, many patients with hypertension take their HBP medication inconsistently, putting them at heightened risk of heart disease. Researchers have shown that these health risks are greater for African Americans than for Caucasians. In this article, we examine barriers and facilitators of medication adherence among urban African Americans with hypertension. We interviewed 24 African Americans with hypertension (58.5% women, average age 59.5 years) and conducted a comprehensive thematic analysis. Twenty-two barriers and 32 facilitators to medication adherence emerged. Barriers included side effects and forgetting while facilitators included reminders, routines, and social support. Using this data, we developed a diagram of theme connectedness of factors that affect medication adherence. This diagram can guide multi-level HBP intervention research that targets African Americans to promote medication adherence, prevent heart disease, and reduce ethnic and racial health disparities.
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Affiliation(s)
- Daniel J Schober
- Master of Public Health Program, DePaul University, 1 E. Jackson Blvd., Daley - 710, Mailstop - Master of Public Health, Chicago, IL, 60604, USA.
| | - Moranda Tate
- Master of Public Health Program, DePaul University, 1 E. Jackson Blvd., Daley - 710, Mailstop - Master of Public Health, Chicago, IL, 60604, USA
| | | | - Todd M Ruppar
- Department of Adult Health & Gerontological Nursing, Rush University College of Nursing, Chicago, IL, 60612, USA
| | - Joselyn Williams
- Department of Preventive Medicine, Rush Medical College, Chicago, IL, 60612, USA
| | - Elizabeth Lynch
- Department of Preventive Medicine, Rush Medical College, Chicago, IL, 60612, USA
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22
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Still CH, Dang PB, Malaker D, Peavy TD. The Design and Rationale of a Pilot Study: A COmmunity and Tech-Based ApproaCh for Hypertension Self-MANagement (COACHMAN). JOURNAL OF NATIONAL BLACK NURSES' ASSOCIATION : JNBNA 2020; 31:52-59. [PMID: 32853497 PMCID: PMC7694869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
African-Americans with hypertension continue to demonstrate poor blood pressure (BP) control and have markedly lower rates of hypertension self-management compared to non-African-Americans. Innovative and practical solutions such as mHealth technology are promising and can be leveraged to promote self-management of hypertension. Substantial evidence has demonstrated the importance of community support in improving patients' management of chronic illnesses. Unfortunately, such programs do not offer technology-based interventions (TBI) as a delivery method. Thus, this paper describes the design and rationale of an ongoing pilot study that incorporates TBI using a community-based participatory approach.
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Affiliation(s)
- Carolyn H Still
- Frances Payne Bolton School of Nursing, Case Western Reserve University, 10900 Euclid Ave., Cleveland, OH 44106.
| | - Phuong B Dang
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH
| | - Dolon Malaker
- Department of Physiology and Biophysics, Case Western Reserve University, Cleveland, OH
| | - Tangela D Peavy
- School of Nursing, Cleveland State University, Cleveland, OH
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23
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Buawangpong N, Pinyopornpanish K, Jiraporncharoen W, Dejkriengkraikul N, Sagulkoo P, Pateekhum C, Angkurawaranon C. Incorporating the patient-centered approach into clinical practice helps improve quality of care in cases of hypertension: a retrospective cohort study. BMC FAMILY PRACTICE 2020; 21:108. [PMID: 32532206 PMCID: PMC7293111 DOI: 10.1186/s12875-020-01183-0] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Accepted: 06/04/2020] [Indexed: 11/10/2022]
Abstract
BACKGROUND Treating hypertensive patients by integrating the patient-centered approach would influence the practice and outcome of treatment. Our purpose was to determine whether the implementation of a patient-centered approach in health care delivery can improve adhering to guidelines and the quality-of-care. METHODS A retrospective study was conducted using secondary data from the electronic medical records of the patients treated in the two primary care outpatient settings at the Family Medicine (FM) and Social Security (SS) clinics. A key feature of the FM clinic is the incorporation of a patient-centered approach in its service delivery. Individual information regarding initial assessment and treatment at the follow-up visits was reviewed for 1 year. Comparison of adherence to treatment guidelines between the two primary care clinics was performed by using chi-square, Fisher's exact test or a t-test. To explore the difference in blood pressure and BP control between the two clinics, linear and logistic regression analysis respectively were performed with an adjustment for CV risk score in 2016 as a key confounder. RESULTS The evidence included 100 records from each clinic, showed variation between the two primary care sites. The FM clinic had more complete records regarding family history of hypertension, assessment for secondary causes, prescription for lifestyle modification and appropriate adjustment of medication. Higher levels of blood pressure control were recorded in the FM clinic, specifically systolic pressure 2.92 mmHg (p = 0.073) and diastolic pressure 5.38 mmHg (p < 0.001) lower than those recorded in the SS clinic. There was a 2.96 times higher chance for BP goals to be achieved in patients in receipt of hypertensive care at the FM clinic (p = 0.004). CONCLUSIONS Adopting a patient-centered approach in service delivery could improve the quality of care for hypertension patients in primary care in Thailand.
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Affiliation(s)
- Nida Buawangpong
- Department of Family Medicine, Faculty of Medicine, Chiang Mai University, 110 Inthawarorot Rd., Sriphum, Muang, Chiang Mai, 50200 Thailand
| | - Kanokporn Pinyopornpanish
- Department of Family Medicine, Faculty of Medicine, Chiang Mai University, 110 Inthawarorot Rd., Sriphum, Muang, Chiang Mai, 50200 Thailand
| | - Wichuda Jiraporncharoen
- Department of Family Medicine, Faculty of Medicine, Chiang Mai University, 110 Inthawarorot Rd., Sriphum, Muang, Chiang Mai, 50200 Thailand
| | - Nisachol Dejkriengkraikul
- Department of Family Medicine, Faculty of Medicine, Chiang Mai University, 110 Inthawarorot Rd., Sriphum, Muang, Chiang Mai, 50200 Thailand
| | - Pakorn Sagulkoo
- Department of Biochemistry, Faculty of Medicine, Chiang Mai University, 110 Inthawarorot Rd., Sriphum, Muang, Chiang Mai, 50200 Thailand
| | - Chanapat Pateekhum
- Department of Family Medicine, Faculty of Medicine, Chiang Mai University, 110 Inthawarorot Rd., Sriphum, Muang, Chiang Mai, 50200 Thailand
| | - Chaisiri Angkurawaranon
- Department of Family Medicine, Faculty of Medicine, Chiang Mai University, 110 Inthawarorot Rd., Sriphum, Muang, Chiang Mai, 50200 Thailand
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Konlan KD, Afam-Adjei CJ, Afam-Adjei C, Oware J, Appiah TA, Konlan KD, Bella-Fiamawle J. Practice and Sociodemographic Factors Influencing Self-Monitoring of Blood Pressure in Ghanaians with Hypertension. Int J Chronic Dis 2020; 2020:6016581. [PMID: 32566645 PMCID: PMC7301236 DOI: 10.1155/2020/6016581] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Accepted: 05/28/2020] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND In sub-Saharan Africa, the prevalence of hypertension has assumed epidemic levels and currently accounts for numerous complications such as stroke, heart failure, and kidney damage. Management of hypertension involves both drug and nonpharmacological approaches. Self-monitoring of blood pressure is an important nonpharmacological approach that facilitates early detection of deteriorating blood pressures and complications. AIMS We determined the practice and sociodemographic factors influencing self-monitoring of blood pressure among Ghanaians with hypertension. METHODS In a cross-sectional design, we recruited four hundred and forty-seven (447) Ghanaians with hypertension receiving care at the hypertensive Outpatient Department (OPD) Clinics of the Medical Department at the Korle-Bu Teaching Hospital (KBTH). The respondents were sampled using a simple random sampling technique of balloting without replacement. A structured questionnaire was used to gather data on the practice of self-monitoring of blood pressure and sociodemographic factors influencing self-monitoring in the respondents. We also measured some anthropometric and haemodynamic indices of the respondents. The data was entered in Microsoft Excel 2010 and exported into SPSS 21.0 to aid with the data analysis. A chi-square test and Student's t-test analysis were done to determine the relationship between the practice of self-monitioring and other sociodemographic variables. Data analayses were conducted at a significant level (alpha 0.05) and power of 95% confidence. Thus, p < 0.05 was considered statistically significant. RESULTS The practice of self-monitoring of blood pressure was 25.3% with more female respondents claiming to practice self-monitoring as compared to their male counterparts (28.6% vs. 20.7%). Awareness of self-monitoring of blood pressure was associated with increased practice of self-monitoring of blood pressure. Health workers (46.8%), colleague patients (39.8%), relatives/spouses (6.7%), and the media (6.7%) were identified as the sources of information about self-monitoring of blood pressure. Awareness of self-monitoring, level of education, valid health insurance, occupation, income levels, and marital status had a significant relationship with self-monitoring of blood pressure among the respondents. Thus, respondents with higher education, awareness of self-monitoring, valid health insurance, formal employment, and higher income were likely to monitor their blood pressure. CONCLUSION Several sociodemographic factors influence the practice of self-monitoring of blood pressure in Ghanaians with hypertension. Thus, targeted hypertension education and social-cognitive interventions should focus on these sociodemographic factors so as to improve self-monitoring of blood pressure in order to reduce the complications of hypertension.
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Affiliation(s)
- Kennedy Dodam Konlan
- Department of Social & Behavioural Sciences, School of Public Health, University of Ghana, Legon, Accra, Ghana
| | | | | | - Jennifer Oware
- Department of Nursing, St. Karol School of Nursing, Aplaku-Accra, Ghana
| | - Theresa Akua Appiah
- School of Business, Ghana Institute of Management & Public Administration (GIMPA), Accra, Ghana
| | - Kennedy Diema Konlan
- Department of Public Health Nursing, School of Nursing and Midwifery, University of Allied Health Sciences, Ho, Ghana
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Spikes T, Higgins M, Clark P, Quyyumi A, Reilly C, Pemu P, Dunbar S. The Relationship Among Health Beliefs, Depressive Symptoms, Medication Adherence, and Social Support in African Americans With Hypertension. J Cardiovasc Nurs 2020; 34:44-51. [PMID: 30273259 PMCID: PMC6752722 DOI: 10.1097/jcn.0000000000000519] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND African Americans are disproportionately affected by hypertension and have lower medication adherence when compared to other racial groups. Antecedent factors such as beliefs surrounding hypertension, the presence or absence of social support, and depressive symptoms have not been extensively studied collectively in relation to hypertension medication adherence in African Americans. OBJECTIVE To determine the associations among demographic and clinical factors, depressive symptoms, hypertension beliefs, and social support with blood pressure medication adherence in middle-aged African American adults with a diagnosis of hypertension. METHODS A cross-sectional study of (N = 120) African Americans (mean age, 49 years; 22.5% men) with a current diagnosis of metabolic syndrome, including hypertension, who reported having and taking a prescribed blood pressure-lowering medication were included. Descriptive statistics, bivariate correlation analysis, and logistic regression using odds ratio were used to examine the effects of high blood pressure beliefs, social support, and depression on medication adherence. RESULTS A small but significant relationship was found between medication adherence and number of comorbidities (r = 0.19, P = .04). In a multivariate regression model, after controlling for gender, comorbidities remained associated with medication adherence (β = 0. 77, P = .04). Depressive symptoms, high blood pressure beliefs, and social support did not have a significant relationship with medication adherence. CONCLUSIONS Multiple comorbidities may have a positive impact upon medication adherence. Further study is needed in a larger sample of African Americans who have a diagnosis of hypertension in addition to other comorbidities requiring medication management.
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Affiliation(s)
- Telisa Spikes
- Nell Hodgson Woodruff School of Nursing, Emory University, 1520 Clifton Rd. NE Atlanta, GA 30322-4027 , 404-493-1161
| | - Melinda Higgins
- Nell Hodgson Woodruff, School of Nursing, Emory University, 1520 Clifton Rd, NE Atlanta, GA 30322-4027, office# 260 ; (office): 404-727-5180
| | - Patricia Clark
- Byrdine F. Lewis College of Nursing and Health Professions, Georgia State University, 140 Decatur St, SE Atlanta, GA 30303, , (office): 404-413-1180 & (fax): 404-413-1205
| | - Arshed Quyyumi
- Emory Clinical Cardiovascular Research Institute, Emory University, 1462 Clifton Rd. NE, Atlanta, GA 30322-4027, Suite 507, ; (office): 404-727-3655 & (fax): 404-712-8785
| | - Carolyn Reilly
- Nell Hodgson Woodruff School of Nursing, Emory University, 1520 Clifton Rd, NE Atlanta, GA office# 366 30322-4027, ; (office): 404-727-9658
| | - Pricilla Pemu
- Morehouse School of Medicine, 720 Westview Drive, Atlanta, GA 30310, ; (office): 404-616-8201
| | - Sandra Dunbar
- Nell Hodgson Woodruff School of Nursing, Emory University, 1520 Clifton Rd, NE office 402B Atlanta, GA 30322-4027, ; (office): 404-727-6939
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26
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Yuniartika W, Muhammad F. Family Support on the Activities of Elderly Hypertension Patients in Elderly Gymnastics Activities. JURNAL NERS 2020. [DOI: 10.20473/jn.v14i3.17213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Introduction: The aging process results in decreased body resistance, physiological functions and diseases which attack the elderly, such as hypertension. Elderly gymnastics is a mild exercise that is applied to the elderly. High family support will make the elderly more actively participate in elderly gymnastics activities, and vice versa. The aim of study was to determine the relationship of Family Support to the Activity of Elderly in Pajang Village.Methods: The design of the study was quantitative research with a cross sectional approach. The population of the study was all elderly people with hypertension who were aged 60 years and over who participated in elderly gymnastics, with total sampling at 95 respondents. This was then analyzed using the Kendall’s Tau formula.Results: The majority of family support was enough (38.8%) and the active category (63.2%), with bivariate analysis a value of 0.001 (<0.05), with a magnitude of 0.082.Conclusion: Families can help overcome the problems of the elderly and provide support for exercise activities. Families can also increase self-confidence to improve the health of the elderly. There is a significant relationship of family support for the activeness of elderly hypertension patients in elderly gymnastics activities in Pajang Village.
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Boulware LE, Ephraim PL, Hill-Briggs F, Roter DL, Bone LR, Wolff JL, Lewis-Boyer L, Levine DM, Greer RC, Crews DC, Gudzune KA, Albert MC, Ramamurthi HC, Ameling JM, Davenport CA, Lee HJ, Pendergast JF, Wang NY, Carson KA, Sneed V, Gayles DJ, Flynn SJ, Monroe D, Hickman D, Purnell L, Simmons M, Fisher A, DePasquale N, Charleston J, Aboutamar HJ, Cabacungan AN, Cooper LA. Hypertension Self-management in Socially Disadvantaged African Americans: the Achieving Blood Pressure Control Together (ACT) Randomized Comparative Effectiveness Trial. J Gen Intern Med 2020; 35:142-152. [PMID: 31705466 PMCID: PMC6957583 DOI: 10.1007/s11606-019-05396-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Revised: 05/15/2019] [Accepted: 08/12/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Effective hypertension self-management interventions are needed for socially disadvantaged African Americans, who have poorer blood pressure (BP) control compared to others. OBJECTIVE We studied the incremental effectiveness of contextually adapted hypertension self-management interventions among socially disadvantaged African Americans. DESIGN Randomized comparative effectiveness trial. PARTICIPANTS One hundred fifty-nine African Americans at an urban primary care clinic. INTERVENTIONS Participants were randomly assigned to receive (1) a community health worker ("CHW") intervention, including the provision of a home BP monitor; (2) the CHW plus additional training in shared decision-making skills ("DoMyPART"); or (3) the CHW plus additional training in self-management problem-solving ("Problem Solving"). MAIN MEASURES We assessed group differences in BP control (systolic BP (SBP) < 140 mm Hg and diastolic BP (DBP) < 90 mmHg), over 12 months using generalized linear mixed models. We also assessed changes in SBP and DBP and participants' BP self-monitoring frequency, clinic visit patient-centeredness (i.e., extent of patient-physician discussions focused on patient emotional and psychosocial concerns), hypertension self-management behaviors, and self-efficacy. KEY RESULTS BP control improved in all groups from baseline (36%) to 12 months (52%) with significant declines in SBP (estimated mean [95% CI] - 9.1 [- 15.1, - 3.1], - 7.4 [- 13.4, - 1.4], and - 11.3 [- 17.2, - 5.3] mmHg) and DBP (- 4.8 [- 8.3, - 1.3], - 4.0 [- 7.5, - 0.5], and - 5.4 [- 8.8, - 1.9] mmHg) for CHW, DoMyPART, and Problem Solving, respectively). There were no group differences in BP outcomes, BP self-monitor use, or clinic visit patient-centeredness. The Problem Solving group had higher odds of high hypertension self-care behaviors (OR [95% CI] 18.7 [4.0, 87.3]) and self-efficacy scores (OR [95% CI] 4.7 [1.5, 14.9]) at 12 months compared to baseline, while other groups did not. Compared to DoMyPART, the Problem Solving group had higher odds of high hypertension self-care behaviors (OR [95% CI] 5.7 [1.3, 25.5]) at 12 months. CONCLUSION A context-adapted CHW intervention was correlated with improvements in BP control among socially disadvantaged African Americans. However, it is not clear whether improvements were the result of this intervention. Neither the addition of shared decision-making nor problem-solving self-management training to the CHW intervention further improved BP control. TRIAL REGISTRY ClinicalTrials.gov Identifier: NCT01902719.
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Affiliation(s)
- L Ebony Boulware
- Division of General Internal Medicine, Department of Medicine, Duke University School of Medicine, 200 Morris Street, 3rd Floor, Durham, NC, 27701, USA.
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA.
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, MD, USA.
- Division of General Internal Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
| | - Patti L Ephraim
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, MD, USA
- Johns Hopkins Center for Health Equity, Johns Hopkins University, MD, USA
| | - Felicia Hill-Briggs
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, MD, USA
- Division of General Internal Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Acute and Chronic Care, Johns Hopkins University School of Nursing, Baltimore, MD, USA
- Department of Health, Behavior and Society, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Debra L Roter
- Department of Health, Behavior and Society, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Lee R Bone
- Johns Hopkins Center for Health Equity, Johns Hopkins University, MD, USA
- Department of Health, Behavior and Society, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Jennifer L Wolff
- Department of Health Policy and Management, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - LaPricia Lewis-Boyer
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, MD, USA
- Division of General Internal Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - David M Levine
- Division of General Internal Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Raquel C Greer
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, MD, USA
- Division of General Internal Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Johns Hopkins Center for Health Equity, Johns Hopkins University, MD, USA
| | - Deidra C Crews
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, MD, USA
- Division of General Internal Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Johns Hopkins Center for Health Equity, Johns Hopkins University, MD, USA
- Division of Nephrology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Kimberly A Gudzune
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, MD, USA
- Division of General Internal Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Michael C Albert
- Division of General Internal Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Johns Hopkins Community Physicians, Johns Hopkins Medicine, Baltimore, MD, USA
| | - Hema C Ramamurthi
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, MD, USA
| | - Jessica M Ameling
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, MD, USA
- Division of General Medicine, Department of Internal Medicine, University of Michigan School of Medicine, Ann Arbor, MI, USA
| | - Clemontina A Davenport
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC, USA
| | - Hui-Jie Lee
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC, USA
| | - Jane F Pendergast
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC, USA
| | - Nae-Yuh Wang
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, MD, USA
- Division of General Internal Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Biostatistics, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Kathryn A Carson
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, MD, USA
- Division of General Internal Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Johns Hopkins Center for Health Equity, Johns Hopkins University, MD, USA
| | - Valerie Sneed
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, MD, USA
- Division of General Internal Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Debra J Gayles
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, MD, USA
- Division of General Internal Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Sarah J Flynn
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, MD, USA
| | - Dwyan Monroe
- Community Advisory Board, Johns Hopkins Center to Eliminate Cardiovascular Health Disparities, Baltimore, MD, USA
- Institute for Public Health Innovation, Washington, DC, USA
| | - Debra Hickman
- Community Advisory Board, Johns Hopkins Center to Eliminate Cardiovascular Health Disparities, Baltimore, MD, USA
- Sisters together and Reaching, Inc., Baltimore, MD, USA
| | - Leon Purnell
- Community Advisory Board, Johns Hopkins Center to Eliminate Cardiovascular Health Disparities, Baltimore, MD, USA
- Men and Families Center, Inc., Baltimore, MD, USA
| | - Michelle Simmons
- Community Advisory Board, Johns Hopkins Center to Eliminate Cardiovascular Health Disparities, Baltimore, MD, USA
| | - Annette Fisher
- Community Advisory Board, Johns Hopkins Center to Eliminate Cardiovascular Health Disparities, Baltimore, MD, USA
- American Heart Association, Baltimore, MD, USA
| | - Nicole DePasquale
- Division of General Internal Medicine, Department of Medicine, Duke University School of Medicine, 200 Morris Street, 3rd Floor, Durham, NC, 27701, USA
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, MD, USA
| | - Jeanne Charleston
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, MD, USA
| | - Hanan J Aboutamar
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, MD, USA
- Division of General Internal Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Armstrong Institute for Patient Safety and Quality, Johns Hopkins Medicine, Baltimore, MD, USA
| | - Ashley N Cabacungan
- Division of General Internal Medicine, Department of Medicine, Duke University School of Medicine, 200 Morris Street, 3rd Floor, Durham, NC, 27701, USA
| | - Lisa A Cooper
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, MD, USA
- Division of General Internal Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Johns Hopkins Center for Health Equity, Johns Hopkins University, MD, USA
- Department of Health, Behavior and Society, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
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AlHadlaq RK, Swarelzahab MM, AlSaad SZ, AlHadlaq AK, Almasari SM, Alsuwayt SS, Alomari NA. Factors affecting self-management of hypertensive patients attending family medicine clinics in Riyadh, Saudi Arabia. J Family Med Prim Care 2019; 8:4003-4009. [PMID: 31879650 PMCID: PMC6924233 DOI: 10.4103/jfmpc.jfmpc_752_19] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Revised: 09/16/2019] [Accepted: 10/14/2019] [Indexed: 11/08/2022] Open
Abstract
Background/Aim: Hypertension (HBP) is a chronic disease that has become a public health problem, which has been attributed to numerous risk factors. However, despite numerous HBP management and behavioral treatment guidelines, HBP is poorly controlled among patients due to insufficient care. We conducted this study to identify the prevalence of self-management behaviors and to explore factors affecting self-management behaviors for controlling HBP among hypertensive patients. Methods: We conducted a survey using the Hypertension Self-Care Profile (HBP-SCP) and the Hill-Bone Adherence Scale among diagnosed HBP patients attending the Family Medicine clinics of King Saud Medical City in Riyadh, Saudi Arabia in January 2019. All patients of Saudi nationality aged 18 years and above were included in the study. Results: A total of 187 patients responded to the survey, 95 (50.8%) males and 92 (49.2%) females. Only 93 patients (49.7%) monitor their BP at home, and 68 (36.4%) always measure their BP. Ninety-one patients (48.7%) said that measuring their BP is not important. The most common reason for not taking the anti-HBP medications is they forget to take the medications in 87 (46.5%) of patients. Seventy-two patients (38.5%) did not restrict salt intake, and 51 patients (27.3%) had no time for exercise. More than half of the patients (51.3%) were not motivated to regularly exercise and 56.7% were motivated to limit salt-intake. Confidence to exercise, check BP at home, and eat low-salt foods were also low at 52.4–53.5%. Significant factors including gender, age, BMI, duration of HBP, and presence of cardiac disease were found to be related toward behavior, motivation, and confidence to self-care. Conclusion: Compliance, behavior, motivation, and self-care among hypertensive patients visiting the primary care clinics in our representative population are low. Various factors were found to be related to poor behavior, poor motivation, and less confidence to do home BP monitoring, to exercise more, restrict salt intake, and value the control of HBP. There is a need for health practitioners to assess self-care activities and blood pressure control, and educate patients the importance of HBP monitoring and teaching practical techniques to boost their confidence and motivation to achieve a better behavior, self-care, and compliance to management.
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Affiliation(s)
- Razan K AlHadlaq
- Department of Family Medicine at King Saud Medical City, Riyadh, Saudi Arabia
| | - Mazin M Swarelzahab
- Department of Preventative Medicine at King Saud Medical City, Riyadh, Saudi Arabia
| | - Samaher Z AlSaad
- Department of Family Medicine at King Saud University Medical City, Riyadh, Saudi Arabia
| | - Abdulrahman K AlHadlaq
- College of Medicine at King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Saad M Almasari
- Department of Family Medicine at King Saud Medical City, Riyadh, Saudi Arabia
| | - Saleh S Alsuwayt
- Department of Family Medicine at King Saud Medical City, Riyadh, Saudi Arabia
| | - Naif A Alomari
- Department of Family Medicine at King Saud Medical City, Riyadh, Saudi Arabia
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Shawler C, Edward J, Ling J, Crawford TN, Rayens MK. Impact of Mother-Daughter Relationship on Hypertension Self-management and Quality of Life: Testing Dyadic Dynamics Using the Actor-Partner Interdependence Model. J Cardiovasc Nurs 2019; 33:232-238. [PMID: 28990970 PMCID: PMC5886818 DOI: 10.1097/jcn.0000000000000448] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND Although hypertension (HTN) treatment rates are similar across age groups of women, effective control is significantly worse among older women. Only 20% of hypertensive women aged 70 to 79 years have controlled blood pressure. OBJECTIVES The purpose of this longitudinal study was to test the effects of the quality of mother-daughter relationship, inner strength, and control on HTN self-management and health-related quality of life (HRQOL) for both members of the dyad at 6 months. The Actor-Partner Interdependence Model was used to examine the direct ("actor") and indirect ("partner") effects of 46 dyads. RESULTS The mothers' perceived relationship quality with daughters directly impacted their own self-management of HTN and HRQOL while also indirectly affecting their daughters' self-management. Similarly, the daughters' perceived strength of their relationship with their mothers directly influenced their self-management and HRQOL and indirectly affected their mothers' self-management and HRQOL.
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Affiliation(s)
- Celeste Shawler
- Celeste Shawler, PhD, PMHCNS-BC Associate Professor, University of Louisville School of Nursing, Kentucky. Jean Edward, PhD, RN, CHPE Assistant Professor, College of Medicine, University of Kentucky Medical School, Lexington. Jiying Ling, PhD, MS, RN Assistant Professor, School of Nursing, Michigan State University, East Lansing. Tim N. Crawford, PhD, MPH Assistant Professor and Biostatistician, University of Louisville School of Nursing, Kentucky. Mary Kay Rayens, PhD Professor, University of Kentucky College of Nursing, Lexington
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Niriayo YL, Ibrahim S, Kassa TD, Asgedom SW, Atey TM, Gidey K, Demoz GT, Kahsay D. Practice and predictors of self-care behaviors among ambulatory patients with hypertension in Ethiopia. PLoS One 2019; 14:e0218947. [PMID: 31242265 PMCID: PMC6594646 DOI: 10.1371/journal.pone.0218947] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Accepted: 06/12/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Despite the benefits of evidence-based self-care behaviors in the management of hypertension, hypertensive patients have low rate of adherence to the recommended self-care behaviors. Studies related to self-care behaviors among hypertensive patients are limited in Ethiopia. OBJECTIVE To assess the rate of adherence to self-care behaviors and associated factors among hypertensive patients. METHOD A cross-sectional study was conducted at the cardiac clinic of Ayder comprehensive specialized hospital among ambulatory hypertensive patients. Self-care behaviors were assessed using an adopted Hypertension Self-Care Activity Level Effects (H-SCALE). Data were collected through patient interview and review of medical records. Binary logistic regression analysis was performed to identify predictors of self-care behaviors. RESULT A total of 276 patients were included in the study. The majority of the participants were nonsmokers (89.9%) and alcohol abstainers (68.8%). Less than half of the participants were adherent to the prescribed antihypertensive medications (48.2%) and recommended physical activity level (44.9%). Moreover, only 21.45% and 29% were adherent to weight management and low salt diet recommendations, respectively. Our finding indicated that rural resident (adjusted odds ratio [AOR]: 0.45, 95% confidence interval [CI]: 0.21-0.97), comorbidity (AOR: 0.16, 95% CI: 0.08-0.31), and negative medication belief (AOR: 0.25, 95% CI: 0.14-0.46) were significantly associated with medication adherence. Female sex (AOR: 0.46, 95% CI: 0.23-0.92), old age (AOR: 0.19, 95% CI: 0.06-0.60) and lack of knowledge on self-care behaviors (AOR: 0.13, 95% CI: 0.03-0.57) were significantly associated with adherence to weight management. Female sex (AOR: 1.97, 95% CI: 1.03-3.75) and lack of knowledge on self-care (AOR: 0.07, 95% CI: 0.03-0.16) were significantly associated with adherence to alcohol abstinence. Female sex (AOR: 6.33, 95% CI: 1.80-22.31) and khat chewing (AOR: 0.08, 95% CI: 0.03-0.24) were significantly associated with non-smoking behavior. There was also a significant association between female sex and physical activity (AOR: 0.22, 95% CI: 0.12-0.40). CONCLUSION The rate of adherence to self-care behaviors particularly weight management, low salt intake, physical exercise, and medication intake was low in our study. Elders, females, khat chewers, rural residents, and patients with negative medication belief, comorbidity, and inadequate knowledge of SCBs were less adherent to self-care behaviors compared to their counterparts. Therefore, health care providers should pay more emphasis to patients at risk of having low self-care behaviors.
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Affiliation(s)
- Yirga Legesse Niriayo
- Department of Clinical Pharmacy, School of Pharmacy, College of Health Sciences, Mekelle University, Mekelle, Tigray, Ethiopia
- * E-mail: ,
| | - Seid Ibrahim
- Department of Clinical Pharmacy, School of Pharmacy, College of Health Sciences, Mekelle University, Mekelle, Tigray, Ethiopia
| | - Tesfaye Dessale Kassa
- Department of Clinical Pharmacy, School of Pharmacy, College of Health Sciences, Mekelle University, Mekelle, Tigray, Ethiopia
| | - Solomon Weldegebreal Asgedom
- Department of Clinical Pharmacy, School of Pharmacy, College of Health Sciences, Mekelle University, Mekelle, Tigray, Ethiopia
| | - Tesfay Mahari Atey
- Department of Clinical Pharmacy, School of Pharmacy, College of Health Sciences, Mekelle University, Mekelle, Tigray, Ethiopia
| | - Kidu Gidey
- Department of Clinical Pharmacy, School of Pharmacy, College of Health Sciences, Mekelle University, Mekelle, Tigray, Ethiopia
| | - Gebre Teklemariam Demoz
- Clinical Pharmacy and Pharmacy Practice Unit, Department of Pharmacy, College of Health Sciences, Aksum University, Aksum, Tigray, Ethiopia
| | - Desalegn Kahsay
- Department of Clinical Pharmacy, School of Pharmacy, College of Health Sciences, Mekelle University, Mekelle, Tigray, Ethiopia
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Asgari MR, Bouraghi H, Mohammadpour A, Haghighat M, Ghadiri R. The role of psychosocial determinants in predicting adherence to treatment in patient with hypertension. Interv Med Appl Sci 2019; 11:8-16. [PMID: 32148898 PMCID: PMC7044565 DOI: 10.1556/1646.10.2018.43] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2018] [Revised: 07/18/2018] [Accepted: 07/19/2018] [Indexed: 02/06/2023] Open
Abstract
INTRODUCTION Non-adherence in patients with hypertension directly exacerbates clinical outcomes. The purpose of the present research is to study the recognition of the relationships between the perceived social support and self-efficacy and the satisfaction of health care agents and the interaction of the patient with therapeutic personnel and access to health care and the behaviors of adherence to treatment in the patients who suffer hypertension. MATERIALS AND METHODS This descriptive cross-sectional correlation study recruited 250 patients from a specialized hypertension clinic in Semnan, who completed the following questionnaires: Multidimensional Scale of Perceived Social Support, self-efficacy, adherence to treatment, access to and satisfaction with health care, and the patient's interaction with treatment personnel. RESULTS An overall statistical description of the sample consists of 89 (35.6%) men and 161 (64.4%) women (SD = 10.41, range = 51.98). Regression coefficient of previous variables (three steps) shows that self-efficacy share, consent form civil services, and job could demonstrate with 99% certainty in the changes of treatment conformity in a meaningful way. CONCLUSIONS High self-efficacy, satisfaction with health care, and a favorable job have a high direct effect on adherence to treatment in patients with hypertension and controlling hypertension. Social support and education do not have a significant impact on adherence to treatment.
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Affiliation(s)
- Mohammad Reza Asgari
- Nursing Care Research Center, Semnan University of Medical Sciences, Semnan, Iran
| | - Hamid Bouraghi
- Department of Health Information Technology, School of Paramedical Sciences, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Ali Mohammadpour
- Department of Health Information Technology, School of Paramedical Sciences, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Mina Haghighat
- Unit of Psychology Consultation, Semnan University, Semnan, Iran
| | - Raheleh Ghadiri
- Jahadieh Health Center, Semnan University of Medical Sciences, Semnan, Iran
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Ademe S, Aga F, Gela D. Hypertension self-care practice and associated factors among patients in public health facilities of Dessie town, Ethiopia. BMC Health Serv Res 2019; 19:51. [PMID: 30665405 PMCID: PMC6341627 DOI: 10.1186/s12913-019-3880-0] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2018] [Accepted: 01/04/2019] [Indexed: 02/07/2023] Open
Abstract
Background Hypertension self-care practice is essential for blood pressure control and reduction of hypertension complications. Nevertheless, we know little concerning hypertension self-care practice in Ethiopia. The purpose of this study was to assess hypertension self-care practice and associated factors among patients in public health facilities in Dessie town, Ethiopia. Methods In this cross-sectional study, 309 hypertensive patients (mean age 58.8 years, 53.4% women) completed the interviewer-administered questionnaire in Amharic language. Descriptive and logistic regression analyses were conducted using SPSS version 22. Result The mean score for hypertension self-care was 37.7 ± 8.2 and 51% scored below the mean. Divorced participants (AOR = 0.115, 95% CI = 0.026, 0.508, p-value < 0.01) and those who lack source of information (AOR = 0.084, 95% CI = 0.022, 0.322, p-value < 0.01) were less likely to have good self-care practice. But, participants who had convenient place for exercise (AOR = 2.968, 95% CI = 1.826, 4.825, p-value < 0.01), who had good social support (AOR = 2.204, 95% CI = 1.272, 3.821, p-value < 0.01), who had traditional clergy-based teaching (AOR = 2.209, 95% CI = 1.064, 4.584, p-value < 0.05), and who had good self-care agency (AOR = 1.222, 2.956, p-value < 0.05) were more likely to have good self-care practice. Conclusion Most of the study participants reported poor self-care practices. Factors associated with hypertension self-care practice are marital status, education, source of self-care information, place for exercise, social support, and self-care agency. Targeted interventions are needed to improve hypertension self-care practice.
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Affiliation(s)
- Sewunet Ademe
- Department of Adult Health Nursing, School of Nursing & Midwifery, Wollo University, P.O. Box: 1145, Dessie, Ethiopia
| | - Fekadu Aga
- Department of Nursing, School of Nursing & Midwifery, College of Health Science, Addis Ababa University, P.O. Box: 9083, Addis Ababa, Ethiopia.
| | - Debela Gela
- Department of Nursing, School of Nursing & Midwifery, College of Health Science, Addis Ababa University, P.O. Box: 4412, Addis Ababa, Ethiopia
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Amuneke-Nze CG, Bamgbade BA, Barner JC. An Investigation of Health Management Perceptions and Wellness Behaviors in African American Males in Central Texas. Am J Mens Health 2019; 13:1557988318813490. [PMID: 30428764 PMCID: PMC6775563 DOI: 10.1177/1557988318813490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Revised: 10/06/2018] [Accepted: 10/10/2018] [Indexed: 11/24/2022] Open
Abstract
Little is known regarding interventions that incorporate health management perceptions among African American (AA) men, to reduce the risk for developing various medical conditions. Using the Theory of Planned Behavior (TPB), the study objective was to better understand health-care perceptions of AA men by assessing participants' attitudes, subjective norms (SNs), and perceived behavioral control (PBC) regarding health management. AA adult males in Texas were recruited to participate in one of four qualitative focus groups. The TPB was used to assess participants' attitudes (advantages/disadvantages), SNs (approvers/disapprovers), and PBC (enablers/barriers) regarding health management. All four sessions were audiotaped, transcribed, and independently analyzed by researchers to identify major themes. Participants ( n = 23) were 45.2 ± 16.2 years of age (range 24-74). Regarding attitudes toward health management, participants viewed increased longevity and avoiding future health problems as advantages; however, increased cost, lack of confidence in health care, and social pressures were disadvantages. Regarding SNs, parents and children were positive influencers, while spouses and coworkers were both positive and negative influencers. For PBC, a support system and health awareness were identified as enablers, while medical mistrust, fear, and culture were barriers. The results convey that health management behaviors in AA males are multifaceted. Health-care providers should seek to understand these factors, discuss these issues with AA males, and integrate treatment strategies that are culturally informed and patient centered. Findings from this study may be used to develop targeted interventions that improve health outcomes for AA males.
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Affiliation(s)
- Chibuokem G. Amuneke-Nze
- Division of Health Outcomes and Pharmacy Practice, College of Pharmacy, The University of Texas at Austin, Austin, TX, USA
| | - Benita A. Bamgbade
- Department of Pharmacy and Health Systems Sciences, Northeastern University, Boston, MA, USA
| | - Jamie C. Barner
- Division of Health Outcomes and Pharmacy Practice, College of Pharmacy, The University of Texas at Austin, Austin, TX, USA
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Hamler TC, Miller VJ, Petrakovitz S. Chronic Kidney Disease and Older African American Adults: How Embodiment Influences Self-Management. Geriatrics (Basel) 2018; 3:E52. [PMID: 31011089 PMCID: PMC6319230 DOI: 10.3390/geriatrics3030052] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2018] [Revised: 08/02/2018] [Accepted: 08/15/2018] [Indexed: 12/22/2022] Open
Abstract
Patients living with chronic kidney disease (CKD) must balance the medical management of their kidney disease and other chronic conditions with their daily lives, including managing the emotional and psychosocial consequences of living with a chronic disease. Self-management is critical to managing chronic kidney disease, as treatment consists of a complex regimen of medications, dosages, and treatments. This is a particularly important issue for older African American adults who will comprise a significant portion of the older adult population in the coming years. Yet current conceptualizations of self-management behaviors cannot adequately address the needs of this population. Embodiment theory provides a novel perspective that considers how social factors and experiences are embodied within decision-making processes regarding self-management care among older African Americans. This paper will explore how embodiment theory can aid in shifting the conceptualization of self-management from a model of individual choice, to a framework that cannot separate lived experiences of social, political, and racial factors from clinical understandings of self-management behaviors. This shift in the conceptualization of self-management is particularly important to consider for CKD management because the profound illness burdens require significant self-management and care coordination skills.
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Affiliation(s)
- Tyrone C Hamler
- Mandel School of Applied Social Sciences, Case Western Reserve University, Cleveland, OH 44106, USA.
| | - Vivian J Miller
- School of Social Work, University of Texas at Arlington, Arlington, TX 76109, USA.
| | - Sonya Petrakovitz
- Department of Anthropology, Case Western Reserve University, Cleveland, OH 44106, USA.
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Tu Q, Xiao LD, Ullah S, Fuller J, Du H. Hypertension management for community-dwelling older people with diabetes in Nanchang, China: study protocol for a cluster randomized controlled trial. Trials 2018; 19:385. [PMID: 30012188 PMCID: PMC6048858 DOI: 10.1186/s13063-018-2766-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Accepted: 06/25/2018] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Although China has a large number of older people living with diabetes and hypertension, the primary care system is underdeveloped and so management of these conditions in community care settings is suboptimal. Studies have shown that the collaborative care model across care settings that address both pharmacology and nonpharmacology interventions can achieve hypertension control for older people with diabetes. Barriers to implementing and evaluating this model of care are widely recognized in low and middle-income countries including China. This study will therefore test the hypothesis that a hypertension management program built on collaboration between hospitals and community health service centers in China can improve blood pressure control in people aged 60 years and older with diabetes as compared to usual care. METHODS A cluster randomized controlled trial will randomly allocate 10 wards from four hospitals in Nanchang to either an intervention group (N = 5) or a usual care group (N = 5). At least 27 participants will be recruited from each ward and the estimated sample size will be 135 patients in each group. The intervention includes individualized self-care education prior to discharge and 6-month follow-up in community health service centers. Health professionals from both hospitals and community health service centers will be resourced to collaborate on the implementation of the postdischarge interventions that reinforce self-care. The primary outcome is systolic blood pressure at 6-month follow-up adjusted for baseline value. Secondary outcomes are self-care knowledge, treatment adherence, HbA1c and lipid levels, quality of life, the incidence of adverse events and the incidence of unplanned hospital readmission at 6-month follow-up adjusted for baseline value. A multilevel mixed-effect linear regression model will be used to compare the changes in health outcomes between the intervention and usual care groups. DISCUSSION This study will determine whether collaborative care among health professionals between hospitals and community health service centers will improve hypertension management for older people with diabetes in the study sites. The program, if effective, will have an immediate application to hypertension management in the healthcare system in China. TRIAL REGISTRATION Australia New Zealand Clinical Trials Registry, ACTRN12617001352392 . Retrospectively registered on 26 September 2017.
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Affiliation(s)
- Qiang Tu
- College of Nursing and Health Sciences, Flinders University, GPO Box 2100, Adelaide, SA 5001 Australia
| | - Lily Dongxia Xiao
- College of Nursing and Health Sciences, Flinders University, GPO Box 2100, Adelaide, SA 5001 Australia
| | - Shahid Ullah
- South Australian Health and Medical Research Institute, Adelaide, SA Australia
| | - Jeffrey Fuller
- College of Nursing and Health Sciences, Flinders University, GPO Box 2100, Adelaide, SA 5001 Australia
| | - Huiyun Du
- College of Nursing and Health Sciences, Flinders University, GPO Box 2100, Adelaide, SA 5001 Australia
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A Theory-Based Self-Care Intervention with the Application of Health Literacy Strategies in Patients with High Blood Pressure and Limited Health Literacy: A Protocol Study. Int J Hypertens 2018; 2018:4068538. [PMID: 30112196 PMCID: PMC6077648 DOI: 10.1155/2018/4068538] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Revised: 04/26/2018] [Accepted: 06/12/2018] [Indexed: 01/24/2023] Open
Abstract
The purpose of this study is to assess the effectiveness of a theory-based self-care intervention with the application of health literacy strategies in patients with high blood pressure and limited health literacy. This is a randomized controlled trial, with measurements at baseline and 1 and 3 months follow-up. 100 patients with high blood pressure and limited health literacy will be randomly allocated to either an intervention group or a usual care control group. We will mainly establish the intervention model based on the principal health belief model components. Patients randomized to the intervention group will receive four educational sessions during four weeks. Considering the limited health literacy level of the patients of the study, health literacy strategies will be used in educational material design for enhancing the quality of the intervention. In order to cover these strategies, we will design four standard animated comics and fact sheets with illustrations and photos consistent with the health belief model constructs and educational sessions' topics. Data will be collected using some questionnaires and will be analyzed using the SPSS software. The findings of this study may assist with the development of a theoretical model for self-care intervention in patients with high blood pressure and limited health literacy.
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Lor M. Systematic Review: Health Promotion and Disease Prevention Among Hmong Adults in the USA. J Racial Ethn Health Disparities 2018; 5:638-661. [PMID: 28795343 PMCID: PMC5807234 DOI: 10.1007/s40615-017-0410-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2017] [Revised: 06/14/2017] [Accepted: 07/04/2017] [Indexed: 10/19/2022]
Abstract
Although disparities in the burden of disease and illness experienced across major racial and ethnic groups in the USA is well known, little is known about subgroups, including the Hmong population. This review sought to determine the current state of health disparities related to health promotion and disease prevention among Hmong adults from 1975 to 2015. Seventy-one descriptive (qualitative, mixed methods, and quantitative) studies were reviewed. Most focused on two areas: (1) health status (mainly breast and cervical cancers) and (2) health-related behaviors. This literature review confirms the existence of health disparities related to health promotion and disease prevention in the Hmong adult population. Effective intervention relies on identifying these disparities. A possible explanation for these disparities is the lack of health data collected on subgroup populations, which include the Hmong adult population. More research and more comprehensive health policies at the organizational level are needed to allow data to be collected on subgroup populations in order to better understand the social determinants that place the Hmong people at risk.
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Affiliation(s)
- Maichou Lor
- School of Nursing, Columbia University , Mailbox 6, 630 W 168th Street, New York City, New York, 10032, USA.
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Jones LM, Veinot T, Pressler SJ, Coleman-Burns P, McCall A. Exploring Predictors of Information Use to Self-Manage Blood Pressure in Midwestern African American Women with Hypertension. J Immigr Minor Health 2018; 20:569-576. [PMID: 28382426 PMCID: PMC5628088 DOI: 10.1007/s10903-017-0573-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Self-management of hypertension requires patients to find, understand, and use information to lower their blood pressure. Little is known about information use among African American women with hypertension, therefore the purpose of this study was to examine predictors of self-reported information use to self-manage blood pressure. Ninety-four Midwestern African American women (mean age = 59) completed questionnaires about information behaviors (seeking, sharing, use) and personal beliefs (attitude, social norms) related to self-management of blood pressure. Linear regression was used to identify significant predictors of information use. The total variance explained by the model was 36%, F(7, 79) = 6.29, p < .001. Information sharing was the only significant predictor (beta = .46, p < .001). These results provide evidence that information sharing is a potential health behavior to support intervention strategies for African American women with hypertension.
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Affiliation(s)
- Lenette M Jones
- Frances Payne Bolton School of Nursing, Case Western Reserve University, 10900 Euclid Avenue, Cleveland, OH, 44106, USA.
| | - Tiffany Veinot
- School of Information and School of Public Health, University of Michigan, Ann Arbor, MI, USA
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Visanuyothin S, Plianbangchang S, Somrongthong R. Appearance and potential predictors of poorly controlled hypertension at the primary care level in an urban community. J Multidiscip Healthc 2018; 11:131-138. [PMID: 29503561 PMCID: PMC5826083 DOI: 10.2147/jmdh.s156518] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Purpose Hypertension (HT) is the major risk factor for cardiovascular diseases because of its poor control. To control HT at the primary care level in urban communities, there is a demand for deeper comprehension of the manifestations of poorly controlled HT. This study aimed to examine appearance of HT, including the association between the appearance and home blood pressure (HBP) control at the primary care level in urban communities. Patients and methods A cross-sectional study was conducted in July-October 2017 in an urban community in Thailand. The total sample size from randomization was 125 poorly controlled HT patients who were diagnosed with an average clinic blood pressure ≥140/90 mmHg in their last three visits. Data were collected by face-to-face interviews, HBP monitoring (HBPM), and blood and urine testing. Data analysis was conducted via descriptive statistics and the chi-square tests, with a significance level of p<0.05. Results HBPM revealed that 58.4% of patients with poorly controlled blood pressure from clinic measurement had a systolic blood pressure and diastolic blood pressure that were below the HBP target. Most patients were overweight/obese, but they were nonsmokers and nondrinkers. As comorbidities, they had hyperlipidemia (64.0%) and diabetes mellitus (53.0%). One-quarter of them had good levels of knowledge and literacy. Nearly half had good health self-care literacy. Only 13% exhibited adequate self-management behaviors, but more than half had biochemistry results within normal limits. There were significant associations of smoking history and having hyperlipidemia as a comorbidity with HBP control (p =0.010 and 0.046, respectively). Conclusion The role of HBPM is important in practice when it comes to monitoring HT control at the primary care level in an urban context. Smoking cessation and control of the blood lipid levels should be highlighted not only at the practice, but also at the policy level.
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Affiliation(s)
- Sawitree Visanuyothin
- Social Medicine Department, Maharat Nakhon Ratchasima Hospital, Nakhon Ratchasima, Thailand.,College of Public Health Sciences, Chulalongkorn University, Bangkok, Thailand
| | | | - Ratana Somrongthong
- College of Public Health Sciences, Chulalongkorn University, Bangkok, Thailand
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Factors Predicting Self-Care Behaviors among Low Health Literacy Hypertensive Patients Based on Health Belief Model in Bushehr District, South of Iran. Int J Hypertens 2018; 2018:9752736. [PMID: 29780639 PMCID: PMC5893004 DOI: 10.1155/2018/9752736] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Accepted: 01/18/2018] [Indexed: 12/13/2022] Open
Abstract
The aim of this study was to determine the factors influencing adherence to self-care behaviors among low health literacy hypertensive patients based on health belief model. A cross-sectional study was conducted among 152 hypertensive patients with low health literacy. Patients with limited health literacy were identified by S-TOFHLA. The data were collected using H-scale for assessing self-care behaviors and, HK-LS for assessing knowledge of hypertension. A researcher-made questionnaire was applied for collecting data of health belief model constructs. Data were analyzed by SPSS version 22 with using multiple logistic regression analyses. Perceived self-efficacy was associated with all self-care behaviors except medication regimens. There was a significant association between perceived susceptibility and adherence to both low-salt diet (OR = 3.47) and nonsmoking behavior (OR = 1.10). Individuals who had more perceived severity (OR = 1.82) had significantly greater adherence to their medication regimens. Perceived benefits and barriers were not significantly associated with either type of hypertension self-care behaviors. It seems that designing and implementation of educational programs to increase self-efficacy of patients and promote their beliefs about perceived susceptibility and severity of complications may improve self-care behaviors among low health literacy hypertensive patients.
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Ybarra Sagarduy JL, Camacho Mata DY, Moral de la Rubia J, Piña López JA, Yunes Zárraga JLM. Psychological, interpersonal, and clinical factors predicting time spent on physical activity among Mexican patients with hypertension. Patient Prefer Adherence 2018; 12:89-96. [PMID: 29379276 PMCID: PMC5757987 DOI: 10.2147/ppa.s147943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND It is widely known that physical activity is the key to the optimal management and clinical control of hypertension. PURPOSE This research was conducted to identify factors that can predict the time spent on physical activity among Mexican adults with hypertension. METHODS This cross-sectional study was conducted among 182 Mexican patients with hypertension, who completed a set of self-administered questionnaires related to personality, social support, and medical adherence and health care behaviors, body mass index, and time since the disease diagnosis. Several path analyses were performed in order to test the predictors of the study behavior. RESULTS Lower tolerance to frustration, more tolerance to ambiguity, more effective social support, and less time since the disease diagnosis predicted more time spent on physical activity, accounting for 13.3% of the total variance. The final model shows a good fit to the sample data (pBS =0.235, χ2/gl =1.519, Jöreskog and Sörbom's Goodness of Fit Index =0.987, adjusted modality =0.962, Bollen's Incremental Fit Index =0.981, Bentler-Bonett Normed Fit Index =0.946, standardized root mean square residual =0.053). CONCLUSION The performance of physical activity in patients with hypertension depends on a complex set of interactions between personal, interpersonal, and clinical variables. Understanding how these factors interact might enhance the design of interdisciplinary intervention programs so that quality of life of patients with hypertension improves and they might be able to manage and control their disease well.
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Affiliation(s)
- José Luis Ybarra Sagarduy
- Unit of Social Work and Human Development, Autonomous University of Tamaulipas, Ciudad Victoria
- Correspondence: José Luis Ybarra Sagarduy, Unit of Social Work and Human Development, Autonomous University of Tamaulipas, University Center “Adolfo López Mateos”, Ciudad Victoria 87000, Tamaulipas, Mexico, Tel +52 834 318 1800, Email
| | | | | | | | - José Luis Masud Yunes Zárraga
- Institute of Health and Safety Services for State Workers, Clinic for the Study and Prevention of the Chilhood Obesity, Ciudad Victoria, Mexico
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Hallberg I, Ranerup A, Bengtsson U, Kjellgren K. Experiences, expectations and challenges of an interactive mobile phone-based system to support self-management of hypertension: patients' and professionals' perspectives. Patient Prefer Adherence 2018; 12:467-476. [PMID: 29643739 PMCID: PMC5885974 DOI: 10.2147/ppa.s157658] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND A well-controlled blood pressure (BP) reduces cardiovascular complications. Patient participation in care using technology may improve the current situation of only 13.8% of adults diagnosed with hypertension worldwide having their BP under control. OBJECTIVE The objective of this study was to explore patients' and professionals' experiences of and expectations for an interactive mobile phone-based system to support self-management of hypertension. METHODS The self-management system consists of: 1) a mobile phone platform for self-reports, motivational messages and reminders; 2) a device for measuring BP and 3) graphical feedback of self-reports. Patients diagnosed with high BP (n=20) and their treating professionals (n=7) participated in semi-structured interviews, after 8 weeks use of the system in clinical practice. Data were analyzed thematically. RESULTS The self-reporting of BP, symptoms, medication use, medication side effects, lifestyle and well-being was perceived to offer insight into how daily life activities influenced BP and helped motivate a healthy lifestyle. Taking increased responsibility as a patient, by understanding factors affecting one's well-being, was reported as an enabling factor for a more effective care. Based on the experiences, some challenges were mentioned: for adoption of the system into clinical practice, professionals' educational role should be extended and there should be a reorganization of care to fully benefit from technology. The patients and professionals gave examples of further improvements to the system, for example, related to the visualization of graphs from self-reports and an integration of the system into the general technical infrastructure. These challenges are important on the path to accomplishing adoption. CONCLUSION The potential of a more autonomous, knowledgeable and active patient, through use of the interactive mobile system would improve outcomes of hypertension treatment, which has been desired for decades. Documentation and visualization of patients' self-reports and the possibilities to communicate these with professionals may be a significant resource for person-centered care.
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Affiliation(s)
- Inger Hallberg
- Institute of Health and Care Sciences, University of Gothenburg, Gothenburg, Sweden
- Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
- Centre for Person-Centred Care (GPCC), University of Gothenburg, Gothenburg, Sweden
- Correspondence: Inger Hallberg, Department of Medicine and Health Sciences, Linköping University, SE-581 83 Linköping, Sweden, Tel +46 13 28 6989, Email
| | - Agneta Ranerup
- Centre for Person-Centred Care (GPCC), University of Gothenburg, Gothenburg, Sweden
- Department of Applied Information Technology, University of Gothenburg, Gothenburg, Sweden
| | - Ulrika Bengtsson
- Institute of Health and Care Sciences, University of Gothenburg, Gothenburg, Sweden
- Centre for Person-Centred Care (GPCC), University of Gothenburg, Gothenburg, Sweden
| | - Karin Kjellgren
- Institute of Health and Care Sciences, University of Gothenburg, Gothenburg, Sweden
- Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
- Centre for Person-Centred Care (GPCC), University of Gothenburg, Gothenburg, Sweden
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Ozkaynak M, Valdez R, Holden RJ, Weiss J. Infinicare framework for integrated understanding of health-related activities in clinical and daily-living contexts. Health Syst (Basingstoke) 2017; 7:66-78. [PMID: 31214339 PMCID: PMC6452830 DOI: 10.1080/20476965.2017.1390060] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2016] [Revised: 12/19/2016] [Accepted: 04/21/2017] [Indexed: 10/18/2022] Open
Abstract
Clinical and consumer health informatics interventions promise to transform health care, yielding higher quality, more accessible care at a lower cost. However, the potential of these interventions cannot be achieved if they are developed and rolled out in a disconnected way: clinic-based systems typically do not interface with home-based systems that capture patient-generated health-related data. The fragmentation between these interventions severely limits the benefits of all interventions; given that health care is a continuum between clinical and daily-living settings. We introduce the Infinicare framework, which posits that clinical health-related activities "shape" daily-living-based health-related activities and, conversely, that daily-living-based health-related activities "inform" activities in clinics. Non-alignment of activities across these diverse contexts yields systemic gaps. Workflow studies that capture health-related activities and characterise gaps between clinical and daily-living contexts can inform the design and implementation of gap-filling, collaborative health information technologies. To inform these technologies, workflow studies should be patient-oriented, include both clinical and daily-living settings and subsume both process and structure variables. Novel methodologies are needed to effectively and efficiently capture health-related activities across both clinical and daily-living settings and their contexts. Guidelines for applying these recommendations in developing collaborative health information technologies are provided.
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Affiliation(s)
- Mustafa Ozkaynak
- College of Nursing, University of Colorado-Denver, Aurora, CO, USA
| | - Rupa Valdez
- Department of Public Health Sciences, University of Virginia, Charlottesville, VA, USA
| | - Richard J. Holden
- Department of BioHealth Informatics, Indiana University School of Informatics and Computing, Indianapolis, IN, USA
| | - Jason Weiss
- College of Nursing, University of Colorado-Denver, Aurora, CO, USA
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Long E, Ponder M, Bernard S. Knowledge, attitudes, and beliefs related to hypertension and hyperlipidemia self-management among African-American men living in the southeastern United States. PATIENT EDUCATION AND COUNSELING 2017; 100:1000-1006. [PMID: 28012680 PMCID: PMC5400720 DOI: 10.1016/j.pec.2016.12.011] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Revised: 12/13/2016] [Accepted: 12/15/2016] [Indexed: 06/01/2023]
Abstract
OBJECTIVE Perceptions of illness affect cardiovascular disease (CVD) self-management. This study explores knowledge, attitudes, and beliefs regarding hypertension and hyperlipidemia management among 34 African-American men with hypertension and/or hyperlipidemia, age 40-65, living in the Southeastern United States. METHODS In-person focus groups were conducted using semi-structured interview questions informed by the Health Belief Model (HBM). RESULTS Participants had a high level of knowledge about hypertension self-management, but less about cholesterol self-management. Perceived severity of both conditions was acknowledged, though participants perceived hypertension as more severe. Barriers to self-management included medication side effects and unhealthy dietary patterns. Facilitators included social support, positive healthcare experiences, and the value placed on family. Cultural implications highlighted the importance of food in daily life and social settings. Participants expressed how notions of masculinity affected self-management-noting the impact of feelings of vulnerability and perceived lack of control stemming from diagnosis and treatment expectations. CONCLUSIONS The findings highlight gaps in knowledge of hyperlipidemia versus hypertension, and the impact of cultural context and perceptions on engagement in self-management behaviors. PRACTICE IMPLICATIONS Public health practitioners and healthcare providers serving African-American men should address cultural factors and notions of masculinity which can hinder effective disease management among this population.
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Affiliation(s)
| | - Monica Ponder
- National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA.
| | - Stephanie Bernard
- National Center for Chronic Disease and Health Promotion, Centers for Disease Control and Prevention, Division for Heart Disease and Stroke Prevention, Atlanta, GA, USA.
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Bajorek B, Lemay K, Magin P, Roberts C, Krass I, Armour C. Patients’ Attitudes and Approaches to the Self-Management of Hypertension: Perspectives from an Australian Qualitative Study in Community Pharmacy. High Blood Press Cardiovasc Prev 2017; 24:149-155. [DOI: 10.1007/s40292-017-0181-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Accepted: 01/19/2017] [Indexed: 10/20/2022] Open
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Phillips KL, Rogers CR, Aiken-Morgan AT. Perceptions of Chronic Disease Among Older African Americans: A Qualitative Analysis. JOURNAL OF HEALTH DISPARITIES RESEARCH AND PRACTICE 2017; 10:52-60. [PMID: 29503763 PMCID: PMC5831544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Research has documented that African Americans suffer disproportionately from chronic diseases when compared to the general population. Yet, limited research examines older African Americans' perceptions about having chronic diseases. Accordingly, the first aim of the study provided insight into this disparity with the intent of revealing how older African Americans feel about their overall health, and how much they understand about their individual chronic disease(s). The second aim was to gather information about strategies and coping mechanisms older African Americans use to manage their chronic diseases. The purpose of this aim was to determine if any of the strategies they employed were related to the positive health outcomes. Two focus groups were conducted with African American older adults who live in community settings. The results from the focus groups indicate that older African Americans are aware of the conditions they have and have developed strong coping methods to help them manage. Recommendations are provided for future research studies and chronic disease management programs.
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Affiliation(s)
- Karon L Phillips
- Department of Sociology, University of Maryland, Baltimore County
| | - Charles R Rogers
- Dept. of Family Medicine & Community Health, University of Minnesota Medical School
| | - Adrienne T Aiken-Morgan
- Department of Psychology, North Carolina A&T State University, Greensboro, NC 27411 USA
- Center on Biobehavioral Health Disparities Research, Duke University, Durham, NC 27708 USA
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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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Grant AB, Seixas A, Frederickson K, Butler M, Tobin JN, Jean-Louis G, Ogedegbe G. Effect of Expectation of Care on Adherence to Antihypertensive Medications Among Hypertensive Blacks: Analysis of the Counseling African Americans to Control Hypertension (CAATCH) Trial. J Clin Hypertens (Greenwich) 2016; 18:690-6. [PMID: 26593105 PMCID: PMC5357563 DOI: 10.1111/jch.12736] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2015] [Revised: 09/16/2015] [Accepted: 09/22/2015] [Indexed: 12/31/2022]
Abstract
Novel ideas are needed to increase adherence to antihypertensive medication. The current study used data from the Counseling African Americans to Control Hypertension (CAATCH) study, a sample of 442 hypertensive African Americans, to investigate the mediating effects of expectation of hypertension care, social support, hypertension knowledge, and medication adherence, adjusting for age, sex, number of medications, diabetes, education, income, employment, insurance status, and intervention. Sixty-six percent of patients had an income of $20,000 or less and 56% had a high school education or less, with a mean age of 57 years. Greater expectation of care was associated with greater medication adherence (P=.007), and greater social support was also associated with greater medication adherence (P=.046). Analysis also showed that expectation of care mediated the relationship between hypertension knowledge and medication adherence (P<.05). Expectation of care and social support are important factors for developing interventions to increase medication adherence among blacks.
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Affiliation(s)
- Andrea Barnes Grant
- Department of Nursing, Graduate Center, City University of New York, New York, NY
- Department of Veterans Affairs, New York Harbor Healthcare System, Brooklyn, NY
| | - Azizi Seixas
- Department of Population Health, Division of Health and Behavior, Center for Healthful Behavior Change, New York University Medical Center, New York, NY
| | - Keville Frederickson
- Department of Nursing, Graduate Center, City University of New York, New York, NY
- Pace University, College of Health Professions, Lienhard School of Nursing, Pleasantville, NY
| | - Mark Butler
- Department of Population Health, Division of Health and Behavior, Center for Healthful Behavior Change, New York University Medical Center, New York, NY
| | - Jonathan N Tobin
- Clinical Directors Network, New York, NY
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine of Yeshiva University, Bronx, NY
- Center for Clinical and Translational Science, the Rockefeller University, New York, NY
| | - Girardin Jean-Louis
- Department of Population Health, Division of Health and Behavior, Center for Healthful Behavior Change, New York University Medical Center, New York, NY
| | - Gbenga Ogedegbe
- Department of Population Health, Division of Health and Behavior, Center for Healthful Behavior Change, New York University Medical Center, New York, NY
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Ojo OS, Malomo SO, Sogunle PT. Blood pressure (BP) control and perceived family support in patients with essential hypertension seen at a primary care clinic in Western Nigeria. J Family Med Prim Care 2016; 5:569-575. [PMID: 28217585 PMCID: PMC5290762 DOI: 10.4103/2249-4863.197284] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Context: Nonadherence to therapeutic plans has been reported among hypertensive patients. Researchers have also shown that adherence to therapeutic plans improves if motivation in the form of social support is provided. There is a dearth of local studies that explore the influence of family support on treatment outcomes of hypertensive patients. Aims: The aim of the study was to determine the relationship between BP control and perceived family support in patients with essential hypertension seen at a primary care setting in Western Nigeria. Settings and Design: This was a cross-sectional hospital-based study. Subjects and Methods: Systematic random sampling technique was used in selecting 360 hypertensive respondents between April and July 2013. Data were collected through a pretested interviewer-administered questionnaire and a standardized tool, Perceived Social Support Family Scale, which measured the respondents’ level of perceived family support. Statistical Analysis Used: Statistical Package for Social Sciences (SPSS) version 17.0 was used to analyze data. Results: The majority of the respondents were middle-aged (61.1%) and female (59.4%). Blood pressure (BP) was controlled in 46.4% of the respondents. Most of the respondents (79.4%) had “strong” perceived family support. Strong perceived family support (odds ratio [OR] 4.778, 95% confidence interval [CI] =2.569–8.887) and female gender (OR 1.838, 95% CI = 1.177–2.869) were independent predictors of controlled BP. Conclusions: The proportion of hypertensive patients with optimal BP control is low in this practice setting. The positive association between BP control and perceived family support emphasizes the need for physicians to reflect on the available family support when managing hypertensive patients.
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Affiliation(s)
- Oluwaseun S Ojo
- Department of Family Medicine, Federal Medical Centre, Abeokuta, Ogun State, Nigeria
| | - Sunday O Malomo
- Department of Family Medicine, Federal Medical Centre, Abeokuta, Ogun State, Nigeria
| | - Peter T Sogunle
- Department of Family Medicine, Federal Medical Centre, Abeokuta, Ogun State, Nigeria
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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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