Designing a Cocreated Intervention with African American Older Adults for Hypertension Self-Management

Abstract

Hypertension is a lifelong disease that requires self-management. Additionally, there are disparities in hypertension self-management that disproportionately affect African Americans. Interventions designed in collaboration with older adults have the potential to improve hypertension self-management. The purpose of this design paper is to describe the process in which African American older adults and nurse researchers cocreated an intervention to address stress in the self-management of hypertension. A semistructured interview guide was used to elicit feedback on self-management behaviors to cocreate an intervention with the participants. Participants provided constant iterative feedback on the design used for the intervention. Participants prioritized the content and mode of delivery. African American older adults with hypertension (N = 31; 87% women) participated in two focus group sessions. The primary stressors identified by the group that influenced their blood pressure self-management were as follows: (a) measuring blood pressure and using home blood pressure monitors; (b) difficulty communicating with family and friends; (c) sleep management and pain at night; and (d) healthy eating. Based on the participants' feedback, we created four biweekly (2-hour) group sessions that incorporated their suggestions and addressed their concerns. Health care providers can use this technique to engage African American older adults in participant-centered hypertension self-management.

Hypertension Self-Management Perspectives From African American Older Adults

“…Co-creation is a form of community-based participatory research that uses a small number of stakeholders, such as the researcher and the older adults, to solve a problem with a participant-feasible solution (Jackson & Greenhalgh, 2015). The process of co-creation has been conducted in businesses to improve processes with input from stakeholders (Greenhalgh, Jackson, Shaw, & Janamian, 2016; Jackson & Greenhalgh, 2015, Wright, Harmon Still, Jones, & Moss, 2018).…”

“…Prior to any data collection, informed consent was obtained. Participants completed demographic forms and other measures related to the quantitative arm of this study, the results of which are reported in another paper (Wright et al, 2018). An interview guide comprised of semi-structured questions was used to ask questions related to self-management of hypertension, including stress management.…”

Challenges to dietary hypertension self‐management as described by a sample of African American older adults

“…The current study was part of a parent study ( N = 31) to cocreate an intervention to improve self‐care behaviors for Black/African American older adults living with hypertension (Wright et al, 2018). The parent study was approved by the institutional review board.…”

“…The parent study was approved by the institutional review board. The first step of the parent study was to conduct four focus groups to co‐create an intervention to help patients manage their hypertension (Moss et al, 2019; Wright et al, 2018). Although larger focus groups are unconventional, to accommodate participants already invested in the research, we included 13–19 participants per focus group.…”

“…Due to the larger size, each focus group was led by one primary facilitator and three cofacilitators (Wright et al, 2018). Study design and rationale are fully reported elsewhere (Wright et al, 2018).…”