Hypertension Self-Management Perspectives From African American Older Adults

Moss, Karen; Still, Carolyn H; Jones, Lenette M.; Blackshire, Gabrielle; Wright, Kathy

doi:10.1177/0193945918780331

Cited by 12 publications

(17 citation statements)

References 18 publications

(29 reference statements)

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“…The interview guide (Additional file 1: Supplemental Material) was developed from the HTN self-management evidence-base by the research team and reviewed by local physicians [15–17]. Conceptually, the instrument covered the core domains of participant self-management by exploring knowledge of HTN, as well as its prevention, treatment and chronic nature.…”

Section: Methodsmentioning

confidence: 99%

Exploring patient experiences with and attitudes towards hypertension at a private hospital in Uganda: a qualitative study

Lynch

Green

Nanyonga

et al. 2019

Int J Equity Health

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BackgroundHypertension is the leading risk factor for mortality worldwide and is more common in sub-Saharan Africa than any other region. Work to date confirms that a lack of human and material resources for healthcare access contributes to this gap. The ways in which patients’ knowledge and attitudes toward hypertension determine their engagement with and adherence to available care, however, remains unclear.MethodsWe conducted an exploratory, qualitative descriptive study to assess awareness, knowledge, and attitudes towards hypertension and its management at a large private hospital in Kampala. We interviewed 64 participants (29 with hypertension and 34 without, 1 excluded) in English. General thematic analysis using the Integrated Conceptual Health Literacy Model was used to iteratively generate themes and categories.ResultsWe identified three main themes: Timing of Hypertension Diagnosis, Aiming for Health Literacy, and the Influence of Knowledge on Behavior. Most participants with hypertension learned of their condition incidentally, speaking to the lack of awareness of hypertension as an asymptomatic condition. Drove nearly all participants to desire more information. However, many struggled to translate knowledge into self-management behaviors due to incomplete information and conflicting desires of participants regarding lifestyle and treatment.ConclusionsInternal patient factors had a substantial impact on adherence, calling attention to the need for educational interventions. Systemic barriers such as cost still existed even for those with insurance and need to be recognized by treating providers.

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Section: Methodsmentioning

confidence: 99%

Exploring patient experiences with and attitudes towards hypertension at a private hospital in Uganda: a qualitative study

Lynch

Green

Nanyonga

et al. 2019

Int J Equity Health

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“…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.…”

Section: Methodsmentioning

confidence: 99%

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

Jones

Moss

Mitchell

et al. 2022

Worldviews Ev Based Nurs

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Background Hypertension rates are disproportionately higher among Black or African Americans (Black/African American) compared to other racial and ethnic groups in the United States. However, research on self‐management strategies to control hypertension through healthy eating such as the Dietary Approaches to Stop Hypertension (DASH), and ketogenic diets has underexplored the use of dietary strategies among older Black/African American adults. In reporting contemporary challenges with implementing dietary strategies targeting blood pressure control among Black/African American older adults living with hypertension, this study addresses a clear need. Aims Prior research has only partially addressed the challenges older Black/African Americans face in implementing and maintaining dietary strategies to control hypertension, therefore the current study aimed to address this gap by reporting contemporary challenges, as reported by a sample of Black/African American older adults living with hypertension. Methods Nineteen Black/African American older adults living with hypertension participated in a focus group. An interview guide with open‐ended questions on dietary approaches to self‐management hypertension was used to guide data collection. Responses were audio‐recorded, transcribed verbatim, and interpreted using qualitative thematic analysis. Results Study participants were 71.6 years (SD = 8.3), 87.1% were women, and all were self‐identified as Black/African American. Overall, participants shared that they were interested in improving their hypertension self‐management skills. They expressed uncertainty about dietary strategies related in part to a lack of knowledge about incorporating or excluding certain foods and adhering to complex dietary recommendations. Participants also related financial concerns about accessing the recommended foods to control hypertension and expressed confusion about how to manage hypertension alongside other comorbidities. Linking Evidence to Action This study highlights several barriers that Black/African American older adults face (lack of dietary knowledge, lack of financial resources, and unique barriers to managing multiple comorbid health conditions), which often pose simultaneous and intersecting barriers to managing hypertension using existing evidence‐based dietary strategies.

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“…The PI provided a sample presentation of the cocreated intervention based on the feedback and preferences from the previous focus group sessions. Brainstorming was used to design the content of the cocreated intervention [ 17 ]. The top 3–5 recommendations from the group were included in the intervention design.…”

Section: Methodsmentioning

confidence: 99%

“…The top 3–5 recommendations from the group were included in the intervention design. A detailed report of the content analysis that led to the intervention development that included three rounds of coding is under review in [ 17 ]. Figure 1 illustrates an example of the decision process that was used to provide content for the intervention.…”

Section: Methodsmentioning

confidence: 99%

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

Wright

Still

Jones

et al. 2018

International Journal of Hypertension

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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.

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Hypertension Self-Management Perspectives From African American Older Adults

Cited by 12 publications

References 18 publications

Exploring patient experiences with and attitudes towards hypertension at a private hospital in Uganda: a qualitative study

Exploring patient experiences with and attitudes towards hypertension at a private hospital in Uganda: a qualitative study

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

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

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