Leveraging Delivery of Blood Pressure Control Interventions among Low-income African American Adults: Opportunities to Increase Social Support and Produce Family-level Behavior Change

Abstract

Purpose: Few family-oriented cardiovas­cular risk reduction interventions exist that leverage the home environment to produce health behavior change among multiple family members. We identified opportu­nities to adapt disease self-management interventions included in a blood pressure control comparative effectiveness trial for hypertensive African American adults to ad­dress family-level factors.Methods: We conducted and analyzed semi-structured interviews with five inter­vention study staff (all study intervention­ists and the study coordinator) between December 2016 and January 2017 and with 11 study participants between Septem­ber and November 2015.1 All study staff involved with intervention delivery and co­ordination were interviewed. We sampled adult participants from the parent study, and we analyzed interviews that were originally obtained as part of a previous study based on their status as a caregiver of an adoles­cent family member.1Results: Thematic analysis identified family influences on disease management and the importance of relationships between index patients and family members, between in­dex patients and study peers, and between index patients and study staff through study participation to understand social effects on healthy behaviors. We identified four themes: 1) the role of family in health behavior change; 2) the impact of family dynamics on health behaviors; 3) building peer relationships through intervention par­ticipation; and 4) study staff role conflict.Conclusions: These findings inform development of family-oriented interven­tions to improve health behaviors among African American index patients at high risk for cardiovascular disease and their family members.Ethn Dis. 2019;29(4):549-558; doi:10.18865/ed.29.4.549

Effectiveness of Chronic Disease Management Program in Improving “CERDIK” Healthy Behavior in Patients with Hypertension in Gunungkidul, Yogyakarta

“…The results show that interventions involving family members will have a greater impact on CVD patients' healthy behavior, including a healthy diet, health checks, and regular exercise (Yang et al, 2019).…”

Clinical Benefits and Harms of Diuretics for Primary Prevention of Cardiovascular Outcomes in Black People With Essential Hypertension: A Protocol for a Systematic Review of Randomized Clinical Trials With Meta-analysis and Trial Sequential Analysis

“…This review is relevant for several reasons. First, hypertension-related mortality and morbidity disproportionately affects the Black population [16,17,[26][27][28], who are at a higher risk of polypharmacy due to the higher prevalence of comorbidities associated with or caused by HTN [29]. Second, a critical appraisal of the current evidence on the clinical bene ts and harms for Black people with EH is required.…”

Depressed mood and environmental mastery as potential pathways linking family relationship quality and disease self‐management for African Americans with hypertension

“…Conversely, conflictual family relationships are linked to greater cardiovascular risk for African Americans (Ford et al, 2019). Strained and unsatisfying family relationships can interfere with patient self-management (Fongwa et al, 2015) via increasing patients' stress, decreasing their emotion regulation, and decreasing a patient's focus on their own needs (Yang et al, 2019).…”

“…One explanation for the shortcomings of these behavioral health interventions is the primary focus on the individual patient with hypertension, failing to account for the impact of family relationships on disease self‐management (Flynn et al, 2013; Yang et al, 2019). This gap persists despite repeated evidence supporting links between family relationship quality and individual patient behavior for African Americans (Warren‐Findlow et al, 2013).…”

“…In fact, family members substantially influence African American patients' hypertension self‐management. Specifically, when family relationships are supportive, family members encourage lifestyle change (Flynn et al, 2013) and provide emotional and instrumental support for self‐management (Woods et al, 2022; Yang et al, 2019). Conversely, conflictual family relationships are linked to greater cardiovascular risk for African Americans (Ford et al, 2019).…”