Preventing stroke: a narrative review of community interventions for improving hypertension control in black adults

Abstract

Incidence rates for stroke and hypertension are higher in black ethnic groups of African descent in the USA and UK than in white groups, suggesting a need for targeted intervention. We conduct a narrative review of published research evidence on community interventions to manage hypertension among black ethnic groups, and explore the concept of cultural sensitivity in these interventions. Data sources comprised computer-aided searches of published studies over the years 1981 to March 2006, on community strategies for improving hypertension control targeting black groups, and further references from these articles. Twenty-seven relevant studies were identified. Health education was associated with improvements in knowledge about hypertension, while education combined with individualised support for patients to self-manage hypertension, including goal setting and monitoring to enhance patient self-management of hypertension, and family support in managing hypertension were associated with reductions in blood pressure levels and improvements in blood pressure control. Collaboration with black communities, using local or minority ethnic staff, conducting preliminary research with target groups to investigate perceptions and canvass ideas for the intervention design were common methods assumed to achieve cultural sensitivity. Studies, however, provided insufficient robust evidence of the effectiveness of these strategies in terms of quantifiable outcomes, although this criterion is contested, with social justice arguments being offered instead. Implicit assumptions about homogeneity and shared interests within the 'community', and representation of 'community' views have implications for the effectiveness of interventions. These findings highlight areas for the future development of interventions to reduce hypertension rates in black groups, and factors that need to be robustly investigated and explicitly addressed in intervention design.

The organisation and delivery of health improvement in general practice and primary care: a scoping study

“…318 However, collaborative methods yielded insufficient evidence of effectiveness in terms of quantifiable outcomes. Intrinsic assumptions about the homogeneity of communities and how they are represented were challenged.…”

Study-design selection criteria in systematic reviews of effectiveness of health systems interventions and reforms: A meta-review

“…The exact text determined to be 'insufficient' to establish the design was highly heterogeneous. For example, some review authors referred to "retrospective" and "prospective" designs [28][29][30], or "pre-post" designs [31][32][33], without sufficient additional details to determine which of the many possible designs in these broad design categories the primary studies had employed. Examples of text determined to be sufficient to establish the study designs of primary studies included "uncontrolled before and after" [34] and "longitudinal prospective crossover" [35] designs.…”

Stroke Knowledge in African Americans: A Narrative Review

“…3,4 Some approaches to addressing stroke disparities in African Americans have focused on improving risk factor awareness and control and increasing stroke literacy, which has been previously defined as the knowledge of stroke symptoms and risk factors. [5][6][7] Additional aspects of stroke literacy may include knowledge of treatment and appropriate stroke-related behavior.…”