“I didn’t tell them. Well, they never ask”. Lay understandings of hypertension and their impact on chronic disease management: implications for nursing practice in primary care

Abstract In the United Kingdom, as in other developed nations, there has been an increased research focus on ethnicity and the mediation of ethnicity on health and illness experience. This paper examines how lay understandings may affect chronic disease management and the steps primary care nurses may take to optimize care delivery for patients/families, using the example of hypertension in the African-Caribbean community. A focused ethnographic approach was adopted for this study. Data were first collected using focus group interviews (2), semi-structured interviews (21), and vignette interviews (5). Data were analyzed with the assistance of Atlas/ti qualitative analysis software using the principles developed by Roper and Shapira. Findings are presented using Kleinman’s seminal work as a theoretical framework: a) the aetiology or cause of the condition, b) the timing and mode of onset, c) the patho-physiological processes involved, d) the natural history and severity of the illness, e) the appropriate treatment for the condition. The paper concludes that it is incumbent upon primary health care nurses to recognize and take account of the lay explanations of health illness that patients/families hold. Failure to do so may compromise effective care-giving.