The Role of Patients’ Explanatory Models and Daily-Lived Experience in Hypertension Self-Management
ABSTRACT BACKGROUND Uncontrolled hypertension remains a significant problem for many patients. Few interventions to improve patients’ hypertension self-management have had lasting effects. Previous work has focused largely on patients’ beliefs as predictors of behavior, but little is understood abou...
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| Veröffentlicht in: | Journal of general internal medicine : JGIM 2012-12, Vol.27 (12), p.1626-1634 |
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| container_title | Journal of general internal medicine : JGIM |
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| creator | Bokhour, Barbara G. Cohn, Ellen S. Cortés, Dharma E. Solomon, Jeffrey L. Fix, Gemmae M. Elwy, A. Rani Mueller, Nora Katz, Lois A. Haidet, Paul Green, Alexander R. Borzecki, Ann M. Kressin, Nancy R. |
| description | ABSTRACT
BACKGROUND
Uncontrolled hypertension remains a significant problem for many patients. Few interventions to improve patients’ hypertension self-management have had lasting effects. Previous work has focused largely on patients’ beliefs as predictors of behavior, but little is understood about beliefs as they are embedded in patients’ social contexts.
OBJECTIVE
This study aims to explore how patients’ “explanatory models” of hypertension (understandings of the causes, mechanisms or pathophysiology, course of illness, symptoms and effects of treatment) and social context relate to their reported daily hypertension self-management behaviors.
DESIGN
Semi-structured qualitative interviews with a diverse group of patients at two large urban Veterans Administration Medical centers.
PARTICIPANTS (OR PATIENTS OR SUBJECTS)
African-American, white and Latino Veterans Affairs (VA) primary care patients with uncontrolled blood pressure.
APPROACH
We conducted thematic analysis using tools of grounded theory to identify key themes surrounding patients’ explanatory models, social context and hypertension management behaviors.
RESULTS
Patients’ perceptions of the cause and course of hypertension, experiences of hypertension symptoms, and beliefs about the effectiveness of treatment were related to different hypertension self-management behaviors. Moreover, patients’ daily-lived experiences, such as an isolated lifestyle, serious competing health problems, a lack of habits and routines, barriers to exercise and prioritizing lifestyle choices, also interfered with optimal hypertension self-management.
CONCLUSIONS
Designing interventions to improve patients’ hypertension self-management requires consideration of patients’ explanatory models and their daily-lived experience. We propose a new conceptual model — the dynamic model of hypertension self-management behavior — which incorporates these key elements of patients’ experiences. |
| doi_str_mv | 10.1007/s11606-012-2141-2 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_3509311</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>1221128792</sourcerecordid><originalsourceid>FETCH-LOGICAL-c640t-6f3534f01b46a6e70410c299e5c7712de4cd8e584c5c43a122a799b7093ac90b3</originalsourceid><addsrcrecordid>eNp1kd9qFDEUh4Modq0-gDcSEMGbaE4mk5ncCFJrW9iiaL0O2cyZbcpssiazxb3zNXw9n8QMu_2j4E1CyHe-k5MfIc-BvwHOm7cZQHHFOAgmQAITD8gMalEzkLp5SGa8bSVrm0oekCc5X3EOlRDtY3JQVgG10jOCF5dIv8QBaezpZzt6DGP-_fMXPf6xHmywY0xbeh47HDK1oaMfrB-2bO6vsZsQTKXAIfWBnm7LacSQfQz0Kw49Oy_1S1wV41PyqLdDxmf7_ZB8-3h8cXTK5p9Ozo7ez5lTko9M9VVdyZ7DQiqrsOESuBNaY-2aBkSH0nUt1q10tZOVBSFso_Wi4bqyTvNFdUje7bzrzWKFnSutkx3MOvmVTVsTrTd_3wR_aZbx2lR1cQAUweu9IMXvG8yjWfnscChfgXGTTWkJINpGi4K-_Ae9ipsUyniFUqrSHPgkhB3lUsw5YX_7GOBmCtHsQjQlRDOFaCbzi_tT3FbcpFaAV3vAZmeHPtngfL7jVFtGgUkkdlwuV2GJ6d4T_9v9D427tNw</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1266390101</pqid></control><display><type>article</type><title>The Role of Patients’ Explanatory Models and Daily-Lived Experience in Hypertension Self-Management</title><source>MEDLINE</source><source>SpringerNature Journals</source><source>EZB-FREE-00999 freely available EZB journals</source><source>PubMed Central</source><source>Alma/SFX Local Collection</source><creator>Bokhour, Barbara G. ; Cohn, Ellen S. ; Cortés, Dharma E. ; Solomon, Jeffrey L. ; Fix, Gemmae M. ; Elwy, A. Rani ; Mueller, Nora ; Katz, Lois A. ; Haidet, Paul ; Green, Alexander R. ; Borzecki, Ann M. ; Kressin, Nancy R.</creator><creatorcontrib>Bokhour, Barbara G. ; Cohn, Ellen S. ; Cortés, Dharma E. ; Solomon, Jeffrey L. ; Fix, Gemmae M. ; Elwy, A. Rani ; Mueller, Nora ; Katz, Lois A. ; Haidet, Paul ; Green, Alexander R. ; Borzecki, Ann M. ; Kressin, Nancy R.</creatorcontrib><description>ABSTRACT
BACKGROUND
Uncontrolled hypertension remains a significant problem for many patients. Few interventions to improve patients’ hypertension self-management have had lasting effects. Previous work has focused largely on patients’ beliefs as predictors of behavior, but little is understood about beliefs as they are embedded in patients’ social contexts.
OBJECTIVE
This study aims to explore how patients’ “explanatory models” of hypertension (understandings of the causes, mechanisms or pathophysiology, course of illness, symptoms and effects of treatment) and social context relate to their reported daily hypertension self-management behaviors.
DESIGN
Semi-structured qualitative interviews with a diverse group of patients at two large urban Veterans Administration Medical centers.
PARTICIPANTS (OR PATIENTS OR SUBJECTS)
African-American, white and Latino Veterans Affairs (VA) primary care patients with uncontrolled blood pressure.
APPROACH
We conducted thematic analysis using tools of grounded theory to identify key themes surrounding patients’ explanatory models, social context and hypertension management behaviors.
RESULTS
Patients’ perceptions of the cause and course of hypertension, experiences of hypertension symptoms, and beliefs about the effectiveness of treatment were related to different hypertension self-management behaviors. Moreover, patients’ daily-lived experiences, such as an isolated lifestyle, serious competing health problems, a lack of habits and routines, barriers to exercise and prioritizing lifestyle choices, also interfered with optimal hypertension self-management.
CONCLUSIONS
Designing interventions to improve patients’ hypertension self-management requires consideration of patients’ explanatory models and their daily-lived experience. We propose a new conceptual model — the dynamic model of hypertension self-management behavior — which incorporates these key elements of patients’ experiences.</description><identifier>ISSN: 0884-8734</identifier><identifier>EISSN: 1525-1497</identifier><identifier>DOI: 10.1007/s11606-012-2141-2</identifier><identifier>PMID: 22821569</identifier><language>eng</language><publisher>New York: Springer-Verlag</publisher><subject>Aged ; Aged, 80 and over ; Antihypertensive Agents - administration & dosage ; Arterial hypertension. Arterial hypotension ; Biological and medical sciences ; Blood and lymphatic vessels ; Blood Pressure Determination - methods ; Cardiology. Vascular system ; Cross-Sectional Studies ; Disease Management ; Female ; General aspects ; Health Behavior ; Health Knowledge, Attitudes, Practice ; Humans ; Hypertension ; Hypertension - diagnosis ; Hypertension - drug therapy ; Internal Medicine ; Life Style ; Male ; Medical sciences ; Medicine ; Medicine & Public Health ; Middle Aged ; Miscellaneous ; Models, Educational ; Original Research ; Patient Compliance - statistics & numerical data ; Patient Education as Topic ; Patients ; Public health. Hygiene ; Public health. Hygiene-occupational medicine ; Self Care - methods ; Severity of Illness Index ; Treatment Outcome ; United States ; United States Department of Veterans Affairs ; Urban Population</subject><ispartof>Journal of general internal medicine : JGIM, 2012-12, Vol.27 (12), p.1626-1634</ispartof><rights>Society of General Internal Medicine 2012</rights><rights>2014 INIST-CNRS</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c640t-6f3534f01b46a6e70410c299e5c7712de4cd8e584c5c43a122a799b7093ac90b3</citedby><cites>FETCH-LOGICAL-c640t-6f3534f01b46a6e70410c299e5c7712de4cd8e584c5c43a122a799b7093ac90b3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC3509311/pdf/$$EPDF$$P50$$Gpubmedcentral$$H</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC3509311/$$EHTML$$P50$$Gpubmedcentral$$H</linktohtml><link.rule.ids>230,314,727,780,784,885,27924,27925,41488,42557,51319,53791,53793</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=26811312$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/22821569$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Bokhour, Barbara G.</creatorcontrib><creatorcontrib>Cohn, Ellen S.</creatorcontrib><creatorcontrib>Cortés, Dharma E.</creatorcontrib><creatorcontrib>Solomon, Jeffrey L.</creatorcontrib><creatorcontrib>Fix, Gemmae M.</creatorcontrib><creatorcontrib>Elwy, A. Rani</creatorcontrib><creatorcontrib>Mueller, Nora</creatorcontrib><creatorcontrib>Katz, Lois A.</creatorcontrib><creatorcontrib>Haidet, Paul</creatorcontrib><creatorcontrib>Green, Alexander R.</creatorcontrib><creatorcontrib>Borzecki, Ann M.</creatorcontrib><creatorcontrib>Kressin, Nancy R.</creatorcontrib><title>The Role of Patients’ Explanatory Models and Daily-Lived Experience in Hypertension Self-Management</title><title>Journal of general internal medicine : JGIM</title><addtitle>J GEN INTERN MED</addtitle><addtitle>J Gen Intern Med</addtitle><description>ABSTRACT
BACKGROUND
Uncontrolled hypertension remains a significant problem for many patients. Few interventions to improve patients’ hypertension self-management have had lasting effects. Previous work has focused largely on patients’ beliefs as predictors of behavior, but little is understood about beliefs as they are embedded in patients’ social contexts.
OBJECTIVE
This study aims to explore how patients’ “explanatory models” of hypertension (understandings of the causes, mechanisms or pathophysiology, course of illness, symptoms and effects of treatment) and social context relate to their reported daily hypertension self-management behaviors.
DESIGN
Semi-structured qualitative interviews with a diverse group of patients at two large urban Veterans Administration Medical centers.
PARTICIPANTS (OR PATIENTS OR SUBJECTS)
African-American, white and Latino Veterans Affairs (VA) primary care patients with uncontrolled blood pressure.
APPROACH
We conducted thematic analysis using tools of grounded theory to identify key themes surrounding patients’ explanatory models, social context and hypertension management behaviors.
RESULTS
Patients’ perceptions of the cause and course of hypertension, experiences of hypertension symptoms, and beliefs about the effectiveness of treatment were related to different hypertension self-management behaviors. Moreover, patients’ daily-lived experiences, such as an isolated lifestyle, serious competing health problems, a lack of habits and routines, barriers to exercise and prioritizing lifestyle choices, also interfered with optimal hypertension self-management.
CONCLUSIONS
Designing interventions to improve patients’ hypertension self-management requires consideration of patients’ explanatory models and their daily-lived experience. We propose a new conceptual model — the dynamic model of hypertension self-management behavior — which incorporates these key elements of patients’ experiences.</description><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Antihypertensive Agents - administration & dosage</subject><subject>Arterial hypertension. Arterial hypotension</subject><subject>Biological and medical sciences</subject><subject>Blood and lymphatic vessels</subject><subject>Blood Pressure Determination - methods</subject><subject>Cardiology. Vascular system</subject><subject>Cross-Sectional Studies</subject><subject>Disease Management</subject><subject>Female</subject><subject>General aspects</subject><subject>Health Behavior</subject><subject>Health Knowledge, Attitudes, Practice</subject><subject>Humans</subject><subject>Hypertension</subject><subject>Hypertension - diagnosis</subject><subject>Hypertension - drug therapy</subject><subject>Internal Medicine</subject><subject>Life Style</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Middle Aged</subject><subject>Miscellaneous</subject><subject>Models, Educational</subject><subject>Original Research</subject><subject>Patient Compliance - statistics & numerical data</subject><subject>Patient Education as Topic</subject><subject>Patients</subject><subject>Public health. Hygiene</subject><subject>Public health. Hygiene-occupational medicine</subject><subject>Self Care - methods</subject><subject>Severity of Illness Index</subject><subject>Treatment Outcome</subject><subject>United States</subject><subject>United States Department of Veterans Affairs</subject><subject>Urban Population</subject><issn>0884-8734</issn><issn>1525-1497</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2012</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>8G5</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><sourceid>GNUQQ</sourceid><sourceid>GUQSH</sourceid><sourceid>M2O</sourceid><recordid>eNp1kd9qFDEUh4Modq0-gDcSEMGbaE4mk5ncCFJrW9iiaL0O2cyZbcpssiazxb3zNXw9n8QMu_2j4E1CyHe-k5MfIc-BvwHOm7cZQHHFOAgmQAITD8gMalEzkLp5SGa8bSVrm0oekCc5X3EOlRDtY3JQVgG10jOCF5dIv8QBaezpZzt6DGP-_fMXPf6xHmywY0xbeh47HDK1oaMfrB-2bO6vsZsQTKXAIfWBnm7LacSQfQz0Kw49Oy_1S1wV41PyqLdDxmf7_ZB8-3h8cXTK5p9Ozo7ez5lTko9M9VVdyZ7DQiqrsOESuBNaY-2aBkSH0nUt1q10tZOVBSFso_Wi4bqyTvNFdUje7bzrzWKFnSutkx3MOvmVTVsTrTd_3wR_aZbx2lR1cQAUweu9IMXvG8yjWfnscChfgXGTTWkJINpGi4K-_Ae9ipsUyniFUqrSHPgkhB3lUsw5YX_7GOBmCtHsQjQlRDOFaCbzi_tT3FbcpFaAV3vAZmeHPtngfL7jVFtGgUkkdlwuV2GJ6d4T_9v9D427tNw</recordid><startdate>20121201</startdate><enddate>20121201</enddate><creator>Bokhour, Barbara G.</creator><creator>Cohn, Ellen S.</creator><creator>Cortés, Dharma E.</creator><creator>Solomon, Jeffrey L.</creator><creator>Fix, Gemmae M.</creator><creator>Elwy, A. Rani</creator><creator>Mueller, Nora</creator><creator>Katz, Lois A.</creator><creator>Haidet, Paul</creator><creator>Green, Alexander R.</creator><creator>Borzecki, Ann M.</creator><creator>Kressin, Nancy R.</creator><general>Springer-Verlag</general><general>Springer</general><general>Springer Nature B.V</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7QL</scope><scope>7RV</scope><scope>7U9</scope><scope>7X7</scope><scope>7XB</scope><scope>88C</scope><scope>8AO</scope><scope>8FD</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>8G5</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>C1K</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FR3</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>GUQSH</scope><scope>H94</scope><scope>K9.</scope><scope>M0S</scope><scope>M0T</scope><scope>M1P</scope><scope>M2O</scope><scope>M7N</scope><scope>MBDVC</scope><scope>NAPCQ</scope><scope>P64</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>Q9U</scope><scope>RC3</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>20121201</creationdate><title>The Role of Patients’ Explanatory Models and Daily-Lived Experience in Hypertension Self-Management</title><author>Bokhour, Barbara G. ; Cohn, Ellen S. ; Cortés, Dharma E. ; Solomon, Jeffrey L. ; Fix, Gemmae M. ; Elwy, A. Rani ; Mueller, Nora ; Katz, Lois A. ; Haidet, Paul ; Green, Alexander R. ; Borzecki, Ann M. ; Kressin, Nancy R.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c640t-6f3534f01b46a6e70410c299e5c7712de4cd8e584c5c43a122a799b7093ac90b3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2012</creationdate><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Antihypertensive Agents - administration & dosage</topic><topic>Arterial hypertension. Arterial hypotension</topic><topic>Biological and medical sciences</topic><topic>Blood and lymphatic vessels</topic><topic>Blood Pressure Determination - methods</topic><topic>Cardiology. Vascular system</topic><topic>Cross-Sectional Studies</topic><topic>Disease Management</topic><topic>Female</topic><topic>General aspects</topic><topic>Health Behavior</topic><topic>Health Knowledge, Attitudes, Practice</topic><topic>Humans</topic><topic>Hypertension</topic><topic>Hypertension - diagnosis</topic><topic>Hypertension - drug therapy</topic><topic>Internal Medicine</topic><topic>Life Style</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Middle Aged</topic><topic>Miscellaneous</topic><topic>Models, Educational</topic><topic>Original Research</topic><topic>Patient Compliance - statistics & numerical data</topic><topic>Patient Education as Topic</topic><topic>Patients</topic><topic>Public health. Hygiene</topic><topic>Public health. Hygiene-occupational medicine</topic><topic>Self Care - methods</topic><topic>Severity of Illness Index</topic><topic>Treatment Outcome</topic><topic>United States</topic><topic>United States Department of Veterans Affairs</topic><topic>Urban Population</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Bokhour, Barbara G.</creatorcontrib><creatorcontrib>Cohn, Ellen S.</creatorcontrib><creatorcontrib>Cortés, Dharma E.</creatorcontrib><creatorcontrib>Solomon, Jeffrey L.</creatorcontrib><creatorcontrib>Fix, Gemmae M.</creatorcontrib><creatorcontrib>Elwy, A. Rani</creatorcontrib><creatorcontrib>Mueller, Nora</creatorcontrib><creatorcontrib>Katz, Lois A.</creatorcontrib><creatorcontrib>Haidet, Paul</creatorcontrib><creatorcontrib>Green, Alexander R.</creatorcontrib><creatorcontrib>Borzecki, Ann M.</creatorcontrib><creatorcontrib>Kressin, Nancy R.</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Bacteriology Abstracts (Microbiology B)</collection><collection>Nursing & Allied Health Database</collection><collection>Virology and AIDS Abstracts</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Healthcare Administration Database (Alumni)</collection><collection>ProQuest Pharma Collection</collection><collection>Technology Research Database</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>Research Library (Alumni Edition)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>Environmental Sciences and Pollution Management</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Engineering Research Database</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>Research Library Prep</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Healthcare Administration Database</collection><collection>Medical Database</collection><collection>Research Library</collection><collection>Algology Mycology and Protozoology Abstracts (Microbiology C)</collection><collection>Research Library (Corporate)</collection><collection>Nursing & Allied Health Premium</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>ProQuest Central Basic</collection><collection>Genetics Abstracts</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Journal of general internal medicine : JGIM</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Bokhour, Barbara G.</au><au>Cohn, Ellen S.</au><au>Cortés, Dharma E.</au><au>Solomon, Jeffrey L.</au><au>Fix, Gemmae M.</au><au>Elwy, A. Rani</au><au>Mueller, Nora</au><au>Katz, Lois A.</au><au>Haidet, Paul</au><au>Green, Alexander R.</au><au>Borzecki, Ann M.</au><au>Kressin, Nancy R.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>The Role of Patients’ Explanatory Models and Daily-Lived Experience in Hypertension Self-Management</atitle><jtitle>Journal of general internal medicine : JGIM</jtitle><stitle>J GEN INTERN MED</stitle><addtitle>J Gen Intern Med</addtitle><date>2012-12-01</date><risdate>2012</risdate><volume>27</volume><issue>12</issue><spage>1626</spage><epage>1634</epage><pages>1626-1634</pages><issn>0884-8734</issn><eissn>1525-1497</eissn><abstract>ABSTRACT
BACKGROUND
Uncontrolled hypertension remains a significant problem for many patients. Few interventions to improve patients’ hypertension self-management have had lasting effects. Previous work has focused largely on patients’ beliefs as predictors of behavior, but little is understood about beliefs as they are embedded in patients’ social contexts.
OBJECTIVE
This study aims to explore how patients’ “explanatory models” of hypertension (understandings of the causes, mechanisms or pathophysiology, course of illness, symptoms and effects of treatment) and social context relate to their reported daily hypertension self-management behaviors.
DESIGN
Semi-structured qualitative interviews with a diverse group of patients at two large urban Veterans Administration Medical centers.
PARTICIPANTS (OR PATIENTS OR SUBJECTS)
African-American, white and Latino Veterans Affairs (VA) primary care patients with uncontrolled blood pressure.
APPROACH
We conducted thematic analysis using tools of grounded theory to identify key themes surrounding patients’ explanatory models, social context and hypertension management behaviors.
RESULTS
Patients’ perceptions of the cause and course of hypertension, experiences of hypertension symptoms, and beliefs about the effectiveness of treatment were related to different hypertension self-management behaviors. Moreover, patients’ daily-lived experiences, such as an isolated lifestyle, serious competing health problems, a lack of habits and routines, barriers to exercise and prioritizing lifestyle choices, also interfered with optimal hypertension self-management.
CONCLUSIONS
Designing interventions to improve patients’ hypertension self-management requires consideration of patients’ explanatory models and their daily-lived experience. We propose a new conceptual model — the dynamic model of hypertension self-management behavior — which incorporates these key elements of patients’ experiences.</abstract><cop>New York</cop><pub>Springer-Verlag</pub><pmid>22821569</pmid><doi>10.1007/s11606-012-2141-2</doi><tpages>9</tpages><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0884-8734 |
| ispartof | Journal of general internal medicine : JGIM, 2012-12, Vol.27 (12), p.1626-1634 |
| issn | 0884-8734 1525-1497 |
| language | eng |
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| source | MEDLINE; SpringerNature Journals; EZB-FREE-00999 freely available EZB journals; PubMed Central; Alma/SFX Local Collection |
| subjects | Aged Aged, 80 and over Antihypertensive Agents - administration & dosage Arterial hypertension. Arterial hypotension Biological and medical sciences Blood and lymphatic vessels Blood Pressure Determination - methods Cardiology. Vascular system Cross-Sectional Studies Disease Management Female General aspects Health Behavior Health Knowledge, Attitudes, Practice Humans Hypertension Hypertension - diagnosis Hypertension - drug therapy Internal Medicine Life Style Male Medical sciences Medicine Medicine & Public Health Middle Aged Miscellaneous Models, Educational Original Research Patient Compliance - statistics & numerical data Patient Education as Topic Patients Public health. Hygiene Public health. Hygiene-occupational medicine Self Care - methods Severity of Illness Index Treatment Outcome United States United States Department of Veterans Affairs Urban Population |
| title | The Role of Patients’ Explanatory Models and Daily-Lived Experience in Hypertension Self-Management |
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