Patient Perspectives on Managing Hypertension: Developing a New Conceptual Model of Patient Behavior

Bokhour BG, Solomon J, Cohn EC, Cortes DE, Haidet P, Elwy AR, Katz L, Borzecki AM, Green AR, Kressin NR. Patient Perspectives on Managing Hypertension: Developing a New Conceptual Model of Patient Behavior. Poster session presented at: VA HSR&D National Meeting; 2009 Feb 13; Baltimore, MD.

Related HSR&D Project(s)

• IIR 05-062 – Culture and Communication in Hypertension Management
• SDR 99-300 – Validating a Measure of Hypertension Care Using Administrative Databases

Objectives: Given that almost 30% of VA patients have uncontrolled hypertension, finding novel ways to improve upon patients' hypertension self-management is a priority. The role of patient perspectives, beliefs and practices in hypertension management is crucial but remains poorly understood. We sought to develop a more comprehensive conceptual model of patient hypertension management. Methods: We conducted semi-structured qualitative interviews with 55 white, Latino and African-American patients with uncontrolled hypertension at two large VAMC's. We used grounded theory methods to analyze the transcribed interviews, theorizing and conducting constant comparison analysis across cases in order to iteratively develop and refine a conceptual model. Results: We identified four domains related to patients' hypertension self-management: 1) Explanatory models - beliefs regarding the cause, mechanisms and course of HTN, and effects of HTN treatment; 2) Planned action -patients' reported plans and motivations to control their hypertension; 3) Daily lived experience - patients' personal and social context, routines and other health problems; and 4) Relationship with providers - patients' attitudes towards and communication with their provider. Breakdowns in any one of these areas interfered with patients' ability to engage in hypertension control behaviors including diet, exercise and medication adherence. For example, many patients believed that stress caused their blood pressure (BP) to rise, and therefore their primary action to control BP was to manage stress. Other patients recognized the long-term health impact of hypertension and how they could control it, but their daily living experiences interfered due to chaos or social isolation. Patients rarely reported discussions with providers about such issues. Implications: Patients' understandings of hypertension, daily living experiences in managing hypertension, and motivations for controlling their hypertension appear to be critical areas related to disease management, yet are often overlooked during patient-provider encounters. Providing information about hypertension and prescribing appropriate medications may be insufficient if other aspects of patients' belief systems and daily living experiences interfere with their ability to follow recommendations. Impacts: Our conceptual model has implications for the how patients are counseled about management of hypertension and other chronic diseases. Designing interventions encompassing the range of factors contributing to patients' hypertension self-management may lead to better BP control and patient health.