The Role of Patients’ Explanatory Models and Daily-Lived Experience in Hypertension Self-Management
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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.
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.
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.
We conducted thematic analysis using tools of grounded theory to identify key themes surrounding patients’ explanatory models, social context and hypertension management behaviors.
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.
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.
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- The Role of Patients’ Explanatory Models and Daily-Lived Experience in Hypertension Self-Management
Journal of General Internal Medicine
Volume 27, Issue 12 , pp 1626-1634
- Cover Date
- Print ISSN
- Online ISSN
- Additional Links
- medication adherence
- qualitative methods
- health behavior
- Industry Sectors
- Barbara G. Bokhour PhD (1) (2)
- Ellen S. Cohn ScD (5)
- Dharma E. Cortés PhD (12) (6)
- Jeffrey L. Solomon PhD (1)
- Gemmae M. Fix PhD (1)
- A. Rani Elwy PhD (1) (2)
- Nora Mueller MA (1)
- Lois A. Katz MD (7) (8)
- Paul Haidet MD, MPH (9)
- Alexander R. Green MD, MPH (10) (11) (12)
- Ann M. Borzecki MD, MPH (1) (4)
- Nancy R. Kressin PhD (3) (4)
- Author Affiliations
- 1. Center for Health Quality, Outcomes & Economic Research, ENRM Veteran Affairs Medical Center, Bedford, MA, 01730, USA
- 2. Boston University School of Public Health, Boston, MA, 02118, USA
- 5. Department of Occupational Therapy, Boston University, College of Health and Rehabilitation Sciences, Boston, MA, 02215, USA
- 12. Harvard University School of Medicine, Boston, MA, USA
- 6. Cambridge Health Alliance, Cambridge, MA, USA
- 7. VA New York Harbor Healthcare System, New York, NY, 10010, USA
- 8. New York University School of Medicine, New York, NY, 10016, USA
- 9. Office of Medical Education and the Departments of Medicine, Humanities, and Public Health Sciences, The Pennsylvania State University College of Medicine, Hershey, PA, 17033, USA
- 10. Massachusetts General Hospital, Mongan Institute for Health Policy, Boston, MA, 02114, USA
- 11. Massachusetts General Hospital, Disparities Solutions Center, Boston, MA, 02114, USA
- 4. Section of General Internal Medicine, Boston University School of Medicine, Boston, MA, 02118, USA
- 3. VA Boston Healthcare System, Boston, MA, 02130, USA