Journal of General Internal Medicine

, Volume 27, Issue 12, pp 1626–1634 | Cite as

The Role of Patients’ Explanatory Models and Daily-Lived Experience in Hypertension Self-Management

  • Barbara G. BokhourEmail author
  • Ellen S. Cohn
  • Dharma E. Cortés
  • Jeffrey L. Solomon
  • Gemmae M. Fix
  • A. Rani Elwy
  • Nora Mueller
  • Lois A. Katz
  • Paul Haidet
  • Alexander R. Green
  • Ann M. Borzecki
  • Nancy R. Kressin
Original Research



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.


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.


hypertension medication adherence qualitative methods health behavior self-management 



This study was supported by the Department of Veterans Affairs, Health Services Research and Development grant #IIR 05-062. Dr. Kressin is supported by a Senior Research Career Scientist award from the Department of Veterans Affairs, Health Services Research & Development Service (RCS 02-066-1). The views expressed in this article are those of the authors and do not necessarily represent the views of the Department of Veterans Affairs. A version of this paper was presented as a poster at the Society of General Internal Medicine in May 2009 and the VA Health Services Research and Development annual meeting in February 2009.

Conflict of Interest

The authors declare that they do not have a conflict of interest.


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Copyright information

© Society of General Internal Medicine 2012

Authors and Affiliations

  • Barbara G. Bokhour
    • 1
    • 2
    Email author
  • Ellen S. Cohn
    • 5
  • Dharma E. Cortés
    • 6
    • 12
  • Jeffrey L. Solomon
    • 1
  • Gemmae M. Fix
    • 1
  • A. Rani Elwy
    • 1
    • 2
  • Nora Mueller
    • 1
  • Lois A. Katz
    • 7
    • 8
  • Paul Haidet
    • 9
  • Alexander R. Green
    • 10
    • 11
    • 12
  • Ann M. Borzecki
    • 1
    • 4
  • Nancy R. Kressin
    • 3
    • 4
  1. 1.Center for Health Quality, Outcomes & Economic ResearchENRM Veteran Affairs Medical CenterBedfordUSA
  2. 2.Boston University School of Public HealthBostonUSA
  3. 3.VA Boston Healthcare SystemBostonUSA
  4. 4.Section of General Internal MedicineBoston University School of MedicineBostonUSA
  5. 5.Department of Occupational TherapyBoston University, College of Health and Rehabilitation SciencesBostonUSA
  6. 6.Cambridge Health AllianceCambridgeUSA
  7. 7.VA New York Harbor Healthcare SystemNew YorkUSA
  8. 8.New York University School of MedicineNew YorkUSA
  9. 9.Office of Medical Education and the Departments of Medicine, Humanities, and Public Health SciencesThe Pennsylvania State University College of MedicineHersheyUSA
  10. 10.Massachusetts General HospitalMongan Institute for Health PolicyBostonUSA
  11. 11.Massachusetts General HospitalDisparities Solutions CenterBostonUSA
  12. 12.Harvard University School of MedicineBostonUSA

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