Facilitators and barriers to hypertension self-management in urban African Americans: perspectives of patients and family members

Sarah J Flynn, Jessica M Ameling, Felicia Hill-Briggs, Jennifer L Wolff, Lee R Bone, David M Levine, Debra L Roter, Lapricia Lewis-Boyer, Annette R Fisher, Leon Purnell, Patti L Ephraim, Jeffrey Barbers, Stephanie L Fitzpatrick, Michael C Albert, Lisa A Cooper, Peter J Fagan, Destiny Martin, Hema C Ramamurthi, L Ebony Boulware, Sarah J Flynn, Jessica M Ameling, Felicia Hill-Briggs, Jennifer L Wolff, Lee R Bone, David M Levine, Debra L Roter, Lapricia Lewis-Boyer, Annette R Fisher, Leon Purnell, Patti L Ephraim, Jeffrey Barbers, Stephanie L Fitzpatrick, Michael C Albert, Lisa A Cooper, Peter J Fagan, Destiny Martin, Hema C Ramamurthi, L Ebony Boulware

Abstract

Introduction: We aimed to inform the design of behavioral interventions by identifying patients' and their family members' perceived facilitators and barriers to hypertension self-management.

Materials and methods: We conducted focus groups of African American patients with hypertension and their family members to elicit their views about factors influencing patients' hypertension self-management. We recruited African American patients with hypertension (n = 18) and their family members (n = 12) from an urban, community-based clinical practice in Baltimore, Maryland. We conducted four separate 90-minute focus groups among patients with controlled (one group) and uncontrolled (one group) hypertension, as well as their family members (two groups). Trained moderators used open-ended questions to assess participants' perceptions regarding patient, family, clinic, and community-level factors influencing patients' effective hypertension self-management.

Results: Patient participants identified several facilitators (including family members' support and positive relationships with doctors) and barriers (including competing health priorities, lack of knowledge about hypertension, and poor access to community resources) that influence their hypertension self-management. Family members also identified several facilitators (including their participation in patients' doctor's visits and discussions with patients' doctors outside of visits) and barriers (including their own limited health knowledge and patients' lack of motivation to sustain hypertension self-management behaviors) that affect their efforts to support patients' hypertension self-management.

Conclusion: African American patients with hypertension and their family members reported numerous patient, family, clinic, and community-level facilitators and barriers to patients' hypertension self-management. Patients' and their family members' views may help guide efforts to tailor behavioral interventions designed to improve hypertension self-management behaviors and hypertension control in minority populations.

Keywords: health disparities; hypertension; patient perspective; qualitative research.

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