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

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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.

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Acknowledgements

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.

Author information

Authors and Affiliations

  1. Center for Health Quality, Outcomes & Economic Research, ENRM Veteran Affairs Medical Center, Bedford, MA, 01730, USA

    Barbara G. Bokhour PhD, Jeffrey L. Solomon PhD, Gemmae M. Fix PhD, A. Rani Elwy PhD, Nora Mueller MA & Ann M. Borzecki MD, MPH

  2. Boston University School of Public Health, Boston, MA, 02118, USA

    Barbara G. Bokhour PhD & A. Rani Elwy PhD

  3. VA Boston Healthcare System, Boston, MA, 02130, USA

    Nancy R. Kressin PhD

  4. Section of General Internal Medicine, Boston University School of Medicine, Boston, MA, 02118, USA

    Ann M. Borzecki MD, MPH & Nancy R. Kressin PhD

  5. Department of Occupational Therapy, Boston University, College of Health and Rehabilitation Sciences, Boston, MA, 02215, USA

    Ellen S. Cohn ScD

  6. Cambridge Health Alliance, Cambridge, MA, USA

    Dharma E. Cortés PhD

  7. VA New York Harbor Healthcare System, New York, NY, 10010, USA

    Lois A. Katz MD

  8. New York University School of Medicine, New York, NY, 10016, USA

    Lois A. Katz MD

  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

    Paul Haidet MD, MPH

  10. Massachusetts General Hospital, Mongan Institute for Health Policy, Boston, MA, 02114, USA

    Alexander R. Green MD, MPH

  11. Massachusetts General Hospital, Disparities Solutions Center, Boston, MA, 02114, USA

    Alexander R. Green MD, MPH

  12. Harvard University School of Medicine, Boston, MA, USA

    Dharma E. Cortés PhD & Alexander R. Green MD, MPH

Authors
  1. Barbara G. Bokhour PhD
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  2. Ellen S. Cohn ScD
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  3. Dharma E. Cortés PhD
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  4. Jeffrey L. Solomon PhD
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  5. Gemmae M. Fix PhD
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  6. A. Rani Elwy PhD
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  7. Nora Mueller MA
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  8. Lois A. Katz MD
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  9. Paul Haidet MD, MPH
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  10. Alexander R. Green MD, MPH
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  11. Ann M. Borzecki MD, MPH
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  12. Nancy R. Kressin PhD
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Corresponding author

Correspondence to Barbara G. Bokhour PhD.

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Bokhour, B.G., Cohn, E.S., Cortés, D.E. et al. The Role of Patients’ Explanatory Models and Daily-Lived Experience in Hypertension Self-Management. J GEN INTERN MED 27, 1626–1634 (2012). https://doi.org/10.1007/s11606-012-2141-2

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  • DOI: https://doi.org/10.1007/s11606-012-2141-2

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