Hypertension Self-management Behaviors Research Articles

Self-management behavior strategy based on behavioral economics in patients with hypertension: a scoping review.

Hypertensive patients often do not make the most favorable choices and behaviors for managing disease. Behavioral economics strategies offer new ideas for guiding patients toward health behavior. The scoping review aimed to summarize behavioral economics strategies designed to improve hypertension self-management behaviors. A literature search was conducted in September 2022 using the following electronic databases: Embase, Medline, CINAHL, PsycINFO, Web of Science, Cochrane Library, CNKI, Wan Fang Database for Chinese Periodicals, and CBM-SinoMed. We screened the literature for experimental studies written in Chinese or English reporting on BE strategies designed to improve self-management behavior in hypertension. We searched 17 820 records and included 18 articles in the final scoping review. We performed qualitative synthesis by the categories of choice architecture. The most common BE strategies were those targeting decision information and decision assistance, such as changing the presentation of information, making information visible, and providing reminders for actions. Most strategies targeted BP, diet, medication adherence, and physical activity behavior. Ten out of 18 studies reported statistically significant improvement in self-management behavior. Further research on BE strategies should focus on addressing the challenges, including changing the decision structure, encompassing a more comprehensive range of target behaviors, and examining the long-term effects of BE strategies.

Factors related to self-management behavior among hypertensive patients in Hue city, Vietnam

Introduction/aim: Hypertension, commonly referred to as high blood pressure, is a leading cause of morbidity and mortality globally. This study aimed to investigate the self-management behavior and related factors among hypertensive patients at Hue University of Medicine and Pharmacy Hospital and find out some factors related to the self-management behavior of hypertensive patients at Hue University of Medicine and Pharmacy Hospital. Methods: In this research, we conducted a cross-sectional descriptive study involving a sample of 223 patients who had been diagnosed with hypertension for at least one year. These patients were receiving outpatient treatment at Hue University of Medicine and Pharmacy Hospital between June 2021 and May 2022. The patients were surveyed using a demographic data questionnaire, the hypertension fact knowledge questionnaire, and the hypertension self-management behavior questionnaire which was referenced from a previous study. Results: The study found that 96.4% of the patients had high level self-management behaviors. Additionally, the study identified a significant relationship between gender, occupation, economic status, living conditions, knowledge about hypertension, and self-management behaviors of hypertensive patients (p < 0.05). Conclusion: The study findings revealed that the levels of self-management for hypertension were consistently high across all components. Moreover, sociodemographic characteristics such as gender, occupation, economic status, living conditions were found to be associated with self-management. Additionally, knowledge emerged as a significant factor positively influencing the self-management behavior of hypertensive patients. These results highlight the importance of considering sociodemographic factors and knowledge enhancement in promoting effective self-management among individuals with hypertension.

FAMILY-BASED CARE USING THE OREM SELF-CARE MODEL IN FAMILIES WITH HYPERTENSION: A CASE STUDY

Introduction: Uncontrolled hypertension can negatively affect a person's physical well-being and quality of life. The implementation of family-based care helps families to achieve independence in maintaining family health. The Orem model approach can explain how the family's role in caring for family health independently. Objectives: This study aims to describe the application of family-based care with the Orem model approach in hypertensive families. Methods: This research was conducted with a case study approach, using a nursing process consisting of assessment with the Orem model, namely assessment of basic conditional factor data, strength components, universal self care, developmental self care, and health deviation and Hypertension Self Management Behavior (HSMB), formulation of nursing diagnoses using SDKI, nursing plans using SIKI, implementation and evaluation. Results: Intervention and implementation were carried out for four meetings including providing family-based health education using leaflet media, foot massage modality therapy and self-management monitoring sheets. The results obtained by both families experienced an increase in behavioral self-management scores and controlled blood pressure. Conclusions: Family-based care can improve behavioral self-management in compliant families.

PEER (DYADIC) SUPPORT: A FEASIBILITY STUDY FOR OLDER AFRICAN AMERICAN WOMEN WITH HYPERTENSION

Abstract African American women have a higher prevalence of hypertension than women of other ethnicities. Interventions have not adequately addressed the higher prevalence of hypertension in this population. Social support networks can be an effective strategy for improving hypertension self-management behaviors. The objective of this study was to evaluate the feasibility of an 8-week peer (dyadic) support intervention to improve diet adherence and reduce systolic blood pressure among older African American women with hypertension and describe the relationship that occurred during the intervention. This mixed methods study used a convergent parallel design. A total of 26 African American women diagnosed with hypertension, aged 60 and older were paired to form 13 dyads. All participants completed a 3-hour training session consisting of home blood pressure monitoring, DASH diet, and communication. Participants completed pre and post DASH diet surveys, and the Social Support Survey (MOS) post intervention. At the end of the 8-week intervention, participants discussed their experiences in a 60-minute focus group session. Content analysis was used to analyze focus group interviews. Preliminary data analysis will be presented. Emerging themes included, accountability, epiphany, challenges with hypertension management, communication with each other, and receiving support. Preliminary findings suggest that peer (dyadic) support is feasible and can be an effective intervention strategy to improve diet and blood pressure management. Future studies should address specific challenges to hypertension management identified by participants. Lastly, this study used random within site pairing for participants without an identified partner. Future studies should develop criteria for pairing partners.

Barriers and facilitators to self-measured blood pressure monitoring among US-resettled Arab refugees with hypertension: a qualitative study

BackgroundMinoritized communities including refugees are at an increased risk of poorly controlled hypertension. Evidence indicates that self-measured blood pressure monitoring (SMBP) is an effective method to improve blood pressure control in patients with hypertension. However, it has not been studied among refugee populations. The objective of this study is to examine barriers and facilitators to SMBP among Arab refugees resettled in the United States (US) with diagnosed hypertension.MethodsA total of 109 participants were recruited through a Federally Qualified Health Center system that is a major provider of healthcare to refugees in San Diego, California. Participants completed a questionnaire and were interviewed using in-depth, semi-structured interviews. Interviews were transcribed and translated, and data were coded using inductive thematic analysis and organized based on the theory of care-seeking behavior.ResultsSeveral barriers to engaging in effective SMBP monitoring were identified. Clinical and sociodemographic barriers included reliance on public monitors and poor hypertension literacy. Psychosocial barriers of affect, norms, and habits included fear and anxiety from hypertension, cultural stigma of illness, and conditional SMBP with symptoms, respectively. Utility psychosocial barriers included lack of SMBP prioritization in treatment and perceived inaccuracy of home monitors. Family members’ support with home monitoring served as an important facilitator to SMBP.ConclusionsThere are several barriers to effective SMBP among the US-resettled Arab refugee population that may reflect unique cultural and care-seeking behaviors. Tailored public health and clinical interventions are needed to support refugee patients and providers to improve hypertension self-management behaviors for this unique population.

"A cuff is not enough": A community-based participatory research approach to soliciting perspectives of African Americans with hypertension and their family members on self-management intervention features.

We aimed to solicit the perspectives of African Americans with hypertension and their family members on the desired features of a behavioral hypertension self-management intervention. Using a community-based participatory approach to intervention design, we conducted four dyadic focus groups, including African American community members with hypertension (n = 23) and their family members (n = 23), recruited from African American-serving Christian churches in a large, southern metropolitan area. We used open-ended questions to elicit participants' perspectives regarding program features they would recommend, intervention delivery, and barriers necessary to address. Our grounded theory analysis identified themes reflecting participants' recommendations for hypertension self-management interventions to enhance health literacy and provide communication training via an accessible, population-tailored, family-based approach, which they believed has the potential to create family-level impact on health across generations. Participants also recommended intervention researchers engage in advocacy (i.e., via physician education and policy change) as part of a broader impact on structural inequities driving worse hypertension and health outcomes for African Americans. The perceptions and recommendations of African Americans with a lived experience of hypertension, as well as their family members, aid in shaping acceptable and efficacious behavioral interventions aiming to promote hypertension self-management behavior while leveraging the unique power of family relationships to create sustained behavior change.

Illness Perception and Self-management of Elderly With Hypertention

Introduction: One of the degenerative diseases that affects the elderly is hypertension, which can impact social interactions, quality of life, and mental health. The perceptions of hypertensive patients who are still diverse are closely related to the way they deal with the disease. The purpose of this study is to identify correlation between illness perception and self-management of elderly with hypertension. Methods: Quantitative method with cross sectional design was approached in this study. 125 participants were involved by using purposive sampling technique. The Brief Illness Perception Questionnaire (Brief IPQ) and Hypertension Self-Management Behavior Questionnaire (HSMBQ) were used to measure illness perception and self-management. The correlation of two variables was analyzed by using Pearson Product Moment. Results: The results showed that the average score of illness perception in the elderly with hypertension was 50.34 (range 0-80) and self-management was 71.18 (range 0-100). Illness perception significantly positively correlated with hypertension self-management of elderly with hypertension (p value < 0.000, r = 0.590), which it means higher the illness perception, it will improve the self-management. Conclusion: This result could be used as data to provide sources of information to the elderly with hypertension to further improve the perception of the disease in relation to daily self-management so that the elderly remain productive.

Emotional Intelligence: A Novel Factor Influencing Hypertension Self-Management.

The purpose of this study was to examine associations among emotional intelligence, quality of patient-provider interaction, and hypertension (HTN) self-management behaviors. A convenience sample of 90 adults (predominately African American women) with primary HTN were recruited from an urban ambulatory internal medicine clinic. Multivariate linear regression models were used to determine the predictive associations among the study variables. Emotional intelligence was associated with the quality of the patient-provider interaction (r = 0.34; p < .001), patient activation (r = 0.56; p < .001), and medication use (r = 0.26; p = .006). The patient-provider interaction was associated with higher states of patient activation (r = 0.42; p < .001) and medication use behavior (r = 0.29; p = .002). Also, the quality of patient-provider interaction partially mediated the relationship between emotional intelligence and self-management behaviors. Emotional intelligence is a promising patient factor that influences quality of patient-provider interaction and self-management behaviors.

Impact of Behavioral Interventions on Patient Activation in Adults with Hypertension: A Systematic Review and Meta-Analysis.

Introduction: Behavioral interventions assist patients in maintaining optimal self-management of their health, especially in those at risk of certain conditions. Little is known about the effects of self-management interventions on patient activation in adults with hypertension. Therefore, this systematic review and meta-analysis aimed to evaluate how self-management strategies affect changes in activation levels in adults with hypertension. Methods: We searched online databases: PubMed, CINAHL, and Cochrane Central Register of Controlled Trials for studies published between January 2004 and May 2021. We included randomized controlled trials that assessed the effects of self-management interventions on patient activation in adults with hypertension and reported patient activation using the patient activation measure (PAM). Results: 4 Four studies (N = 1415 participants) met the inclusion criteria. In adults with hypertension, self-management interventions improved patient activation with moderate strength of evidence. A community-based self-management program, motivational interviewing strategies, and home-based patient-activated care were associated with better PAM scores than usual care. Conclusion: Our findings reinforce the need for healthcare providers to incorporate these interventions into primary care to support the adoption of recommended hypertension self-management behaviors. Future studies must focus on tailoring support to the patient’s level of activation in hypertension self-management.

Psychometric Analysis of Hypertension Self-Management Behaviors Questionnaire; an Application of Intervention Mapping Approach in Questionnaire Development

Aims: High blood pressure is one of the common main preventable risk factors for many diseases. This study aimed to psychometric properties of the cognitive determinants of hypertension self-management questionnaire among Iranian hypertensive patients based on the Intervention Mapping approach. Instrument & Methods: This psychometric study was conducted in Abadan in 2019. Content Validity Ratio and Content Validity Index of the questionnaire were calculated by ten hypertensive patients and 12 experts. Construct validity was investigated using Classical Item Analysis and Exploratory Factor Analysis by the participation of 315 hypertensive patients. The internal consistency was measured by using Cronbach’s Coefficient Alpha of the various cognitive determinants of the questionnaire. Data were analyzed by SPSS 16. Findings: The mean age of patients was 57.53±11.30 years, ranging from 30 to 70 years. Five factors (attitude, outcome expectation, self-efficacy, subjective norms, and barriers) and behavior were confirmed. The Kaiser-Meyer Olkin test was generally satisfactory (calculated: 0.817). The factors explained 61.86% of the variance of the hypothesized model. Estimated reliability using alpha Cronbach coefficient for each cognitive determinants were as follows: attitude (α=0.75), outcome expectations (α=0.79), self-efficacy (α=0.80), subjective norms (α=0.85), barriers (α=0.88), behavior (α=0.82). Conclusion: The application of the intervention mapping approach in questionnaire development offers a useful questionnaire to measurement self-management hypertension behaviors, and psychometric analysis shows that it could be useful for related planning programs.

Determinants of Hypertension Self-management Behaviors: An Application of the Intervention Mapping Approach

Background: Hypertension is one of the key risk factors for several diseases. Objectives: The aim of this study was to determine the determinants of hypertension self-management behaviors (HSBs) based on intervention mapping approach. Methods: A cross-sectional study was conducted among 800 hypertensive patients in southwestern Iran in 2018. A structured questionnaire was applied for data collection. Data were analyzed using SPSS version 16. Results: The mean age of respondents was 58.25 years (SD: 12.10; age range: 30 - 74 years). The best predictors for HSBs were perceived barriers, outcome expectations, and self-efficacy. Conclusions: Our findings have implications for the evidence-based design of HSBs promotion interventions.

A Comprehensive 6A Framework for Improving Patient Self-Management of Hypertension Using mHealth Services: Qualitative Thematic Analysis.

BackgroundHypertension affects over 15% of the world’s population and is a significant global public health and socioeconomic challenge. Mobile health (mHealth) services have been increasingly introduced to support hypertensive patients to improve their self-management behaviors, such as adherence to pharmacotherapy and lifestyle modifications.ObjectiveThis study aims to explore patients’ perceptions of mHealth services and the mechanisms by which the services support them to self-manage their hypertension.MethodsA semistructured, in-depth interview study was conducted with 22 outpatients of the General Hospital of Ningxia Medical University from March to May 2019. In 2015, the hospital introduced an mHealth service to support community-dwelling outpatients with self-management of hypertension. Content analysis was conducted by following a grounded theory approach for inductive thematic extraction. Constant comparison and categorization classified the first-level codes with similar meanings into higher-level themes.ResultsThe patient-perceived mechanisms by which the mHealth service supported their self-management of hypertension were summarized as 6A: access, assessment, assistance, awareness, ability, and activation. With the portability of mobile phones and digitization of information, the mHealth service provided outpatients with easy access to assess their vital signs and self-management behaviors. The assessment results gave the patients real-time awareness of their health conditions and self-management performance, which activated their self-management behaviors. The mHealth service also gave outpatients access to assistance, which included health education and self-management reminders. Both types of assistance could also be activated by abnormal assessment results, that is, uncontrolled or deteriorating blood pressure values, discomfort symptoms, or not using the service for a long period. With its scalable use to handle any possible information and services, the mHealth service provided outpatients with educational materials to learn at their own pace. This led to an improvement in self-management awareness and ability, again activating their self-management behaviors. The patients would like to see further improvements in the service to provide more useful, personalized information and reliable services.ConclusionsThe mHealth service extended the traditional hypertension care model beyond the hospital and clinician’s office. It provided outpatients with easy access to otherwise inaccessible hypertension management services. This led to process improvement for outpatients to access health assessment and health care assistance and improved their awareness and self-management ability, which activated their hypertension self-management behaviors. Future studies can apply the 6A framework to guide the design, implementation, and evaluation of mHealth services for outpatients to self-manage chronic conditions.

Hypertension Self-management in Socially Disadvantaged African Americans: the Achieving Blood Pressure Control Together (ACT) Randomized Comparative Effectiveness Trial.

Effective hypertension self-management interventions are needed for socially disadvantaged African Americans, who have poorer blood pressure (BP) control compared to others. We studied the incremental effectiveness of contextually adapted hypertension self-management interventions among socially disadvantaged African Americans. Randomized comparative effectiveness trial. One hundred fifty-nine African Americans at an urban primary care clinic. Participants were randomly assigned to receive (1) a community health worker ("CHW") intervention, including the provision of a home BP monitor; (2) the CHW plus additional training in shared decision-making skills ("DoMyPART"); or (3) the CHW plus additional training in self-management problem-solving ("Problem Solving"). We assessed group differences in BP control (systolic BP (SBP) < 140 mm Hg and diastolic BP (DBP) < 90 mmHg), over 12 months using generalized linear mixed models. We also assessed changes in SBP and DBP and participants' BP self-monitoring frequency, clinic visit patient-centeredness (i.e., extent of patient-physician discussions focused on patient emotional and psychosocial concerns), hypertension self-management behaviors, and self-efficacy. BP control improved in all groups from baseline (36%) to 12 months (52%) with significant declines in SBP (estimated mean [95% CI] - 9.1 [- 15.1, - 3.1], - 7.4 [- 13.4, - 1.4], and - 11.3 [- 17.2, - 5.3] mmHg) and DBP (- 4.8 [- 8.3, - 1.3], - 4.0 [- 7.5, - 0.5], and - 5.4 [- 8.8, - 1.9] mmHg) for CHW, DoMyPART, and Problem Solving, respectively). There were no group differences in BP outcomes, BP self-monitor use, or clinic visit patient-centeredness. The Problem Solving group had higher odds of high hypertension self-care behaviors (OR [95% CI] 18.7 [4.0, 87.3]) and self-efficacy scores (OR [95% CI] 4.7 [1.5, 14.9]) at 12 months compared to baseline, while other groups did not. Compared to DoMyPART, the Problem Solving group had higher odds of high hypertension self-care behaviors (OR [95% CI] 5.7 [1.3, 25.5]) at 12 months. A context-adapted CHW intervention was correlated with improvements in BP control among socially disadvantaged African Americans. However, it is not clear whether improvements were the result of this intervention. Neither the addition of shared decision-making nor problem-solving self-management training to the CHW intervention further improved BP control. ClinicalTrials.gov Identifier: NCT01902719.

Effect of nursing teaching program on knowledge and self-management behaviors for patients with essential hypertension

Background: Essential hypertension is the most common cardiovascular disease (CVD), affecting about one billion individuals worldwide.Aim of the study: was to evaluate the effect of nursing teaching program on knowledge and self-management behaviors for patients with essential hypertension. Study design; quasi-experimental research design was utilized to conduct this study.Setting: The study was conducted in the internal medicine department and outpatient clinics at Assiut University Hospital.Sample: Sixty adult patients of both sexes divided equally into 2 groups study and control group (thirty for each). Tools; four tools were used for data collection; Patients, assessment sheet, Hypertension Knowledge-Level Scale (HK-LS), Hypertension Self-Management Be-havior Questionnaire (HSMBQ)” and Nursing Teaching Program. Results; the majority of the study and control groups were female (83.3%, 66.7%), married (80.0%, 86.7%), illiterate (66.7%, 60.0), and house wives (83.3%, 63.3%).Conclusion: Nursing teaching program was effective in improving patients’ knowledge and self-management behaviors. Recommenda-tions; educational program should be planned and offered to patients on regular basis. Simple booklets should be available for patients to provide them with simple explanation about the disease.Â

Design of a randomized controlled trial comparing a mobile phone-based hypertension health coaching application to home blood pressure monitoring alone: The Smart Hypertension Control Study

BackgroundHypertension is a major cause of morbidity and mortality but frequently remains uncontrolled. A smartphone application that provides coaching regarding home blood pressure monitoring and other aspects of hypertension self-care and related behavior change may be a scalable way to help manage hypertension. Methods/designThe Smart Hypertension Control Study is a prospective, randomized controlled trial to assess the effects of a hypertension personal control program (HPCP), which consists of an automated artificial intelligence smartphone application that provides individualized support and coaching to promote home monitoring and healthy behavior changes related to hypertension self-management. Enrolled adults with uncontrolled hypertension will be randomized in a 1:1 fashion to the HPCP with home blood pressure monitoring or to home monitoring alone. We plan to enroll 350 participants, with a target of 300 participants with complete six-month follow-up data. The primary study outcome will be systolic blood pressure at six months. Additional outcomes include measures of antihypertensive medication adherence, home blood pressure monitoring practices, self-management practices, weight, and self-reported health behaviors. ConclusionThe Smart Hypertension Control Study will evaluate blood pressure and hypertension self-management behavior outcomes in participants with uncontrolled hypertension exposed to a smartphone-based hypertension health coaching application in addition to home blood pressure monitoring compared to those exposed to home blood pressure monitoring alone.

Comparing the effects of education using telephone follow-up and smartphone-based social networking follow-up on self-management behaviors among patients with hypertension

Background: Little is known about the benefits of social networks in the management of patients. Objective: The aim of this study was to compare the effects of self-management (SM) education using telephone follow-up and mobile phone-based social networking on SM behaviors among patients with hypertension. Methods: This randomized clinical trial was conducted with 100 patients. They were randomly allocated to four groups: (i) control, (ii) SM training without follow-up, (iii) telephone follow-up and (iv) smartphone-based social networking follow-up. The hypertension SM behavior questionnaire was used for data collection before and six weeks after the study. Results: Those patients who underwent SM education training (with and without follow-up) had statistically significant differences from those in the control group in terms of SM behaviors (p < .001). There was no statistically significant difference between different types of follow-up. Conclusion: SM education using telephone follow-up and/or smartphone-based social networking follow-up influenced SM behaviors among patients with hypertension.

Predictors of Self-Management Behaviors in Older Adults with Hypertension.

The purpose of this study was to develop a prediction model of demographic and sociobehavioral characteristics common among older adults with hypertension (HTN) who engage in self-management behavior. A descriptive, correlational predictive design was used to collect data at 14 faith-based and senior citizen organizations in a major urban northeastern city. Participants ranged in age from 63 to 96 with a mean age of 77 (SD 6.9). A 33-item questionnaire was used to gather data on 15 explanatory and 5 outcome variables. Instruments were the Perceived Stress Scale, the Duke Social Support Index, the stage of change for physical activity scale, and the DASH Food Frequency Questionnaire. Correlation and regression analyses were used to test the hypothesis. Results indicate there is a common set of characteristics such as higher stage of change, reading food labels, and higher self-rated health that can predict the older adult's likelihood to engage in hypertension self-management behavior. The significant correlations found in this preliminary study warrant further study and validation. Findings are clinically relevant as knowledge of demographic and sociobehavioral characteristics associated with engagement in self-management behavior enables health care clinicians to support and encourage older adults to improve management of this common, chronic condition.

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

IntroductionWe 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 methodsWe 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.ResultsPatient 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.ConclusionAfrican 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.

Factors Associated with Non-Adherence to Three Hypertension Self-Management Behaviors: Preliminary Data for a New Instrument

Clinicians have difficulty in identifying patients that are unlikely to adhere to hypertension self-management. Identifying non-adherence is essential to addressing suboptimal blood pressure control and high costs. 1) To identify risk factors associated with non-adherence to three key self-management behaviors in patients with hypertension: proper medication use, diet, and exercise; 2) To evaluate the extent to which an instrument designed to identify the number of risk factors present for non-adherence to each of the three hypertension self-management behaviors would be associated with self-management non-adherence and blood pressure. Cross-sectional analysis of randomized trial data. Six hundred and thirty-six primary care patients with hypertension. 1) Demographic, socioeconomic, psychosocial, and health belief-related factors; 2) measures of self-reported adherence to recommended medication use, diet recommendations, and exercise recommendations, all collected at baseline assessment; 3) systolic blood pressure (SBP) and diastolic blood pressure (DBP). We identified patient factors associated with measures of non-adherence to medications, diet, and exercise in hypertension. We then combined risk factors associated with ≥1 adherence measure into an instrument that generated three composite variables (medication, diet, and exercise composites), reflecting the number of risk factors present for non-adherence to the corresponding self-management behavior. These composite variables identified subgroups with higher likelihood of medication non-adherence, difficulty following diet recommendations, and difficulty following exercise recommendations. Composite variable levels representing the highest number of self-management non-adherence risk factors were associated with higher SBP and DBP. We identified factors associated with measures of non-adherence to recommended medication use, diet, and exercise in hypertension. We then developed an instrument that was associated with non-adherence to these self-management behaviors, as well as with blood pressure. With further study, this instrument has potential to improve identification of non-adherent patients with hypertension.

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

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.