Center for Health Quality, Outcomes & Economic Research, ENRM Veteran Affairs Medical Center, Bedford, MA 01730, USA.
J Gen Intern Med. 2012 Dec;27(12):1626-34. doi: 10.1007/s11606-012-2141-2. Epub 2012 Jul 21.
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.
许多患者的高血压仍然无法得到控制。很少有干预措施能改善患者的高血压自我管理，且这些措施都未能产生持久效果。先前的工作主要集中在患者的信念作为行为预测因素上，但对于信念如何嵌入患者的社会背景中却知之甚少。
本研究旨在探讨患者对高血压的“解释模型”（对病因、发病机制或病理生理学、疾病过程、症状和治疗效果的理解）以及社会背景如何与他们报告的日常高血压自我管理行为相关。
在两个大型城市退伍军人管理局医疗中心，对来自不同背景的患者进行半结构化定性访谈。
参与者（或患者或受试者）：患有未控制血压的退伍军人事务部（VA）初级保健患者，包括非裔美国人、白人和拉丁裔。
我们使用扎根理论的工具进行主题分析，以确定围绕患者解释模型、社会背景和高血压管理行为的关键主题。
患者对高血压病因和病程、高血压症状体验以及对治疗效果的信念与不同的高血压自我管理行为有关。此外，患者的日常生活体验，如孤立的生活方式、严重的健康问题、缺乏习惯和日常生活规律、运动障碍以及优先考虑生活方式选择，也干扰了最佳的高血压自我管理。
设计改善患者高血压自我管理的干预措施需要考虑患者的解释模型和他们的日常生活体验。我们提出了一个新的概念模型——高血压自我管理行为的动态模型，该模型包含了患者体验的这些关键要素。
