Family and Community Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA.
Medical School, University of Texas Southwestern Medical Center, Dallas, TX, USA.
Ethn Health. 2023 Apr;28(3):373-398. doi: 10.1080/13557858.2022.2040958. Epub 2022 Feb 28.
African Americans are at significantly greater risk for hypertension, as well as worse hypertension-related morbidity and mortality than other racial/ethnic groups. Prior research aiming to address these health disparities has focused on improving individual patient self-management, with few studies testing family-centered interventions. We aimed to explore the perspectives of African Americans with hypertension and their family members on hypertension, self-management, and reciprocal family-hypertension impacts to inform future intervention design.
We conducted four dyadic focus groups (90-120 minutes) of African American adults with hypertension (i.e. patients) and their family members. We recruited patients (= 23) and their family members (= 23) from four African American-serving Christian churches over a period of three months (69.6% female, age = 60.73 years). Patient-family member dyads were interviewed conjointly (groups ranged from 4 to 6 dyads, each) by facilitators using open-ended questions to elicit perspectives regarding contributors to hypertension, self-management strategies, family influence on self-management, and the impact of hypertension on the family. A grounded theory approach was used for analysis.
Participants' responses highlighted themes of societal risk factors and barriers (e.g. racism-related stress worsens blood pressure), influences of African American culture (e.g. culturally-informed diet practices), the patient-physician relationship (e.g. proactive communication is beneficial), family-level influences on health (e.g. family monitoring patients' health behaviors), and patient-level risk factors and self-management strategies (e.g. prayer to cope with stress). Themes reflected a hierarchical, nested, ecological structure such that themes within unique levels of participants' social systems affected, and were affected by, stress, change, or behavior in the other levels.
African American adults with hypertension and their family members described multilevel influences on hypertension and disease self-management, with a strong emphasis on the value of family support. Developing culturally appropriate, family-centered interventions to improve hypertension self-management will be an important next step.
非裔美国人患高血压的风险显著高于其他种族/族裔群体，高血压相关发病率和死亡率也更差。先前旨在解决这些健康差异的研究侧重于改善个体患者的自我管理，很少有研究测试以家庭为中心的干预措施。我们旨在探讨高血压的非裔美国患者及其家庭成员对高血压、自我管理以及相互影响的看法，以为未来的干预措施设计提供信息。
我们对四组有高血压的非裔美国成年人（即患者）及其家庭成员进行了四项二元焦点小组（90-120 分钟）。我们在三个月的时间内从四家非裔美国人服务的基督教教堂招募了患者（=23）及其家庭成员（=23）（69.6%为女性，年龄=60.73 岁）。主持人使用开放式问题对患者-家庭成员二人组进行联合访谈（每个小组的范围从 4 到 6 对二人组），以引出他们对高血压的病因、自我管理策略、家庭对自我管理的影响以及高血压对家庭的影响的看法。采用扎根理论方法进行分析。
参与者的回答突出了社会风险因素和障碍的主题（例如，与种族有关的压力会使血压恶化），非裔美国人文化的影响（例如，具有文化特色的饮食实践），医患关系（例如，积极沟通有益），家庭对健康的影响（例如，家庭监测患者的健康行为）以及患者的风险因素和自我管理策略（例如，祈祷应对压力）。主题反映了一个分层、嵌套的生态结构，即参与者社会系统中独特层次的主题会影响其他层次的压力、变化或行为，反之亦然。
患有高血压的非裔美国成年人及其家庭成员描述了高血压和疾病自我管理的多层次影响，强调了家庭支持的重要性。开发文化上合适、以家庭为中心的干预措施来改善高血压自我管理将是下一步的重要步骤。
