Kramer Justin, Gupta Aditi, Ellis Shellie, Reed Jessica, McWilliams Andrew, Pokharel Yashashwi, Debinski Beata, Watson Brittany, Sparks Neil, Daniel Stephanie, Taylor Yhenneko J
Department of Family and Community Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, USA.
Atrium Health, Center for Health System Sciences, Charlotte, NC, USA.
J Gen Intern Med. 2025 Mar 21. doi: 10.1007/s11606-025-09470-1.
Nearly half of US adults have hypertension, with blood pressure (BP) uncontrolled in over two-thirds of cases. Significant disparities exist in BP control, particularly for Southern and rural-dwelling Americans.
To examine the impact of patients' relationships with families, communities, and providers on BP control efforts.
Semi-structured interviews explored patient and provider experiences managing hypertension and controlling BP.
Twenty-nine providers and 25 patients with hypertension were recruited from 13 high- and low-performing primary care clinics (assessed via hypertension control rates) and one cardiology clinic across two health systems in North Carolina and Kansas.
A health equity framework-shaped interview guide and codebook development. Inductive and deductive coding methodologies were employed, with thematic analysis used to organize emergent themes.
Patients frequently discussed the prevalence of hypertension within their families, with some detailing feelings of inevitability and/or linking their cardiovascular outcomes to family histories. Cultural expectations were often mentioned, with families' and communities' normative behaviors sometimes creating barriers to hypertension management. Southern and/or rural culture (e.g., diet) may pose unique challenges, as some providers cited patients' resistance to deviate from regional norms. The importance of tailoring hypertension care to patients' unique circumstances was often cited and linked with increased trust and patient activation, with the utilization of culturally appropriate, patient-facing resources being identified as a best practice. While providers in high-performing clinics more consistently discussed approaches to tailoring care and using culturally appropriate materials, providers in low-performing clinics more often referenced time constraints limiting personalized care and having non-inclusive resources.
Effective hypertension management may be impacted by patients' relationships, both external (e.g., family, community) and internal (e.g., providers) to healthcare. Future research should explore strategies for tailoring culturally appropriate hypertension care to patients, specifically identifying ways to overcome structural barriers that can hinder clinics' utilization.
近一半的美国成年人患有高血压，其中超过三分之二的患者血压未得到控制。血压控制方面存在显著差异，尤其是对于美国南部和农村地区的居民。
研究患者与家庭、社区及医疗服务提供者的关系对血压控制工作的影响。
采用半结构化访谈，探讨患者和医疗服务提供者在管理高血压和控制血压方面的经验。
从北卡罗来纳州和堪萨斯州两个医疗系统的13家高血压控制率高和低的基层医疗诊所（通过高血压控制率评估）以及一家心脏病诊所招募了29名医疗服务提供者和25名高血压患者。
采用健康公平框架构建访谈指南和编码手册。运用归纳和演绎编码方法，通过主题分析来组织新出现的主题。
患者经常讨论高血压在其家庭中的普遍性，一些人详细描述了必然性的感受，并/或将他们的心血管疾病结果与家族病史联系起来。经常提到文化期望，家庭和社区的规范行为有时会给高血压管理带来障碍。南方和/或农村文化（如饮食）可能带来独特挑战，一些医疗服务提供者提到患者抵制偏离地区规范。经常提到根据患者的独特情况调整高血压护理的重要性，并将其与增强信任和患者积极性联系起来，利用适合文化背景、面向患者的资源被视为最佳实践。虽然高血压控制率高的诊所的医疗服务提供者更一致地讨论了调整护理和使用适合文化背景材料的方法，但高血压控制率低的诊所的医疗服务提供者更常提到时间限制限制了个性化护理以及资源缺乏包容性。
有效的高血压管理可能会受到患者与医疗保健外部（如家庭、社区）和内部（如医疗服务提供者）关系的影响。未来的研究应探索为患者量身定制适合文化背景的高血压护理的策略，特别是确定克服可能阻碍诊所利用的结构性障碍的方法。
