Woods Sarah B, Roberson Patricia N E, Pryor Jaida B, Obregon Silvia D, Nesbitt Shawna, Udezi Victoria
Department of Family and Community Medicine, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, K2-50075390-9194, USA.
College of Nursing, University of Tennessee Knoxville, 1412 Circle Dr, Knoxville, TN, 37996, USA.
J Racial Ethn Health Disparities. 2025 Jul 2. doi: 10.1007/s40615-025-02534-2.
Culturally responsive, family-based interventions to promote hypertension self-management may be a particularly effective approach to improving hypertension outcomes for African Americans who experience persistent hypertension-related disparities in morbidity and mortality. We aimed to further develop and culturally adapt the Walk Together program-a multilevel family-based hypertension self-management intervention implemented in primary care-using a community-based participatory research (CBPR) approach.
African American primary care patients (18-75) with uncontrolled hypertension were recruited from a community-based family medicine clinic; patients invited a family support person (defining "family" broadly) to participate (N = 24). We used a dyadic (i.e., patient plus family) focus group design to solicit feedback which informed responsive, iterative adaptations to the intervention protocol. Intervention credibility and expectation of benefit was assessed via questionnaire. Thematic analysis was used to inductively and deductively identify themes.
Participants in seven focus groups suggested novel additions to the intervention to target environmental barriers to self-management, promote collaboration between the study and healthcare teams, and enhance hypertension education. Participants also recommended adaptations to the hypertension-focused and relationship-focused content. Finally, participants reported ideal interventionist characteristics and strengths of the intervention, which they described as justified, improving access to care, and pragmatic. Survey results indicated participants, on average, found the program logical and convincing and felt meaningful improvements in hypertension could be achieved. Recruitment was ceased when saturation was achieved.
We leveraged a CBPR approach to inform the development and adaptation of the Walk Together program and enhance the intervention's feasibility and acceptability ahead of Stage IB pilot testing.
采用具有文化适应性的家庭干预措施来促进高血压自我管理，对于在发病率和死亡率方面存在持续高血压相关差异的非裔美国人而言，可能是改善高血压治疗效果的一种特别有效的方法。我们旨在进一步开发并在文化上调整“一起步行”项目——一种在初级保健中实施的多层次家庭高血压自我管理干预措施——采用基于社区的参与性研究（CBPR）方法。
从一家社区家庭医学诊所招募未控制高血压的非裔美国初级保健患者（18 - 75岁）；患者邀请一名家庭支持人员（广义定义“家庭”）参与（N = 24）。我们采用二元（即患者加家庭）焦点小组设计来征求反馈意见，这些反馈为干预方案的针对性、迭代性调整提供了依据。通过问卷调查评估干预的可信度和对益处的期望。采用主题分析法进行归纳和演绎以确定主题。
七个焦点小组的参与者建议在干预措施中新增内容，以针对自我管理的环境障碍、促进研究团队与医疗团队之间的协作并加强高血压教育。参与者还建议对以高血压为重点和以关系为重点的内容进行调整。最后，参与者报告了理想的干预者特征以及干预措施的优点，他们将其描述为合理、改善了就医机会且务实。调查结果表明，参与者平均认为该项目合乎逻辑且有说服力，并认为高血压状况能得到有意义的改善。达到饱和状态后停止招募。
我们利用CBPR方法为“一起步行”项目的开发和调整提供依据，并在1B期试点测试之前提高了干预措施的可行性和可接受性。
