Lay beliefs about hypertension: An interpretive synthesis of the qualitative research

Schlomann, Pam; Schmitke, Joan

doi:10.1111/j.1745-7599.2007.00238.x

Cited by 43 publications

(76 citation statements)

References 14 publications

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“…20 One explanation for poorer communication between physicians and black patients may lie in potential differences in illness perceptions. 55,56 While physicians see hypertension as a chronic, asymptomatic condition needing lifelong pharmacologic therapy, patients may view it as an intermittent, but acutely symptomatic condition that can be treated intermittently or with nonpharmacologic therapies or home remedies. 55,57,58 Clinicians' attempts to replace patients' views with the "professional" view may exacerbate black patients' feelings of distrust and emotional distance.…”

Section: Discussionmentioning

confidence: 99%

The Effect of Patient Race and Blood Pressure Control on Patient-Physician Communication

et al. 2009

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BACKGROUND: Racial disparities in hypertension control contribute to higher rates of cardiovascular mortality among blacks. Patient-physician communication quality is associated with better health outcomes, including blood pressure (BP) control. Both race/ethnicity and BP control may adversely affect communication. OBJECTIVE:To determine whether being black and having poor BP control interact to adversely affect patient-physician communication more than either condition alone, a situation referred to as "double jeopardy." DESIGN, SETTINGS, AND PATIENTS:Cross-sectional study of enrollment data from a randomized controlled trial of interventions to enhance patient adherence to therapy for hypertension. Participants included 226 hypertensive patients and 39 physicians from 15 primary care practices in Baltimore, MD. MEASUREMENTS:Communication behaviors and visit length from coding of audiotapes. RESULTS:After controlling for patient and physician characteristics, blacks with uncontrolled BP have shorter visits (B=−3.9 min, p<0.01) with less biomedical (B=−24.0, p=0.05), psychosocial (B=−19.4, p< 0.01), and rapport-building (B=−19.5, p=0.01) statements than whites with controlled BP. Of all communication outcomes, blacks with uncontrolled BP are only in "double jeopardy" for a patient positive affect-coders give them lower ratings than all other patients. Blacks with controlled BP also experience shorter visits and less communication with physicians than whites with controlled BP. There are no significant communication differences between the visits of whites with uncontrolled versus controlled BP.CONCLUSIONS: This study reveals that patient race is associated with the quality of patient-physician communication to a greater extent than BP control. Interventions that improve patient-physician communication should be tested as a strategy to reduce racial disparities in hypertension care and outcomes.

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Section: Discussionmentioning

confidence: 99%

The Effect of Patient Race and Blood Pressure Control on Patient-Physician Communication

et al. 2009

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“…no language restriction), how the quality impacted the findings (including a sensitivity analysis) and what this meant for research and practice. Schlomann and Schmitke's 167 review was more focused (e.g. only USA-based studies included) and scored low on our assessment of quality (Table 76).…”

Section: Quality Assessmentmentioning

confidence: 99%

“…157 Both were of lower quality on AMSRAR and only some of the studies they included were relevant to our meta-review Epilepsy 0 N/A Hypertension 2 Both reviews focused on lay perspectives about hypertension and medication adherence 166,167 IAs 2 Both reviews focused on RA, precluding general conclusions about IAs. One was about the drivers and barriers to help-seeking behaviour in people with new onset RA, 179 and the other about experiences of living with RA …”

Section: Implementing National Programmesmentioning

confidence: 99%

“…Following title and abstract screening, four qualitative reviews and two mixed reviews were reviewed for exclusion separately on both qualitative and quantitative criteria. After full-text screening, two reviews 166,167 (published 2007 and 2012 in peer-reviewed journals) were included in the hypertension qualitative meta-review ( Figure 32). The reviews reported a total of 64 primary qualitative studies (published between 1980 and 2011).…”

Section: How and Who?mentioning

confidence: 99%

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A rapid synthesis of the evidence on interventions supporting self-management for people with long-term conditions: PRISMS – Practical systematic RevIew of Self-Management Support for long-term conditions

Taylor

Pinnock

Epiphaniou

et al. 2014

Health Services and Delivery Research

345

451

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BackgroundDespite robust evidence concerning self-management for some long-term conditions (LTCs), others lack research explicitly on self-management and, consequently, some patient groups may be overlooked.AimTo undertake a rapid, systematic overview of the evidence on self-management support for LTCs to inform health-care commissioners and providers about what works, for whom, and in what contexts.MethodsSelf-management is ‘the tasks . . . individuals must undertake to live with one or more chronic conditions . . . [including] . . . having the confidence to deal with medical management, role management and emotional management of their conditions’. We convened an expert workshop and identified characteristics of LTCs potentially of relevance to self-management and 14 diverse exemplar LTCs (stroke, asthma, type 2 diabetes mellitus, depression, chronic obstructive pulmonary disease, chronic kidney disease, dementia, epilepsy, hypertension, inflammatory arthropathies, irritable bowel syndrome, low back pain, progressive neurological disorders and type 1 diabetes mellitus). For each LTC we conducted systematic overviews of systematic reviews of randomised controlled trials (RCTs) of self-management support interventions (‘quantitative meta-reviews’); and systematic overviews of systematic reviews of qualitative studies of patients’ experiences relating to self-management (‘qualitative meta-reviews’). We also conducted an original systematic review of implementation studies of self-management support in the LTCs. We synthesised all our data considering the different characteristics of LTCs. In parallel, we developed a taxonomy of the potential components of self-management support.ResultsWe included 30 qualitative systematic reviews (including 515 unique studies), 102 quantitative systematic reviews (including 969 RCTs), and 61 studies in the implementation systematic review. Effective self-management support interventions are multifaceted, should be tailored to the individual, their culture and beliefs, a specific LTC and position on the disease trajectory, and underpinned by a collaborative/communicative relationship between the patient and health-care professional (HCP) within the context of a health-care organisation that actively promotes self-management. Self-management support is a complex intervention and although many components were described and trialled in the studies no single component stood out as more important than any other. Core components include (1) provision of education about the LTC, recognising the importance of understanding patients’ pre-existing knowledge and beliefs about their LTC; (2) psychological strategies to support adjustment to life with a LTC; (3) strategies specifically to support adherence to treatments; (4) practical support tailored to the specific LTC, including support around activities of daily living for disabling conditions, action plans in conditions subject to marked exacerbations, intensive disease-specific training to enable self-management of specific clinical tasks; and (5) social support as appropriate. Implementation requires a whole-systems approach which intervenes at the level of the patient, the HCP and the organisation. The health-care organisation is responsible for providing the means (both training and time/material resources) to enable HCPs to implement, and patients to benefit from, self-management support, regularly evaluating self-management processes and clinical outcomes. More widely there is a societal need to address public understanding of LTCs. The lack of public story for many conditions impacted on patient help-seeking behaviour and public perceptions of need.ConclusionsSupporting self-management is inseparable from the high-quality care for LTCs. Commissioners and health-care providers should promote a culture of actively supporting self-management as a normal, expected, monitored and rewarded aspect of care. Further research is needed to understand how health service managers and staff can achieve this culture change in their health-care organisations.Study registrationThis study is registered as PROSPERO CRD42012002898.FundingThe National Institute for Health Research Health Services and Delivery Research programme.

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“…E, assim, abordagens interpretativas podem auxiliar na compreensão da constituição das subjetividades dos hipertensos e da não-adesão ao tratamento, quer farmacológico, como não-farmacológico. [3][4][5] Desse modo, a aproximação com o conceito de identidade dos Estudos Culturais pode contribuir para esta pesquisa. De acordo com esse campo teórico, a produção de sujeitos, a partir de diferentes práticas simbólicas, está sempre situada em um determinado espaço-tempo.…”

Section: Introductionunclassified

Idosos hipertensos na atenção básica em saúde: discursos e identidades

Renovato

Bagnato

2012

Rev. bras. geriatr. gerontol.

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ResumoO objetivo da pesquisa foi conhecer e compreender como os sujeitos se reconhecem na posição de idosos, como se percebem hipertensos e como experienciam o tratamento anti-hipertensivo. Pesquisa de abordagem qualitativa, descritiva e exploratória, realizada em unidade de saúde da família de Dourados, MS. Os aportes teóricos da análise foram os Estudos Culturais. Foram entrevistados dez idosos hipertensos, sendo dois homens e oito mulheres. Os idosos tinham entre 60 e 88 anos, sendo cinco viúvas, e todos com ensino fundamental incompleto. Os processos identitários estão vinculados a gênero, estado marital e relação com as gerações. O envelhecimento parece se concretizar quando não se sentem produtivos. A hipertensão e o tratamento decorrente estão entremeados nos processos de subjetivação dos idosos, sendo que o uso de medicamentos para alguns parece estar incorporado ao cotidiano, porém outros relataram aversão. Desse modo, os significados da velhice contemporânea pertencem a um período singular e são integrantes de processos históricos mais amplos e complexos. AbstractThe aim was to know and understand how subjects recognize themselves in the position of older men and women, how they perceive themselves with hypertension and high blood pressure, and how they experience the anti-hypertensive treatment. It is a qualitative, descriptive and exploratory research approach, performed in family health units, in Dourados. The theoretical framework of analysis was the Cultural Studies. We interviewed ten elderly hypertensive patients, two men and eight women, aged 60-88 years, five widows, and all with elementary education. The processes are linked to gender identity, marital status and relationship with the generations. Aging seems to be realized when they are not productive. Hypertension treatment and due process are interspersed in the subjectivity of the elderly, and drug use for some seems to be incorporated into everyday life, but others reported aversion. Thus, the contemporary meanings of old age belong to a unique period and are members of larger historical processes and complex.Palavras-chave: Saúde do idoso. Atenção primária em saúde. Hipertensão. Uso de medicamentos.

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Lay beliefs about hypertension: An interpretive synthesis of the qualitative research

Cited by 43 publications

References 14 publications

The Effect of Patient Race and Blood Pressure Control on Patient-Physician Communication

The Effect of Patient Race and Blood Pressure Control on Patient-Physician Communication

A rapid synthesis of the evidence on interventions supporting self-management for people with long-term conditions: PRISMS – Practical systematic RevIew of Self-Management Support for long-term conditions

Idosos hipertensos na atenção básica em saúde: discursos e identidades

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