Perceived Barriers to and Facilitators of Hypertension Management among Underserved African American Older Adults

Abstract

Objective: To understand the perceived barriers to and facilitators of hypertension self-management among underserved African American older adults in a southeastern clinic. Design: Qualitative descriptive.Setting: Urban cardiovascular health clinic in a southeastern state.Participants: 28 African Americans diagnosed with hypertension. Methods:Interview questions were focused on knowledge of hypertension management and barriers and facilitators to hypertension self-management. Thematic content analysis was applied. Results:Patients reported increased hypertension knowledge after attending the clinic. All patients reported knowledge of the severe consequences of uncontrolled hypertension. Perceived barriers to hypertension management included lack of money, lack of motivation to exercise, and fear of injury from exercising. Perceived facilitators of hypertension management included weight loss, unexpected diagnosis of hypertension, family members with hypertension and diabetes, and social support. Conclusions:Findings suggest that perceived barriers and facilitators influence a patient's decision to manage hypertension. Findings suggest the importance of health literacy and patient-provider communication at this particular clinic. Possible factors in the social environment may influence hypertension management. This study adds to the literature by understanding the perceived barriers to and facilitators of hypertension management of an underserved sample in a southeastern clinic. The results suggest a need for the redesign and transformation of future hypertension education strategies aimed at this clinic sample. Ethn Dis. 2015;25(3):329-336.

Educational diagnosis of self‐management behaviours in patients with diabetes mellitus, hypertension and hypercholesterolaemia based on the PRECEDE model: Qualitative study

“…Similarly, and in line with previous literature, among the factors which facilitate self‐management behaviour, we find: awareness (Rimando, ), self‐efficacy (Shoal et al, ), motivation (Fukunaga et al, ) and existence of family and social support (Legido‐Quigley et al, ; Lou et al, ; Rasmussen, Terkildsen, Livingston, Dunning, & Lorentzen, ; Shen et al, ). Furthermore, this study has discovered other factors that improve adherence to self‐management behaviour, which are not mentioned in previous literature, such as accessibility of self‐management information and tools such as glucose and blood pressure monitoring metres; and the perception that the efforts and changes in behaviour pay off and serve as positive reinforcing factors.…”

“…Some of the factors associated with patients which hinder self‐management behaviours that were identified in this study had already been named in other studies: a lack of awareness of the recommended diet and preventative measures for complications (Lou et al, ; Rushforth et al, ; Shoal et al, ), a lack of awareness and misperceptions of the illness (Legido‐Quigley et al, ; Vedanthan et al, ), low socio‐economic status (Rimando, ), a perception that there is a lack of time to prepare adequate meals or do physical exercise (Fukunaga, Uehara, & Tom, ), a lack of self‐motivation (Khatib et al, ), the fact that social relations go hand‐in‐hand with eating habits (Legido‐Quigley et al, ; Shoal et al, ), a fear of self‐injecting insulin (Funnell, Bootle, & Stuckey, ), a lack of family and/or social support (Jones et al, ; Khatib et al, ; Shen et al, ), a perception of social stigma (Fukunaga et al, ), a perception of numerous prohibitions from medical staff (Fukunaga et al, ) and suffering aches and pains after physical exercise (Fukunaga et al, ). Furthermore, this study has identified other key factors, such as the belief that many patients share, in which they consider that taking the prescribed medication is sufficient to manage the illness and prevent any derived health complications.…”

“…A review of the literature shows the existence of different studies that have aimed to identify the determining factors of the behaviours that helps changes in lifestyle habits in people with diabetes (Jones, Crabb, Turnbull, & Oxlad, 2014;Lou et al, 2015;Rushforth, McCrorie, Glidewell, Midgley, & Foy, 2016;Shen, Edwards, Coutney, McDowell, & Wei, 2013;Shoal, Shoal, King-Shier, & Khan, 2015), with hypertension (Devkota et al, 2016;Khatib et al, 2014;Legido-Quigley et al, 2015;Rimando, 2015;Vedanthan et al, 2016), and hypercholesterolaemia (Chacón et al, 2013). Moreover, in some cases, the literature addresses the determining factors of behaviours that favour changes in lifestyle habits in people with diabetes and hypertension together (Font et al, 2013;Goebel, Khttak, Ballony, & Gress, 2006).…”

Health Belief Model for the Analysis of Factors Affecting Hypertension Preventive Behavior among Adolescents in Surakarta

“…Similar to the previous study, the numerous barriers or obstacles undergone by adolescents may influence to perform health behavior, such as lack of motivation to exercise and afraid of getting injured or pain because of exercise, personal shame to have blood pressure check (Rimando, 2015).…”

Knowledge, attitudes, and beliefs related to hypertension and hyperlipidemia self-management among African-American men living in the southeastern United States

“…Other studies show that African-American women with hypertension or hyperlipidemia identify unique barriers to self-management, such as difficulty maintaining healthy diets due to family expectations about food preparation practices [29]. For older African-Americans, research shows that the desire to spend time with grandchildren serves as a cue-to-action for increasing engagement in physical activity and better nutrition [31]. Such findings help inform the development of interventions aimed at improving disease self-management behaviors among African-Americans.…”