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BACKGROUND/RATIONALE:
Background: Hypertension affects more than 50 million Americans, and a disproportionate number of patients with poorly controlled blood pressure are ethnic minorities. Studies in VA have confirmed these disparities in hypertension control in the veteran population. Moreover, both African American and Hispanic patients are less likely than non-Hispanic Whites to take antihypertensives as prescribed. Although both underprescribing by physicians and non-adherence by patients both seem to play a role in this problem, the underlying causes of the disparities in control and adherence are not well understood. One important determinant of adherence to medications and other medical recommendations is doctor-patient communication, and poor communication is thought to contribute to poorer care for ethnic minority patients.
OBJECTIVE(S):
Objectives: In this study we are examining the relationships between patient preferences, patients' health literacy, cultural explanatory models, patient-provider communication and behaviors patients engage in to control their blood pressure, what we call hypertension self-management. The primary objective of the proposed study is to better understand the ways in which cultural factors affect patient-provider communication and behaviors patients engage in to control their hypertension, particularly adherence to medication regimens. This innovative study uses qualitative methods to study the ways in which patients' cultural backgrounds, perspectives and preferences affect communication with providers about hypertension care and patients' health behaviors related to their blood pressure.
METHODS:
Methods: We are examining differences in culture and communication in three populations, African-American, Hispanic and non-Hispanic Whites, at two large urban VA medical centers with diverse populations. We are audiotaping clinical interactions and conducting semi-structured interviews with patients and providers about hypertension management. We have audio recorded 44 patient interviews, 48 provider-patient interactions, and 12 provider interviews. We have begun to conduct qualitative analyses of these data to identify cultural explanatory models, describe communication patterns between providers and patients, and identify differences between cultural groups.
FINDINGS/RESULTS:
Findings: Early analysis indicates that in addition to patients' explanatory models of hypertension, patients' individual contexts, especially their day-to-day living situations, play an important role in both their management and understandings of hypertension. But providers rarely ask patients about their living situations and their understandings of, or management strategies for, hypertension. Instead, providers focus on standard medical scripts to assess patient symptomatology and other disease indicators. This represents a significant gap between provider clinical tasks and patient illness experiences.
IMPACT:
The results will suggest specific possible communication interventions to reduce disparities. The study begins to address the complexities of communication with ethnic minority veterans. This study will contribute to the sensitization of VA to patients' cultural differences in beliefs and communication with their providers, and will point to ways in which the VA can implement programs for both providers and for veterans to improve communication about hypertension management.
PUBLICATIONS:
None at this time.
DRA:
Chronic Diseases, Health Services and Systems
DRE:
Communication and Decision Making, Treatment
Keywords:
Communication -- doctor-patient, Ethnic/cultural, Hypertension
MeSH Terms:
none
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