Patient participants identified facilitators to their hypertension self-management at the patient, family, clinic, and community levels (for example, God as an important source of support, family members encouraging lifestyle changes, positive relationships with doctors, and community organizations sponsoring health-related events). Patient participants also discussed barriers to their hypertension self-management at the patient, clinic, and community levels (for example, difficulty sustaining self-management behaviors, long wait times inhibiting engagement in care, and insufficient access to community resources). Family member participants described additional multilevel facilitators (for example, using their own health condition to encourage patients’ behavior changes and participating in patients’ medical visits) and barriers (for example, patients’ lack of motivation to pursue behavior changes and their own limited health knowledge) that influenced their support of patients’ hypertension self-care.
Our findings may inform efforts to tailor behavioral interventions to improve African Americans’ hypertension self-management behaviors. The broad range of facilitators and barriers reported by patients at the patient, family, clinic, and community levels emphasize the importance of designing interventions that address multiple determinants of hypertension self-management and meet the specific needs of minority populations. Given that focus group participants reported difficulty managing other nonhypertensive comorbidities such as smoking and diabetes, and since they often did not prioritize their hypertension management, patients could benefit from interventions that simultaneously address multiple factors influencing patients’ blood pressure control. Interventions that improve patients’ health knowledge and problem-solving skills could also help patients incorporate and sustain the lifestyle changes necessary for hypertension control. Interventions incorporating patients’ self-identified supports for self-management such as religion or spirituality may also improve patients’ self-management behaviors.
In addition to highlighting the need for patients’ sustained execution of hypertension self-management behaviors, our findings underscore the importance of developing strategies to support patients’ efforts to engage with clinical practices and their communities as resources for care. Studies should not only address patients’ specific personal facilitators and barriers, but they should also address external factors at the clinic and community levels. Interventions that enhance patients’ relationships with providers, reduce clinic wait times, improve engagement with clinic outreach programs, and connect patients with community resources may improve patients’ adherence to hypertension self-care behaviors.
Researchers have previously shown that family support can have a powerful influence on patients’ long-term hypertension control and associated decreases in morbidity and mortality.27
In our focus groups, both patient and family member participants recognized family members as important facilitators to patients’ hypertension self-care. We identified family members’ perceived facilitators and barriers to supporting patients’ hypertension management. Our findings suggest that encouraging family support may aid patients’ hypertension self-management. They also suggest that family members may desire their own interventions. For instance, family members may benefit from increased health knowledge about hypertension and its associated comorbidities. Future interventions could jointly engage patients and family members to collaboratively identify ways family members can help patients sustain motivation for behavior change and achieve their hypertension self-management goals. Future interventions could also encourage family members to take a participatory role during patients’ clinic visits while still respecting patients’ autonomy to make decisions and guide patient–provider discussions.
To our knowledge, this is one of the first studies to ask patients with controlled and uncontrolled hypertension and their family members to offer their independent perceptions about facilitators and barriers to hypertension self-management. Interestingly, the findings from the focus group sessions were similar, suggesting that controlled and uncontrolled hypertensive patients may frequently confront similar facilitators and barriers to hypertension control, and that their family members may encounter similar challenges to supporting patients’ hypertension self-management. Based on these findings, additional efforts to significantly tailor interventions on the basis of patients’ hypertension status, as either controlled or uncontrolled, may not be needed.
Our study has several potential limitations. First, our study population was limited to a select group of African American patients with hypertension and their family members living in a few neighborhoods in Baltimore, Maryland, and their experiences may not reflect the experiences of other hypertensive patients. Second, we did not confirm or validate patients’ level of engagement in their self-management behaviors prior to their participation in the focus group sessions. Patients with controlled hypertension may or may not have better engagement than patients with uncontrolled hypertension in self-management behaviors. Third, patients identified one family member to participate in family member focus groups, and it is possible that family members participating in the groups were more supportive of patients than family members not participating. It is also possible that other family members who did not participate in the sessions had different perspectives. Furthermore, our findings are similar to prior work in identifying potential barriers to hypertension self-management in African Americans and more diverse populations.18
Nonetheless, we believe our findings may help inform efforts to develop tailored interventions to improve hypertension self-management behaviors among similar urban African American populations in other studies. Future work is needed to help prioritize which factors may yield the most effective targets for interventions in order to improve hypertension control among urban minority populations.