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Relationships Matter: Exploring the Impact of Patients' Familial, Community, and Provider Relationships on
Justin Kramer1,2, Aditi Gupta3,4, Shellie Ellis5
1Department of Family and Community Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, USA. jwkramer@wakehealth.edu.
Insights
Patient relationships with family, community, and providers significantly impact hypertension control. Tailoring care to individual circumstances and utilizing culturally appropriate resources are key for effective blood pressure management.
Area of Science:
- Public Health
- Health Equity
- Cardiovascular Disease Management
Background:
- Hypertension affects nearly half of US adults, with blood pressure (BP) uncontrolled in over two-thirds of cases.
- Significant disparities in BP control exist, particularly among Southern and rural populations.
Purpose of the Study:
- To examine how patients' relationships with families, communities, and healthcare providers influence hypertension control efforts.
- To identify barriers and facilitators to effective blood pressure management in diverse patient populations.
Main Methods:
- Semi-structured interviews were conducted with 29 providers and 25 patients managing hypertension.
- Participants were recruited from primary care and cardiology clinics in North Carolina and Kansas, representing high- and low-performing sites.
- A health equity framework guided the interview process, with thematic analysis used to interpret findings.
Main Results:
- Patients' family histories and cultural expectations often influenced their approach to hypertension management.
- Regional cultural norms, particularly in Southern and rural areas, presented challenges to adherence.
- Tailoring care to individual circumstances and using culturally appropriate resources improved patient trust and activation.
- Providers in high-performing clinics more frequently discussed tailored care and culturally sensitive materials compared to those in low-performing clinics.
Conclusions:
- Effective hypertension management is influenced by a patient's social and clinical relationships.
- Future research should focus on strategies for culturally tailored hypertension care and overcoming structural barriers to its implementation.
Background:
Nearly half of US adults have hypertension, with blood pressure (BP) uncontrolled in over two-thirds of cases. Significant disparities exist in BP control, particularly for Southern and rural-dwelling Americans.
Objective:
To examine the impact of patients' relationships with families, communities, and providers on BP control efforts.
Design:
Semi-structured interviews explored patient and provider experiences managing hypertension and controlling BP.
Participants:
Twenty-nine providers and 25 patients with hypertension were recruited from 13 high- and low-performing primary care clinics (assessed via hypertension control rates) and one cardiology clinic across two health systems in North Carolina and Kansas.
Approach:
A health equity framework-shaped interview guide and codebook development. Inductive and deductive coding methodologies were employed, with thematic analysis used to organize emergent themes.
Key Results:
Patients frequently discussed the prevalence of hypertension within their families, with some detailing feelings of inevitability and/or linking their cardiovascular outcomes to family histories. Cultural expectations were often mentioned, with families' and communities' normative behaviors sometimes creating barriers to hypertension management. Southern and/or rural culture (e.g., diet) may pose unique challenges, as some providers cited patients' resistance to deviate from regional norms. The importance of tailoring hypertension care to patients' unique circumstances was often cited and linked with increased trust and patient activation, with the utilization of culturally appropriate, patient-facing resources being identified as a best practice. While providers in high-performing clinics more consistently discussed approaches to tailoring care and using culturally appropriate materials, providers in low-performing clinics more often referenced time constraints limiting personalized care and having non-inclusive resources.
Conclusion:
Effective hypertension management may be impacted by patients' relationships, both external (e.g., family, community) and internal (e.g., providers) to healthcare. Future research should explore strategies for tailoring culturally appropriate hypertension care to patients, specifically identifying ways to overcome structural barriers that can hinder clinics' utilization.
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