Shared Decision-Making Preferences of Black Men With Hypertension in the United States Mid-South: A Qualitative Study

Black men in the United States face disproportionately high rates of uncontrolled hypertension, contributing to premature mortality. Effective blood pressure control depends on high-quality and ongoing patient-clinician communication. However, poor communication and mistrust reduce engagement in treatment discussions. Shared decision-making (SDM) can enhance this engagement, but there is limited research on the SDM preferences of Black men in hypertensive care.

The aim was to explore the factors shaping Black men's SDM preferences for hypertension treatment and management.

We conducted a qualitative study using semi-structured interviews with 16 Black men diagnosed with hypertension in the Mid-South United States. Participants were recruited through community-based settings and digital platforms. Interviews were transcribed and analyzed using reflexive thematic analysis to identify key themes.

We describe 3 overarching themes that characterize Black men's SDM preferences: (1) patient-related preferences for involvement in SDM: race and cultural concordance, patient's ability to negotiate decision-making power with clinician, and reported concerns about stereotype threat in clinical interactions; (2) clinician-related preferences: participants preferred clinicians who were relatable, who conducted thorough assessments, and who discussed a full range of treatment options instead of medications alone; and (3) optimal SDM encounters: effective SDM requires a therapeutic working alliance, clinician respect for their patient's decision-making autonomy, and trust to open discussions about hypertension treatment, particularly with challenges with adherence.

We highlight how cultural alignment and interpersonal dynamics shape SDM engagement among Black men with hypertension.

Clinicians should use culturally responsive strategies that support autonomy, build relational trust, and expand treatment discussions beyond medications. Findings can inform clinician training and practice guidelines to improve hypertension care for Black men.