Patient and primary care perspectives on hypertension management: short report of a qualitative study in a tribal health system

ABSTRACT

The prevalence of self-reported hypertension is higher among Alaska Native and American Indian (ANAI) individuals than in the majority USA population. Although hypertension is the primary modifiable risk factor for cardiovascular disease and stroke, it can be difficult to manage successfully. The objective of this study was to explore patients’ and providers’ perspectives about hypertension, hypertension management strategies, and patient-provider communication strategies within a tribally-owned and operated health system in Alaska. We conducted four focus groups that included 16 ANAI patients and five primary care providers. Patient participants tended to consider hypertension a transient state, in contrast with providers’ understanding of hypertension as a chronic condition. Differences were noted in participants’ perceptions regarding providers’ counselling and education efforts, with providers feeling that current strategies are effective and patients desiring a more personalised discussion about hypertension. Patients expressed preferences for behaviour change approaches compared with pharmacotherapy; providers often resorted to medication as a first step towards controlling blood pressure. Our findings suggest areas of potentially promising future research with respect to patient-provider communication and treatment of hypertension.

KEYWORDS:

• Alaska Native
• hypertension
• blood pressure
• self-management

Acknowledgments

The authors thank the study participants, the SCF and Alaska Native Tribal Health Consortium research review committees, and the Community Advisory Board for their guidance on this study. We are grateful to Charlene Apok for her assistance with data collection and analysis, and Devon Sigourney for helping with study recruiting and logistics. This work was supported by the National Institute on Minority Health and Health Disparities under Grant U54MD011240. The authors report no conflict of interest.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

This work was supported by the National Institute on Minority Health and Health Disparities of the National Institutes of Health [U54MD011240]. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.