title: The role of patients' explanatory models and daily-lived experience in hypertension self-management.
abstract: BACKGROUND
  Uncontrolled hypertension remains a significant problem for many patients. Few interventions to improve patients' hypertension self-management have had lasting effects. Previous work has focused largely on patients' beliefs as predictors of behavior, but little is understood about beliefs as they are embedded in patients' social contexts.
  
  
  OBJECTIVE
  This study aims to explore how patients' "explanatory models" of hypertension (understandings of the causes, mechanisms or pathophysiology, course of illness, symptoms and effects of treatment) and social context relate to their reported daily hypertension self-management behaviors.
  
  
  METHODS
  Semi-structured qualitative interviews with a diverse group of patients at two large urban Veterans Administration Medical centers.                                PARTICIPANTS (OR PATIENTS OR SUBJECTS):                  African-American, white and Latino Veterans Affairs (VA) primary care patients with uncontrolled blood pressure.
  
  
  METHODS
  We conducted thematic analysis using tools of grounded theory to identify key themes surrounding patients' explanatory models, social context and hypertension management behaviors.
  
  
  RESULTS
  Patients' perceptions of the cause and course of hypertension, experiences of hypertension symptoms, and beliefs about the effectiveness of treatment were related to different hypertension self-management behaviors. Moreover, patients' daily-lived experiences, such as an isolated lifestyle, serious competing health problems, a lack of habits and routines, barriers to exercise and prioritizing lifestyle choices, also interfered with optimal hypertension self-management.
  
  
  CONCLUSIONS
  Designing interventions to improve patients' hypertension self-management requires consideration of patients' explanatory models and their daily-lived experience. We propose a new conceptual model - the dynamic model of hypertension self-management behavior - which incorporates these key elements of patients' experiences.
authors: Center for Health Quality, Outcomes & Economic Research, ENRM Veteran Affairs Medical Center, Bedford, MA 01730, USA. Barbara.Bokhour@va.gov
authors: Barbara G
authors: BG
authors: Bokhour
authors: Ellen S
authors: ES
authors: Cohn
authors: Dharma E
authors: DE
authors: Cortés
authors: Jeffrey L
authors: JL
authors: Solomon
authors: Gemmae M
authors: GM
authors: Fix
authors: A Rani
authors: AR
authors: Elwy
authors: Nora
authors: N
authors: Mueller
authors: Lois A
authors: LA
authors: Katz
authors: Paul
authors: P
authors: Haidet
authors: Alexander R
authors: AR
authors: Green
authors: Ann M
authors: AM
authors: Borzecki
authors: Nancy R
authors: NR
authors: Kressin
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000959:Antihypertensive Agents / Q000008:administration & dosage; D001795:Blood Pressure Determination / Q000379:methods; D003430:Cross-Sectional Studies; D019468:Disease Management; D005260:Female; D015438:Health Behavior; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D006973:Hypertension / Q000175:diagnosis* / Q000188:drug therapy*; D008019:Life Style; D008297:Male; D008875:Middle Aged; D017145:Models, Educational; D010349:Patient Compliance / Q000706:statistics & numerical data; D010353:Patient Education as Topic; D012648:Self Care / Q000379:methods*; D012720:Severity of Illness Index; D016896:Treatment Outcome; D014481:United States; D014493:United States Department of Veterans Affairs; D014505:Urban Population
chemical_list: D000959:Antihypertensive Agents