Multiethnic Perspectives of Shared Decision‐Making in Hypertension: A Mixed‐Methods Study
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Published:2024-07-16
Issue:14
Volume:13
Page:
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ISSN:2047-9980
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Container-title:Journal of the American Heart Association
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language:en
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Short-container-title:JAHA
Author:
Elias Sabrina1ORCID, Wenzel Jennifer12, Cooper Lisa A.23ORCID, Perrin Nancy1ORCID, Commodore‐Mensah Yvonne13ORCID, Lewis Krystina B.4ORCID, Koirala Binu1ORCID, Slone Sarah1ORCID, Byiringiro Samuel1ORCID, Marsteller Jill23ORCID, Himmelfarb Cheryl R.123ORCID, Marsteller Jill A., Ahima Rexford, Alvarez Carmen, Antoine Denis G., Avornu Gideon, Bhattarai Jagriti, Bone Lee, Boonyasai Romsai T., Carson Kathryn A., Charleston Jeanne, Chung Suna, Cort Marcia, Crews Deidra C., Daumit Gail L., Dietz Katherine B., Eyer Teresa, Frazier Demetrius, Greer Raquel, Hickman Debra, Hill‐Briggs Felicia, Dennison Himmelfarb Cheryl R., Hines Anika, Hull Tammie, Ibe Chidinma A., Johnson Lawrence, Johnson Susan, Kargbo Mary, Kelleher Mary, Lazo Mariana, Lubomski Lisa, Mathews Lena M., Miller Edgar R., Ndumele Chiadi E., Turkson‐Ocran Ruth‐Alma, Parker Randy, Peterson Cassandra, Purnell Tanjala S., Spicyn Natalie, Teagle DeNotta, Wang Nae‐Yuh, White Marcee, Yeh Hsin‐Chieh, Young Joan, Zeren Kimberly L.
Affiliation:
1. Johns Hopkins School of Nursing Baltimore MD USA 2. Johns Hopkins School of Medicine Baltimore MD USA 3. Johns Hopkins Bloomberg School of Public Health Baltimore MD USA 4. University of Ottawa School of Nursing Ottawa ON Canada
Abstract
Background
Shared decision‐making (SDM) has the potential to improve hypertension care quality and equity. However, research lacks diverse representation and evidence about how race and ethnicity affect SDM. Therefore, this study aims to explore SDM in the context of hypertension management.
Methods and Results
Explanatory sequential mixed‐methods design was used. Quantitative data were sourced at baseline and 12‐month follow up from RICH LIFE (Reducing Inequities in Care of Hypertension: Lifestyle Improvement for Everyone) participants (n=1212) with hypertension. Qualitative data were collected from semistructured individual interviews, at 12‐month follow‐up, with participants (n=36) selected based on their SDM scores and blood pressure outcome. Patients were cross‐ categorized based on high or low SDM scores and systolic blood pressure reduction of ≥10 or <10 mm Hg. Multinomial logistic regression analysis showed that predictors of SDM scores and blood pressure outcome were race and ethnicity (relative risk ratio [RRR], 1.64;
P
=0.029), age (RRR, 1.03;
P
=0.002), educational level (RRR, 1.87;
P
=0.016), patient activation (RRR, 0.98;
P
<0.001; RRR, 0.99;
P
=0.039), and hypertension knowledge (RRR, 2.2;
P
<0.001; and RRR, 1.57;
P
=0.045). Qualitative and mixed‐methods findings highlight that provider–patient communication and relationship influenced SDM, being emphasized both as facilitators and barriers. Other facilitators were patients' understanding of hypertension; clinicians' interest in the patient, and clinicians' personality and attitudes; and barriers included perceived lack of compassion, relationship hierarchy, and time constraints.
Conclusions
Participants with different SDM scores and blood pressure outcomes varied in determinants of decision and descriptions of contextual factors influencing SDM. Results provide actionable information, are novel, and expand our understanding of factors influencing SDM in hypertension.
Publisher
Ovid Technologies (Wolters Kluwer Health)
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