EXPECTATIONS OF BLOOD PRESSURE MANAGEMENT: METHODS

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Design

Several methods have been proposed for eliciting patients’ expectations, including use of self-administered questionnaires, semistructured interviews, and focus groups. We conducted a qualitative study using in-depth, open-ended individual interviews to elicit expectations of blood pressure treatment in a group of hypertensive African-American patients.

Participants and Data Collection

We recruited patients from the Cornell Internal Medicine Associates; a primary care practice at the New York Presbyterian Hospital in New York City affiliated with the Weill Medical College of Cornell University. Institutional review board approval was obtained for this study. Details of recruitment and data collection have been provided elsewhere. Briefly, patients were identified from a review of electronic medical records and appointment logs. Eligibility criteria were diagnosis of hypertension, being African American as determined by self-report, age 18 years or older, fluency in English, and treatment with at least one antihypertensive medication for a period of at least one year. In all, 108 patients were approached and a total of 93 patients agreed to be interviewed. The mean age of patients was 58 years, women comprised 58%, and most of these patients earn an annual income of less than $20,000. In order to explore patients’ expectations of treatment, individual interviews were conducted in person with consecutive patients during routine clinic visits. Patients who could not be interviewed in the clinic either due to lack of time or because of prior commitments were interviewed by telephone. All patients enrolled in this study were asked the following open-ended question: What are your expectations of the treatment your doctor prescribed for your high blood pressure? Patients could cite as many expectations as they wished. In addition, their responses were explored with the following probes: 1) Do you expect to take your blood pressure medications for the rest of your life? 2) Do you expect to take your medications daily regardless of symptoms? 3) Do you expect a cure for your high blood pressure?

Definition of Biomedical and Nonbiomedical Expectations

In order to provide context for the different types of expectations elicited from patients, we created two broad categories of expectations (biomedical and nonbiomedical expectations). Biomedical expectations are those that coincide with traditional biomedical notions about hypertension as a chronic, largely asymptomatic, and incurable disease that requires lifelong treatment with medications. Thus, patients were categorized as having nonbiomedical expectations if they: a) expected to take medications only when symptoms occur; b) expected their hypertension to be cured; and c) expected not to take medications for life. A patient could cite all three types of nonbiomedical expectations. canadian pharmacy online

All interviews were conducted by one of the investigators (GO) and lasted anywhere from 2030 minutes. Patients’ responses were written verbatim in field notes by the interviewers. Medical records were reviewed for number of antihypertensive medications prescribed, comorbid conditions, and average ambulatory blood pressure readings for the 12 months prior to the study. Other data collected included demographic data, duration of diagnosis, and treatment for hypertension.

Data Analysis

Assembly of patient expectations. Patients’ responses were analyzed using standard qualitative research techniques. For this purpose, the field notes were read multiple times and responses coded into recurring concepts, which were then sorted and grouped into categories of similar content. At the point of data saturation, when no new concepts emerged on analysis of additional responses, the identified categories were labeled and the themes uniting them identified. Patients’ responses were coded with the aid of a qualitative research software package, The Ethnograph version v5.0® for Windows, which is designed to organize large textual data and facilitate content analysis. Field notes were coded and categories generated by two investigators independently. Both met on several occasions to discuss the similarities and differences between categories, and disagreements between them were resolved by discussion. Details of the data analysis have also been provided elsewhere. canadian cialis online