Educational/Counseling Model Health Care
A stories-based interactive DVD intended to help people with hypertension achieve blood pressure control through improved communication with their doctors

https://doi.org/10.1016/j.pec.2009.09.021Get rights and content

Abstract

Objective

Our goal was to develop an interactive DVD to help African American and Caucasian American adults with hypertension learn how to become better communicators during medical interactions. Material was to be presented in several formats, including patients’ narratives (stories).

Methods

To develop the narratives we recruited members of the target audience and elicited stories and story units in focus groups, interviews, and seminars. Story units were ranked-ordered based on conformance with the theory of planned behavior and narrative qualities and then melded into cohesive stories. The stories were recounted by actors on the DVD.

Results

55 adults (84% women; 93% African American) participated in a focus group, interview, or seminar; transcripts yielded 120 story units. The most highly rated units were woven into 11 stories. The six highest rated stories/actor–storytellers were selected for presentation on the DVD.

Conclusion

We achieved our goal of developing an easy-to-use, story-driven product that may teach adults how to talk effectively with their doctors about hypertension. The DVD's effectiveness should be tested in a randomized trial.

Practice implications

Behavioral interventions aimed at improving patients’ ability to communicate during doctor visits may be useful adjuncts in the achievement of BP goals.

Introduction

Hypertension affects half to two-thirds of people over age 60 [1], [2] and is a major etiologic factor of the leading causes of morbidity and mortality in developed countries [3]. Only about half of Americans with treated hypertension achieve blood pressure (BP) control [4], [5], [6]. Physicians’ failure to adjust medications in the face of poor control appears to contribute [7].

Many behavioral interventions to improve BP control have been tested [8], [9], [10], [11], [12], but teaching patients to communicate more effectively about hypertension during the medical interaction has received little attention. This is a curious finding, given that at least three studies, one a randomized trial of patient activation, have documented a relationship between the quality of doctor–patient communication and BP control [13], [14], [15].

The patient who asks the doctor questions like, “What is my blood pressure today? If my BP is not at goal, how can we get it there?” may be more likely to achieve control than the passive patient. We developed a patient activation curriculum intended for community groups [16] as part of a research program in health disparities and doctor–patient communication [17]. The curriculum was based on the linguistic model of doctor–patient interaction and was built around patient communication behaviors that have been shown to elicit more information from doctors [18], [19], [20], [21], [22].

We describe here the development of an interactive digital videodisc (DVD) for patient activation for hypertension control that may extend the reach of the program. Though we will describe all segments of the DVD, we will devote most attention to the one in which narrative communication—patients’ stories—was used as the tool to encourage behavior change [23].

Section snippets

Methods

The study was approved by the institutional review board of the University of Alabama at Birmingham.

Participants and data collection

Fifty-five people (46 women, 9 men; 51 African Americans) participated in one or more sessions. We conducted five hour-long all-women focus groups, 13 semi-structured one-on-one half-hour interviews (7 of men, 6 of women), and two 90-min seminars (mixed women and men).

Constructing the stories

Transcripts from the sessions yielded 120 relevant story units (Table 2) from which 11 stories were created (Table 4 presents an example). Stories were rated by the study team for conformance with the theory of planned behavior

Discussion

In this project we achieved our goal of developing an easy-to-use and easy-to-disseminate DVD that may activate patients and teach them how to talk more effectively about high blood pressure with their doctors. The choice of DVD content was guided by the linguistic model of doctor–patient communication and the theory of planned behavior.

Patients’ narratives were one way in which content was presented on the DVD. The use of narrative to effect behavioral change in health practices is an emerging

Conflict of interest

None of the authors has any conflicts of interest to disclose.

Acknowledgments

This project was supported by grant #0755233B to Dr. Ashton from the Greater Southeast Affiliate of the American Heart Association and the Division of Preventive Medicine of the University of Alabama School of Medicine. Drs. Ashton and Wray were members of the UAB Division of Preventive Medicine when the project was performed. We gratefully acknowledge the contributions of the people who participated in the interviews, focus groups, and training seminars conducted as part of this project.

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