Educational/Counseling Model Health CareA stories-based interactive DVD intended to help people with hypertension achieve blood pressure control through improved communication with their doctors
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.
References (32)
- et al.
Global mortality, disability, and the contribution of risk factors: global burden of disease study
Lancet
(1997) - et al.
An evidence-based review of patient-centered behavioral interventions for hypertension
Am J Prev Med
(2001) - et al.
Empowering communication: a community-based intervention for patients
Patient Educ Couns
(2004) Information-giving in medical consultations: the influence of patients’ communicative styles and personal characteristics
Soc Sci Med
(1991)Communicative styles and adaptations in physician–parent consultations
Soc Sci Med
(1992)The theory of planned behavior
Organiz Behav Human Decis Process
(1991)- et al.
Adding story-centered care to standard lifestyle intervention for people with Stage 1 hypertension
Appl Nurs Res
(2006) - et al.
Patient education about anticoagulant medication: is narrative evidence or statistical evidence more effective?
Patient Educ Couns
(2007) - et al.
Improved hypertension management and control: results from the health survey for England, 1998
Hypertension
(2001) - et al.
Hypertension in adults across the age spectrum: current outcomes and control in the community
J Amer Med Assoc
(2005)
Racial disparities in hypertension prevalence, awareness, and management
Arch Intern Med
Hypertension management and control in primary care: a study of 20 practices in 14 states
Pharmacotherapy
A quasi-experimental test of an intervention to increase the use of thiazide-based treatment regimens for people with hypertension
Implement Sci
Inadequate management of blood pressure in a hypertensive population
N Engl J Med
Quality improvement strategies for hypertension management: a systematic review
Med Care
Cited by (15)
A multi-step approach to develop a “storytelling” intervention to improve patient gout knowledge and improve outpatient follow-up
2023, Contemporary Clinical Trials CommunicationsCan stories influence African-American patients’ intentions to change hypertension management behaviors? A randomized control trial
2016, Patient Education and CounselingCitation Excerpt :We found that patients reported being more likely to talk to their doctors after viewing the stories. As others have found, the stories may prime patients to talk with their providers about their hypertension [52]. Patients often have difficulty raising issues surrounding chronic illness management with their providers.
A novel process for integrating patient stories into patient education interventions: Incorporating lessons from theater arts
2012, Patient Education and CounselingCitation Excerpt :In our prior work, we started with 50 videotaped interviews of actual patients, which were rated, and edited to create four interventional stories [10]. In work with Ashton et al. [9], we dissected real patients’ stories, rewove them into narratives matching project goals and used actors to retell the stories. In another study [8], we filmed real patients and edited footage to create a final video.
Storytelling: a Cultural Determinant of Health Among African American Cancer Patients
2021, Journal of Cancer EducationA Quantitative Measurement Model for Persuasive Technologies Using Storytelling via a Virtual Narrator
2020, International Journal of Human-Computer Interaction