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Using Patient Stories to Improve Blood Pressure Control FREE

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The full report is titled “Culturally Appropriate Storytelling to Improve Blood Pressure. A Randomized Trial.” It is in the 18 January 2011 issue of Annals of Internal Medicine (volume 154, pages 77-84). The authors are T.K. Houston, J.J. Allison, M. Sussman, W. Horn, C.L. Holt, J. Trobaugh, M. Salas, M. Pisu, Y.L. Cuffee, D. Larkin, S.D. Person, B. Barton, C.I. Kiefe, and S. Hullett.

Ann Intern Med. 2011;154(2):I-24. doi:10.7326/0003-4819-154-2-201101180-00001
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What is the problem and what is known about it so far?

High blood pressure (hypertension) can cause such problems as heart attack, heart failure, kidney failure, and stroke. Lowering blood pressure helps to prevent these problems; unfortunately, even persons who are getting health care often do not reach healthy blood pressures. Blood pressure treatments include diet, exercise, and drugs. Many people find it hard to follow diets, exercise regularly, or take medicines daily, and because patients usually feel well even with very high blood pressure, many patients with hypertension do not understand the importance of lowering their blood pressure. New ways to motivate patients with hypertension to follow diet and exercise advice and to take their medication as prescribed would be useful.

Why did the researchers do this particular study?

To see whether listening to stories from other patients with hypertension could help to improve blood pressure control.

Who was studied?

299 patients with hypertension, all of whom were African American and receiving care in a Birmingham, Alabama, clinic that served the poor. Blood pressure control in these patients varied.

How was the study done?

The researchers conducted a series of focus groups and interviews and identified 14 persons with hypertension who told convincing stories about their own experience with hypertension. They then developed 3 DVDs that included short videos of these persons telling their own stories. Study patients were assigned to view 1 of 2 types of DVDs. The storytelling group watched the hypertension DVDs that included the stories about hypertension. The control group watched a brief DVD that contained health tips that were not about hypertension. All of the patients watched the first video in the clinic, and the next 2 videos were mailed to the patients' homes. The researchers measured patient blood pressure at the start of the study, 3 months later, and then 6 to 9 months later.

What did the researchers find?

At the start of the study, both groups had similar blood pressures. After 3 months, patients in the storytelling group had more improvement in blood pressure than those in the control group. However, most of the improvement was in patients who had uncontrolled blood pressure at the start of the study. The benefit of storytelling compared with control DVDs remained at 6 to 9 months in patients who had uncontrolled blood pressure at the start of the study.

What were the limitations of the study?

Almost one quarter of the patients dropped out of the study before follow-up blood pressure measurement. It is not known whether patients actually watched the DVDs that were mailed to their homes. Results might differ in other types of patients or health care settings.

What are the implications of the study?

This study suggests that listening to the stories of other patients who have hypertension can improve blood pressure control in patients who are receiving care but still have high blood pressure.





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