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            "title": "Culturally appropriate storytelling to improve blood pressure: a randomized trial",
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                    "firstName": "Thomas K",
                    "lastName": "Houston"
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                    "firstName": "Catarina I",
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            "abstractNote": "BACKGROUND\n\nStorytelling is emerging as a powerful tool for health promotion in vulnerable populations. However, these interventions remain largely untested in rigorous studies.\n\n\nOBJECTIVE\n\nTo test an interactive storytelling intervention involving DVDs.\n\n\nDESIGN\n\nRandomized, controlled trial in which comparison patients received an attention control DVD. Separate random assignments were performed for patients with controlled or uncontrolled hypertension. (ClinicalTrials.gov registration number: NCT00875225)\n\n\nSETTING\n\nAn inner-city safety-net clinic in the southern United States.\n\n\nPATIENTS\n\n230 African Americans with hypertension.\n\n\nINTERVENTION\n\n3 DVDs that contained patient stories. Storytellers were drawn from the patient population.\n\n\nMEASUREMENTS\n\nThe outcomes were differential change in blood pressure for patients in the intervention versus the comparison group at baseline, 3 months, and 6 to 9 months.\n\n\nRESULTS\n\n299 African American patients were randomly assigned between December 2007 and May 2008 and 76.9% were retained throughout the study. Most patients (71.4%) were women, and the mean age was 53.7 years. Baseline mean systolic and diastolic pressures were similar in both groups. Among patients with baseline uncontrolled hypertension, reduction favored the intervention group at 3 months for both systolic (11.21 mm Hg [95% CI, 2.51 to 19.9 mm Hg]; P = 0.012) and diastolic (6.43 mm Hg [CI, 1.49 to 11.45 mm Hg]; P = 0.012) blood pressures. Patients with baseline controlled hypertension did not significantly differ over time between study groups. Blood pressure subsequently increased for both groups, but between-group differences remained relatively constant.\n\n\nLIMITATION\n\nThis was a single-site study with 23% loss to follow-up and only 6 months of follow-up.\n\n\nCONCLUSION\n\nThe storytelling intervention produced substantial and significant improvements in blood pressure for patients with baseline uncontrolled hypertension.\n\n\nPRIMARY FUNDING SOURCE\n\nFinding Answers: Disparities Research for Change, a national program of the Robert Wood Johnson Foundation.",
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                    "firstName": "Carla",
                    "lastName": "Boutin-Foster"
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            "abstractNote": "OBJECTIVE\n\nThe objective was to elicit patients' perceptions regarding the meaning of hypertension and to identify the personal, social, and environmental factors that might influence their perceptions.\n\n\nDESIGN\n\nQualitative study.\n\n\nSETTING\n\nAdult ambulatory care practice\n\n\nPARTICIPANTS\n\nAfrican American patients with uncontrolled hypertension. INTERVENTION/METHODS: In-depth structured interviews were conducted with a purposive sample of 60 patients. Interviews were audiotaped, transcribed verbatim, and analyzed by using grounded theory.\n\n\nRESULTS\n\nPatient descriptions of hypertension were grouped into three categories: 1) their thoughts on hypertension; 2) the consequences of hypertension; and 3) the impact that having hypertension had on their lifestyle. Factors that might have shaped how patients described hypertension were grouped into three categories: 1) the experiences of their social networks such as family and friends; 2) their personal experiences; and 3) information about hypertension that they might have gathered from the medical literature or during an encounter with a healthcare provider. Patients with family members who had experienced hypertension-related complications such as stroke were more likely to view hypertension as a serious condition. Patients who themselves experienced hypertension-related symptoms and who also had family members with a history of hypertensive disease were more likely to describe a willingness to make lifestyle changes.\n\n\nCONCLUSIONS\n\nIn this study, personal experiences, experiences of family and friends, and encounters with the healthcare environment influenced patients' perceptions of hypertension and their willingness to make lifestyle changes. These findings can be used as a framework for helping to tailor effective and culture-specific interventions.",
            "publicationTitle": "Ethnicity & Disease",
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                    "firstName": "Gbenga",
                    "lastName": "Ogedegbe"
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            "abstractNote": "OBJECTIVE\n\nThis study explored the perspectives of hypertensive African-American patients, in 2 primary care practices, regarding the factors they perceived as barriers or facilitators of adherence to prescribed antihypertensive medications.\n\n\nDESIGN\n\nThis qualitative study used a grounded theory methodology with data collection occurring through in-depth individual patient interviews.\n\n\nSETTING AND PARTICIPANTS\n\nOne hundred and six hypertensive African-American patients followed at 2 urban primary care practices participated in the open-ended interviews.\n\n\nMETHODS\n\nDuring interviews, patients' experiences taking antihypertensive medications and their perceptions of the challenges they face in adhering to their medications as prescribed were explored. Patients were also asked about the situations that make it easy or difficult for them to take their antihypertensive medications as prescribed and the skills they thought were necessary for patients to adhere to their medications as prescribed. All responses were recorded verbatim and analyzed using grounded theory methodology.\n\n\nRESULTS\n\nFifty-eight percent of participants were women, mean age was 56 years, and 60% had uncontrolled hypertension. Four categories of barriers and 5 categories of facilitators were identified. The barriers included patient-specific, medication-specific, logistic, and disease-specific barriers. The facilitators included use of reminders, having a routine, knowledge about hypertension, its treatment and complications, having social support and good doctor-patient communication.\n\n\nCONCLUSION\n\nThis study provides a framework for investigating issues of medication adherence in hypertensive African Americans by describing a taxonomy of barriers and facilitators of adherence identified by patients.",
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