Multiethnic Perspectives of Shared Decision Making in Hypertension

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Project Summary/Abstract Hypertension (HTN) is a major risk factor for heart disease and stroke, contributing to about 1,000 deaths a day with persistent racial/ethnic disparities. Higher prevalence and poor HTN control rates are common among Blacks (57%, 37%) and Hispanics (45%, 42%), compared to Whites (44%, 46%) in the US. Shared decision making (SDM) is an approach where clinicians and patients make decisions together using the best available evidence, along with patients' preferences and values, and is a possible strategy to improve HTN control. Little is known about the influence of race/ethnicity on SDM practices or the impact of SDM on HTN control in ethnically diverse groups. To address this gap, the applicant proposes to conduct a mixed methods explanatory sequential study to examine SDM in HTN management from the perspectives of multiethnic patients with HTN. This dissertation study will be conducted within the Parent Study, the RICH LIFE Project. Specific aims include: 1) Examine the relationship between SDM, change in level of blood pressure (BP), and self-reported race and ethnicity in patients with HTN; 2) Examine baseline determinants of decision that predict SDM at 12 months, including sociodemographic and clinical characteristics, perception of the decision (i.e., HTN knowledge), perception of important others (i.e., satisfaction and trust in providers), and resources to make and implement decisions; 3) Explore SDM in BP management from the perspective of HTN patients with high/low SDM scores, and improvement/no improvement over 12 months in level of BP; 4) Describe SDM in the BP management context in relation to SDM score and BP level. This study will be carried out in three phases. During Phase 1, quantitative data collected in the Parent Study at baseline and 12 month follow up will be analyzed. These results will then guide purposeful sampling of Parent Study participants for participation in semi-structured interviews to obtain qualitative data in Phase 2. Qualitative data will be used to help explain the findings from Phase 1. In Phase 3, quantitative and qualitative data will be integrated. The study will follow a fixed-design approach since the methods are predetermined during the planning phase with a specific intent to mix qualitative and quantitative approaches. The application of mixed methods to enhance understanding of the cultural and contextual factors influencing SDM in HTN is innovative and will inform the development of culturally congruent interventions to promote HTN control and reduce racial/ethnic disparities. This study and proposed training plan will provide foundational experience and skills in mixed methods research among multiethnic populations experiencing health disparities. The proposed study and training plan will allow the applicant to develop into a nurse scientist who will lead interdisciplinary research to improve cardiovascular risk management through SDM. The proposed study addresses the National Institute of Nursing Research's “Wellness: Promoting Health and Preventing Illness” area of scientific focus and will add to the scientific knowledge base on the impact of race, ethnicity, and other factors on SDM and the relationship between SDM and HTN control.