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HSR&D Citation Abstract

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Patients’ cultural models of hypertension: The discourse of stress

Bokhour BG, Cohn ES, Cortes DE, Fix GM, Solomon J. Patients’ cultural models of hypertension: The discourse of stress. Paper presented at: Communication, Medicine and Ethics (COMET) Interdisciplinary Annual Conference; 2009 Jun 21; Cardiff, Wales.

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Hypertension, often dubbed 'the silent killer' is a serious condition that has the potential to cause long lasting physical illness and even death. Subsequently, medical management of hypertension involves taking medication as prescribed, modifying diets and getting exercise. However, patients' experience of how to best manage hypertension may differ substantially from the biomedical model described above. Patients' explanatory models - their perceptions of etiology, time and onset of symptoms, pathophysiology, course of illness, and treatment are likely to guide patients' decisions about how best to manage this chronic condition. In this paper we examine semi-structured interviews conducted with 55 patients with uncontrolled hypertension at two large US Department of Veterans Affairs Medical Centers. Through grounded theory analyses, we explored patients' explanatory models of hypertension, its treatment and management. Our findings reveal that descriptions patients give regarding their hypertension deviate from the traditional biomedical explanatory model. In particular patients frequently focused on the role of stress as an initial cause of hypertension, and as a cause for an individual's blood pressure to rise. Patients described stress as anxiety, tension, and 'feeling the blood rise up,' and told of ways they try to 'calm down' to lower their blood pressure .Consequently, stress management is viewed as a key way in to control hypertension. This paper explores the myriad of ways in which patients describe the relationship of stress to hypertension, the role of the language of 'hypertension' plays in this conceptualization and how in turn patients choose to manage their condition.

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