The meaning and consequences of hypertension for individuals of African Caribbean origin : perceptions of primary health care services : an ethnographic study of hypertension in England

This thesis presents a focused ethnographic study of hypertension in people of African Caribbean origin, residing in England. Hypertension remains a major health issue amongst migrant and UK born African Caribbean people. The research investigates the meaning and consequences of hypertension from the participants' perspectives exploring both personal and societal influences on the development and management of hypertension, health beliefs, risk perception and decision-making processes. Perceptions of Primary Health Care (PHC) services are evidenced. The research draws heavily upon the ethnographic tradition (adjectival), utilising qualitative methods to elicit data from 36 participants. Data were collected using focus group interviews, semi-structured interviews and vignette interviews. The participants were accessed via GP practices and community groups and associations in two English cities. Data was analysed with the aid of Atlas/ti. The study findings are organised in four themes 1) Early diagnosis, 2) The meaning of high blood pressure, 3) Consequences and management of high blood pressure, and 4) The participant's experience of PHC. Almost all participants articulated their hypertension as high blood pressure. High blood pressure and the bio-medically defined condition of hypertension were not viewed synonymously. Stress was regarded as major precursor of high blood pressure, arising from both personal and structural influences, such as migration, cultural adaptation, personal and institutionalised racism, relationship and financial problems. Diagnosis was accompanied by shock and attempts to normalise this experience. Participants' explanatory models of hypertension are presented and considered in the light of existing theoretical frameworks. These explanatory models encompass health beliefs, risk perception and decision-making. Non-concordance and traditional herbal remedies are employed by participants, as strategies of empowerment. A level of satisfaction with existing PHC services was expressed, with a small number of participants using private general practitioners. The implications for PHC services are postulated and the provision of culturally sensitive care.