Interviews reveal caregivers underappreciate high blood pressure significance in children
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Key takeaways:
- Qualitative interviews showed caregivers worry about hypertension as a chronic disease.
- Caregivers did not express concern when high BP was noted in children at the clinic, often following provider attitudes.
Data from qualitative interviews show parents and caregivers understand and worry about hypertension as a chronic disease, yet expressed little concern when high BP was noted for their children in the clinic, researchers reported.
In an analysis of interview data from 13 caregivers of children aged 6 to 18 years with a diagnosis of hypertension, researchers from Nemours Children’s Health also found that parents tended to be dismissive of antihypertensive medications for children, often citing concern about adverse effects or citing the provider’s lack of urgency about any high BP readings, according to Abbas Zaidi, MD, a pediatric cardiologist affiliated with Nemours Children’s Hospital-Delaware.
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That disconnect could lead parents to underappreciate a hypertension diagnosis and fail to pursue follow-up care, Zaidi said.
“High BP among adolescents is common, but the challenge is it goes unrecognized and less than 25% of this gets picked up,” Zaidi told Healio. “With changing populations and obesity rates, plus the pandemic, this prevalence is likely shifting. We know high BP in childhood leads to high BP in adulthood.”
Misunderstanding hypertension risk
Zaidi and colleagues conducted qualitative interviews with 13 caregivers of patients aged 6 to 18 years who received a diagnostic code for hypertension and had previously documented BP in the range of stage 2 hypertension. Caregivers had diverse backgrounds based on the childhood opportunity index. Researchers used an implementation science-based framework to design questions under major themes, such as barriers and challenges related to returning for follow-up care.
“The families we interviewed were those with kids with diagnosed hypertension with multiple high BPs documented in their chart who did not come back for follow-up,” Zaidi said during an interview. “These are high-risk kids who are not coming back because of barriers. We went through a script-building process, we timed it and went through a whole process to develop and ask the appropriate questions.”
The findings were presented at the World Congress of Pediatric Cardiology and Cardiac Surgery Conference.
The researchers found that caregivers trust the child’s clinician and hospital, worry about the possibility of hypertension as a chronic disease in their child based on family experiences, understand the importance of BP monitoring and testing, and prioritize hypertension over other health issues. However, many caregivers did not express concern when high BP was noted at the clinic, attributing it to situational causes and lack of concern by the provider. Feedback included that high BP was “something to keep an eye on” that does not require medication, or that hypertension will “go away” as a child grows or becomes more active.
Another major theme that emerged, Zaidi said, was “I do not want my child on medications,” with caregivers stating they want to lower BP “naturally,” or avoid medication “dependence” or adverse effects.
“Going in, I went in with my own subconscious biases, but it was eye-opening to me how often I heard from families about how much they know about hypertension based on family experience; how they are aware that it is a silent killer,” Zaidi told Healio. “Many of our families had a family member who died or dealt with hypertension and came in with a lot of knowledge. The dichotomy I saw was, whenever BP was measured, it was not a concern. Caregivers thought, the child is young, they just need to adjust their diet, it is all situational. They had all these perceptions about it not being a problem.”
Ask questions differently
To improve hypertension detection, Zaidi said providers should address these perceptions during clinic visits, emphasizing the importance of hypertension diagnosis and ongoing follow-up.
“You are going to get different answers when you ask questions differently,” Zaidi said. “Now, I ask more open-ended questions. Instead of asking, ‘Do you have a family history of hypertension?’ I say, ‘Do you or a family member have high BP, and what do you know based on your experiences?’ That gets right at the perceptions they may have.”
Zaidi said next steps include working with providers across Nemours to form a multi-stakeholder team, including primary care physicians, nurses and diverse caregivers to develop and test strategies for working with families who have children with high BP readings.
“We need uniformity of what we do within our health care system and care coordination,” Zaidi told Healio. “Families need a little bit of hand-holding with coming back, scheduling appointments, and someone to say, ‘This is important’. Then we need an overall system in place to track outcomes.”
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Zaidi A, et al. Poster 3183. Presented at: World Congress of Pediatric Cardiology and Cardiac Surgery; Aug. 27- Sept. 1, 2023; Washington, D.C.
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