Kudos to the Annals of Internal Medicine for getting a little bit outside the box. This week’s lead article deals with the difficult problem of hypertension among African-Americans, who are more likely to get high blood pressure than Caucasians, and to have organ damage as a result.
There are many reasons for this, but at least some is a decreased willingness to engage the medical profession and follow the dictates of medication and diet. The authors theorized that there is inadequate cultural relevance to promote greater awareness of this condition.
The study used culturally-appropriate storytelling as an intervention, because it was felt that “narrative communication can break down cognitive resistance to behavior-change messages.” Patients were recruited to tell the story of their own lives with hypertension–dealing with the illness, the treatment and its outcomes–in their own narrative voices with the help of a guide, and DVDs were made of the stories.
Fourteen stories were chosen as most clear and persuasive narratives and were shown to a group of people with various degrees of hypertension. A follow-up “Learn More” DVD was mailed to the group, who watched it at home. The control group watched some “Healthy Habits” sound bites from a local TV station, to equalize the DVD-watching aspect of the study.
The results? None for those whose hypertension was already well-controlled. But for people with uncontrolled hypertension, there were significant reductions in both systolic and diastolic blood pressure readings in the group that watched the stories, which were sustained through a 9-month follow-up.
Those of us involved in changing care paradigms have learned how important stories can be in getting a message across that stays with people. Here is another example of the power of the story!