Challenges with hypertension self-care among survivors of adverse childhood experiences

Abstract

Uncontrolled hypertension remains a serious public health problem. Despite the long-term negative effects of adverse childhood experiences (ACEs) on health and health behaviors, few studies have explored how to support ACE survivors with uncontrolled hypertension. We conducted semi-structured individual interviews with 24 diverse patients to understand how ACE survivors may manage their hypertension compared to those who had not experienced ACEs. Using qualitative descriptive methods we categorized participants based on ACE experience: non ACEs, ACEs with sexual abuse, and ACEs without sexual abuse. Our thematic analysis revealed 5 themes: stress, childhood experiences, social support, experiences with health care, and attitudes about self-care. These themes revealed more about antecedents to health behaviors than about actual management of hypertension. Although all participants experienced challenges with healthy lifestyle changes, comments from those who did not experience ACEs reflected a more positive attitude about self-care, and adaptive strategies for overcoming challenges related to hypertension management. ACE survivors reported more depressive symptoms, maladaptive strategies, and negative experiences with health care which negatively impacted their disease management. ACE survivors may need additional resources for depression management and coping strategies for self-care—all of which may improve health behavior and blood pressure control.

Keywords

• Hypertension
• Adverse childhood experiences
• Coping
• Attitudes