Running head: INTEGRATIVE REVIEW 1

An Integrative Review: Young Adults and Hypertension

Sarah Rankin

Bon Secours Memorial College of Nursing

Nursing Research 4122

March 24th, 2017

I pledge
INTEGRATIVE REVIEW 2

Abstract

The goal of this integrative review is to evaluate the literature regarding hypertension awareness

in young adults who have received lifestyle education. Hypertension is a major health problem

for all ages and more recently, has become common among young adults. Lifestyle education is

often one of the first lines of treatment clinicians use to treat hypertension because it has been

shown to be just as effective as pharmacological therapy in controlling blood pressure. The

research design is an integrative review. A literature search was conducted using the computer

based search engines PubMed and EBSCO. The search yielded 143 articles total and five of

those articles met the criteria for inclusion. The results and findings of the literature

demonstrated a lack of hypertension awareness among young adults along with a lack of lifestyle

education. Findings also showed a beneficial effect of lifestyle education programs as a way to

control hypertension. Limitations to this review include the novice researcher and the fact that it

is not an exhaustive review due to the imposed restriction of only using five articles. Findings

can be implemented into practice by encouraging young adults to see their primary care providers

at least once a year and tailoring lifestyle education to meet the specific needs of the young adult.

Future research should include evaluating young adults hypertension control when education has

been tailored to their specific needs.

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An Integrative Review

The purpose of this integrative review is to gather literature that pertains to the use of life-

style education as a way to treat young adults with hypertension. Hypertension is a major health

problem that affects millions around the world and has become a major issue in young adults. Of

those diagnosed with hypertension in the United States, young adults have the lowest control

rates (Johnson, Warner, Bartels, & LaMantia, 2017; Johnson, Warner, LaMantia, & Bowers,

2016). Several factors contribute to this low control rate among young adults including a lack of

awareness of having hypertension. This is compounded by the fact that young adults are more

likely to be uninsured and less likely to have a primary care provider, decreasing the likelihood

they will be diagnosed with hypertension and receive education (Gooding, McGinty, Richmond,

Gillman, & Field, 2014). The researchers proposed PICO question is, in young adults how does

lifestyle education compared to no lifestyle education effect hypertension awareness?

Design and Search Methods

This research design is an integrative review done as a class assignment. Two computer-

based databases were used to find articles that fit the researchers criteria; PubMed and EBSCO.

Key terms used in the searches included, young adults, hypertension, and lifestyle

education. The PubMed search yielded 17 articles and the EBSCO search yielded 126 articles.

In order to maintain a contemporary approach to the issue, the search was limited to peer-

reviewed journal articles published in the last five years that were written in English. Articles

were selected that applied to the researchers PICO question, in young adults how does lifestyle

education compared to no lifestyle education effect hypertension awareness? The articles

selected met the following inclusion criteria: young-adult age population, hypertension, and
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lifestyle education. Articles that did not meet the criteria were excluded from the integrative

review. After limiting the search criteria the researcher was able to locate five articles, two

qualitative and three quantitative that met the criteria for inclusion.

Findings and Results

The findings and results of the five articles clearly identified a gap in young adults

receiving lifestyle education to help manage their hypertension (Ferrara et al., 2012; Gooding et

al., 2014; Johnson et al., 2014; Johnson et al., 2017; Johnson et al., 2016). A summary of all five

of the research articles can be found in Appendix 1. The researcher based the integrative review

off two major themes found within the research: hypertension awareness and documented

lifestyle education.

Hypertension Awareness

Four studies addressed the theme of young adults hypertension awareness (Gooding et

al., 2014; Johnson et al., 2014; Johnson et al., 2017; and Johnson et al., 2016). In a quantitative

study Gooding et al. (2014) evaluated hypertension awareness and control among young adults.

Gooding et al. were specifically interested in understanding the impact that young adults self-

perception of their health had on hypertension awareness and control. A sample of 13,512 young

adults ages 24-32 years old were included in the study.

Gooding et al. measured blood pressure, evaluated health insurance status, a recent

physical or check-up (within the last two years), and self rated health. The researchers only

assessed awareness of hypertension if the participant already had a diagnosis or they got an

elevated reading. The data collected was analyzed and three major statistical tests were used to

check for significance. Out of the 13,512 participants 3,303 were found to have hypertension,
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76% of those had uncontrolled hypertension (Gooding et al., 2014). Of those participants found

to have uncontrolled hypertension three-fourths were not aware that they even had hypertension.

Young adults who are not aware that they have hypertension cannot seek out treatment and get

the proper education they need to control it.

Johnson et al. (2014) used a quantitative approach to evaluate different patient, provider,

and visit predictors that affect lifestyle education among young adults with hypertension. Data

for the study was manually abstracted electronic health records. Participants were ages 18-39

who met the Joint National Committee (JNC) 7 clinical criteria for hypertension. Their main

area of focus was whether or not the patient received lifestyle education after meeting the JNC

criteria for hypertension.

Through the random chart abstraction 500 young adults were selected to participate. Data

was analyzed and categorical variables were summarized using percentages, while continuous

variables were summarized using means. Overall it was found that 22% of participants did not

receive any lifestyle education or treatment (Johnson et al., 2014). This gap in teaching and

treatment that appears with the young adult population emphasizes a lack in hypertension

awareness.

Johnson et al. (2016) conducted a qualitative study in order to identify barriers specific to

hypertension control and treatment in young adults. Using focus groups 38 young adults ages

18-39 that had been diagnosed with hypertension were sampled. The main topic explored in the

focus groups was young adults feelings about their hypertension diagnosis.

Transcripts were coded and the data collected was analyzed. All participants were able to

give at least one example of a health complication associated with hypertension (i.e., heart attack,
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stroke, death). Johnson et al. (2016) used this data as the indicator of hypertension awareness in

their study. While this does show the participants had a good understanding of the consequences

of hypertension, it does not show that they are self-aware that these things (i.e., heart attack,

stroke, death) can happen to them. If patients are not self-aware and do not acknowledge that if

their hypertension goes untreated consequences can occur, they are less likely to follow lifestyle

changes suggested by the clinicians.

Further research done by Johnson et al. (2017) also takes a qualitative approach but,

explores the providers perspectives on hypertension management in young adults. Data was

collected by conducting interviews with physicians and advanced practice providers who were

actively managing young adults with uncontrolled hypertension. A total of 16 questions on topics

related to treating young adults with hypertension were discussed in the interview.

Interview transcripts were coded and a data analysis was then performed. Many of the

physicians interviewed expressed their reluctance to diagnose young adults with hypertension

(Johnson et al., 2017). One reason for this reluctance includes a possible false hypertension

diagnosis. An elevated blood pressure reading can be caused by stress, white coat syndrome,

caffeine, alcohol, or tobacco use. This reluctance among physicians to diagnosis or even discuss

hypertension with young adults leads to a lack of awareness.

Receiving Lifestyle Education

Three of the five articles specifically looked at lifestyle education as a way to treat

hypertension (Ferrara et al., 2012; Johnson et al., 2014; Johnson et al., 2016). Johnson et al.

(2014) found that 55% of the participants had at least one documented lifestyle education

experience after being diagnosed with hypertension. In a qualitative study performed by Johnson
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et al. (2016) a similar finding was also discovered regarding lifestyle education. What was most

alarming was that over 50% of the young adults who received handouts as education threw them

away as soon as they left the doctors office. This shows that young adults dont utilize the

information they are given.

Ferrara et al. (2012) examined the effects lifestyle education had on adults control of

hypertension. Collecting quantitative data with an experimental design Ferrara et al. examined

188 hypertensive patients that were randomly divided into two groups an Educational Care group

(EC) and a Usual Care group (UC). The EC group participated in small group meetings once a

month for three months. These meetings were run by doctors and well-trained dieticians.

After attending the educational sessions patients were seen at an outpatient clinic by

doctors and dieticians. At these visits they measured the participants blood pressure, weight,

body mass index, caloric intake, lipids, cholesterol, and protein intake. Data was analyzed using

Statistical Package for the Social Sciences; through the data analysis it was found that patients in

the EC group had statistically significant lower blood pressures than the UC group, even at the

two year follow up. The number of patients in the EC group performing physical activity

increased and reached statistical significance. These findings demonstrate the impact lifestyle

education can have on the control of blood pressure. While this study did not examine young

adults specifically the findings can be applied to the young adults population.

Discussion and Implications

The findings of the integrative review address the use of lifestyle education as a

way to manage hypertension in young adults. For that reason, the integrative review findings

relate and support the researchers PICO question. The PICO question specifically looked at the
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effects that lifestyle education would have on young adults awareness of hypertension. Four of

the quantitative studies demonstrated that a statistically significant number of young adults lack

hypertension awareness (Gooding et al., 2014; Johnson et al., 2014, Johnson et al., 2017; Johnson

et al., 2016). If this population is not aware that they have hypertension it is unlikely they are

receiving treatment or making the proper lifestyle modifications to treat their disease. Johnson et

al. (2014) also showed that there is a gap in the number of young adults who even receive

lifestyle education once they are diagnosed with hypertension. Lifestyle modifications are often

clinicians first line of treatment when it comes to controlling hypertension, without proper

education young adults cannot take the first step in controlling their blood pressure. Ferrara et al.

(2012) demonstrated the impact that lifestyle education can have on the control of hypertension

in adults. These findings can be translated to the young adult population. For the young adults

who do receive education often times the material does not meet their specific needs or questions,

this was demonstrated in the two qualitative studies (Johnson et al., 2017; Johnson et al., 2016).

Tailoring lifestyle education to young adults specific needs will make it easier and more likely

for them to follow the guidelines in order to control their hypertension and help prevent future

health problems later in life. Nurses do a large amount of patient teaching; this is one area we

can help to improve and tailor the hypertension education to young adults.

The implications of the findings suggest that lifestyle education needs to be geared more

towards young adults specific needs and questions. In order for these young adults to receive

lifestyle education they must be aware of their hypertension in the first place. One way to do this

would be to encourage young adults to have a consistent primary care provider (PCP). This way,

even if they only go to their PCP when they are sick or once a year for a physical their records

will be in the same place and multiple elevated blood pressure readings are more likely to be
INTEGRATIVE REVIEW 9

caught. The researcher recommends future research should focus on how lifestyle education

specifically geared towards young adults affects their blood pressure control.

Limitations

There are various limitations acknowledged by the researcher that have affected this

integrative review. The integrative review is a class assignment being conducted by only one

novice researcher. The assignment criteria were limited to five journal articles written within the

last five years, this is not an exhaustive review.

Conclusion

By conducting this integrative review the researcher demonstrated the importance of first

identifying young adults with hypertension and then tailoring lifestyle education to meet their

needs. The researcher found a lack of consistent health care, as well as a lack of hypertension

awareness among young adults (Gooding et al., 2014; Johnson et al., 2014; Johnson et al., 2017;

and Johnson et al., 2016). The researcher also found that significant changes in blood pressure

occurred following participation in a lifestyle education program (Ferrara et al., 2012).

Participation in lifestyle education programs has strong positive relationships in long term blood

pressure control. This integrative review demonstrates that young adults with hypertension are

not receiving the lifestyle education they need to control their disease. Nurses have the

opportunity to change hypertension awareness in young adults, first by making young adults

aware of their hypertension and then tailoring the lifestyle education to meet their needs. This

will help young adults have better control of their hypertension and improve their health

outcomes later in life.

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References

Ferrara, A.L., Pacioni, D., Fronzo, V.D., Russo, B.F., Staiano, L., Speranza, E., Gente, R.,

Gargiulo, F., & Ferrara, F. (2012). Lifestyle educational program strongly increases

compliance to nonpharmacological intervention in hypertensive patients: A 2-year

follow-up study. The Journal of Clinical Hypertension 14(11), 767-772. doi:

10.111/jch.12016

Gooding, H.C., McGinty, S., Richmond, T.K., Gillman, M.W., & Field, A.E. (2014).

Hypertension awareness and control among young adults in the national longitudinal

study of adolescent health. Journal of General Internal Medicine 29(8), 1098-1104. doi:

10.1007/s11606-014-28909-x

Johnson, H.M., Olson, A.G., LaMantia, J.N., Kind, A.J., Pandhi, N., Mandonca, E.A., Craven,

M., & Smith, M.A. (2014). Documented lifestyle education among young adults with

incident hypertension. Journal of General Internal Medicine 30(5), 556-564. doi:

10.1007/s11606-014-3059-7

Johnson, H.M., Warner, R.C., Bartels, C.M., & LaMantia, J.N. (2017). Theyre youngerits

harder. Primary providers perspectives on hypertension management in young adults: A

multicenter qualitative study. BMC Research Notes 10(9). doi: 10.1186/s13104-016-

2332-8

Johnson, H.M., Warner, R.C., LaMantia, J.N., & Bowers, B.J. (2016) I have to live like Im

old. Young adults perspectives on managing hypertension: A multi-center qualitative

study. BMC Family Practice 17 (31). doi:10.1186/s12875-016-0428-9.

INTEGRATIVE REVIEW
First Author Aldo L. Farrara (2012) Dr. at department of Clinical and Experimental Medicine at
(Year)/Qualifications
Background/Problem
Statement
Conceptual/theoretical
Framework
Design/
Method/Philosophical
Underpinnings
Sample/ Setting/Ethical
Considerations
Major Variables Studied
(and their definition), if
appropriate
Measurement Tool/Data
11
Appendix 1
Quantitative and Qualitative Tables of Evidence
Federico 2nd University of Naples (Naples, Italy)
Goal of normal BP level achieved in less than 25% of patients DX with HTN
Evaluate whether an educational program dedicated to lifestyle changes to treat
hypertension would be useful in achieving better and long lasting results in the
control of BP levels
Lifestyle changes frequently considered stressful in daily life so they are harder to
maintain and implement
Quantitative? Experimental since they separated into two groups
Experimental (separated into two groups 1-educational care program 2-usual care
program
Educational care program met 3 times a month with doctors and well-trained
dieticians and spoke about different topics like: stress management, explaining the
relationship between sodium intake and hypertension and the importance of a low-
salt diet, recognition of high fat foods How different aspects of the diet can be
controlled/tailored to help treat and control their hypertension
188 hypertensive patients with stable blood pressure levels and drug therapy in the
previous six months
Randomly divided into 2 groups (educational care and usual care)
Followed at 3 moth intervals for 2 years
BP
Body weight
BMI
Caloric intake
Lipids
Cholesterol
Protein intake
Follow-up physical exams with patients after educational courses
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Collection Method
Data Analysis SPSS was used to do a t test for unpaired data and a one-way analysis of variance
with Tukeys multiple comparisons
Findings/Discussion PTS in EC group significantly decreased their overall nutrient intake (specifically
decreased saturated fats and carbohydrates
Number of patients performing physical activity significantly increased in EC
groupreached statistical significance
EC group saw significant changes in BP
o Changes in BP at one year follow up were significantly related to changes in
body weight, BMI, Caloric intake, Lipids, Cholesterol, And Sodium
o At 2 year follow-up when they hadnt had education for a year still had lower
and better numbers
Appraisal/Worth to Educational programs to improve adherence to non-pharmacological treatment of
practice hypertension is a low-cost/effective way to improve outcomes and reduce the risks of
cardiovascular events. May even eliminate drug therapy
INTEGRATIVE REVIEW
First Author Holly C. Gooding (2014) division of adolescent and Young Adult medicine at Boston
(Year)/Qualifications
Background/Problem
Statement
Conceptual/theoretical
Framework
Design/
Method/Philosophical
Underpinnings
Sample/ Setting/Ethical
Considerations
Major Variables Studied
(and their definition), if
appropriate
13
Childrens Hospital and Department of pediatrics at Harvard medical school
Young adults are less likely than older adults to be aware that they have
hypertension.
They are also less likely to be treated for hypertension compared to older adults. No
specific lit review, but reference some previous research in intro.
Aimed to describe rates of hypertension awareness and control using the National
Longitudinal Study of Adolescent Health
Not stated
Cross-sectional study of 13,512 young adults
data collected from 4th wave of the National Longitudinal Study of Adolescent Health
in 2007-2008
at the time participants were ages 24-32 years old
Extracted data
13,512 young adults participating in wave 4 of the National Longitudinal Study of
Adolescent Health in 2007-2008.
Informed consent was obtained during the first wave of the study
IRB approval was given by the institutional review board at the University of North
Carolina Chapel Hill and additional analyses were approved by the Bostons
Childrens hospital Office of Clinician Investigation
Blood pressure was measured by trained ADD Health field interviewers. Stated the
type of BP cuff and measuring device (automatic) approved by British hypertension
society
Stated exactly how they measured the BPs step by step and with what instruments.
This allows you to easily replicate their study
Defined what blood pressure control was (systolic <140, diastolic < 90)
Awareness of hypertension was only assessed in those with uncontrolled
hypertension
Health Insurance status (uninsured, public insurance, or commercial insurance)
based on self report
Recent preventative care (reporting seeing a health care provider for a routine
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check-up within the past 2 years

Self- rated health (excellent vs. very good, good, fair, poor)
Measurement Tool/Data Blood pressure (correct cuff size measured digitally, taken at 30 second intervals
Collection Method from the right arm with patient in resting and seated position after 5 mins.)
Questionnaire/Interview

Data Analysis Bivariate analyses of the covariates of interest

chi-square test for categorical variables
linear regression for continuous variables
Findings/Discussion 3,303 young adults were found to have hypertension.
76% were uncontrolled and
-75% of those with uncontrolled hypertension were not aware they had
hypertension.
-Of those adults those that thought they were in excellent health were 64%
less likely to be aware that they had hypertension
Lack of htn awareness and control may have a significant clinical impact in terms of
increasing rates of M.I., stroke, CHF, and kidney failure as this population ages
HTN awareness higher in young adults who had seen a provider for routine health
care in last 2 years
Appraisal/Worth to Need to increase detection of hypertension in all ages and make the public aware it is not
practice just a disease for older adults. Address young adults access to health care and their
perception of their need for care
INTEGRATIVE REVIEW
First Author Heather M Johnson, (2014) (Department of Medicine at University of Wisconsin
(Year)/Qualifications School of Medicine and Public Health, Part of Health Innovation Program, and
Background/Problem
Statement
Conceptual/theoretical
Framework
Design/
Method/Philosophical
Underpinnings
Sample/ Setting/Ethical
Considerations
Major Variables Studied
(and their definition), if
appropriate
Measurement Tool/Data
Collection Method
15
Division of Cardiovascular Medicine)
Most young adults who have hypertension do not take the proper steps to control it.
Lifestyle education is critical in the control of hypertension.
Looking at lifestyle education (type and frequency) in young adults diagnosed with
hypertension to see if that affects the control of their blood pressure.
Purpose was to determine if ANY documented lifestyle education was present in the
EMR
Not Stated
Retrospective analysis of manually abstracted health records
Quantitative
Random selection of 500 adults ages 18-39 years old for manual electronic health
record chart abstraction
Adults ages 18-39 who were being currently managed for hypertension in a large
Midwestern, multidisciplinary academic group between January 1 st 2008 and
December 31st 2011.
Pt had to meet blood pressure eligibility criteria (Very detailed explanations as to
how patient could qualify for study had to meet certain criteria)
Stated number of adults who met criteria and then clearly stated their sample size
was a random selection of 500 of those people.
Study approved by University of Wisconsin-Madison Health Silences IRB
Mainly looking to see if the young adults received lifestyle education after meeting
the criteria for hypertension
Education had to have been documented and could include topics such as exercise,
alcohol use, stress management/reduction, DASH diet, Low salt/sodium, weight
reduction, or tobacco cessation.
Random selection of 500 adults ages 18-39 years old for manual electronic health
record chart abstraction, 10% random re-abstraction was performed for every 100
patients
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Data Analysis SAS 9.1.3 and Stata/MP 12.1.

Categorical measurements were summarized using percentages
Continuous variables were summarized using means.
Findings/Discussion Most young adults with hypertension were male (62%), obese or morbidly obese
(63%), and had a family history of hypertension and/or premature coronary artery
disease in a first-degree relative (53%).
Overall 55% of patients had at least one documented lifestyle education experience
within meeting the criteria for HTN
Exercise was the most popular topic (64%). Followed by tobacco cessation
Only 25% of patients who were given education received DASH diet education
Comorbities more likely to receive education
Overall 22% did not have any documentation emphasizing a lack of HTN awareness
Young adults males had significantly decreased odds of documented education-
decreased odds of receiving education
Appraisal/Worth to Patient needs to be given proper lifestyle management options of treating disease,
practice especially those in the higher risk category (ie:males) and clinicians need to document this
education b/c if you didnt document it, it didnt happen.
INTEGRATIVE REVIEW
First Author
(Year)/Qualifications
Background/Problem
Statement
Conceptual/theoretical
Framework
Design/
Method/Philosophical clinical practices (academic, rural, and urban clinics)
Underpinnings
Sample/ Setting/Ethical
Considerations
Major Variables Studied Asked 16 questions on the following topics:
(and their definition), if
appropriate
Measurement Tool/Data
Collection Method
17
Heather M. Johnson, (2017) (Department of Medicine at University of Wisconsin
School of Medicine and Public Health, Part of Health Innovation Program, and
Division of Cardiovascular Medicine)
Young adults with hypertension have lowest hypertension control rates.
Differences in young adults and older adults in education
Understanding these differences can allow us to tailor hypertension interventions to
young adults.
Explore primary care providers perspectives on barriers to diagnosing, treating, and
controlling hypertension in young adults.
Multi-center qualitative study
Semi-structured qualitative interviews were conducted in three diverse Midwestern
Primary care providers (physicians and advanced practice providers) actively
managing young adults with uncontrolled hypertension were recruited by the
Wisconsin Research & Education Network (WREN), a statewide practice-based
research network.
Study approved by the University of Wisconsin-Madison Health Sciences IRB. Prior
to starting the interview all participants reviewed an IRB approved summary sheet
and gave verbal consent, written consent had been waived.
1. Personal blood pressure threshold to diagnose HTN and start lifestyle modification
and/or anti-hypertensive medications
2. Reluctance of hesitancy among themselves or their colleagues to diagnose HTN
and/or start medication
3. HTN guidelines applicability for young adults compared to middle-aged and older
adults
Table included in paper that had sample questions
Provider interviews and then a qualitative data analysis of the question content
(coding) occurred.
Data were managed with Microsoft excel
Did not discuss reliability or validity
INTEGRATIVE REVIEW 18

Data Analysis qualitative data analysis of the question content (coding) occurred
Findings/Discussion Clearly listed out variables that were being discussed in each paragraph and gave
samples of the transcripts within the paper.
1. Guidelines and young adults- all providers felt JNC guidelines were applicable to
young adults. 3-6 months of lifestyle modifications needed prior to medication
initiation
2. Reported spectrum of clinical care barriers
Psychosocial consequence of HTN diagnosis (sick identity for young
adults, anxiety, and fear)
A possible false HTN diagnosis (ADHD med and Birth control can
contribute to this)
Visit adherence (decreased visitor adherence among young adults)
Gender differences in BP management (Easier to achieve BP follow-up
among young women b/c of visits required for contraception or b/c visits
coordinated with other members of household, i.e. children)
Reluctant to start BP medication
Appraisal/Worth to Tailored interventions need to be put into place to treat the unique needs of young adults
practice diagnosed with hypertension
INTEGRATIVE REVIEW 19

First Author Heather M. Johnson, (2016) (Department of Medicine at University of Wisconsin

(Year)/Qualifications School of Medicine and Public Health, Part of Health Innovation Program, and
Division of Cardiovascular Medicine)
Background/Problem Young adults in the U.S. ages (18-39) have the lowest hypertension control rates.
Statement GOAL: identify barriers to hypertension control specific to young adults and develop
effective interventions, get insight from young adults about their experiences in
order to do this.
We need to understand their perceptions and feelings about hypertension control
so we can give them the education they need to lower their blood pressure and
keep their hypertension under control
Multiple prior studies have demonstrated that there are provider barriers in new
diagnosis of HTN-specifically lack of documented lifestyle education
Conceptual/theoretical Theoretical framework: philosophy not discussed in the body of the paper or the
Framework abstract
Multi-center qualitative study
Design/ Focus groups= selected methodology
Method/Philosophical Theoretical framework: philosophy
Underpinnings Philosophical underpinning: phenomenology

Sample/ Setting/Ethical Young adults ages 18-39 diagnosed with hypertension in Wisconsin.
Considerations 38
Eligible pts were identified via medical health records and invited to participate in
the study by their primary health care provider, study recruitment flyers were also
placed in family medicine waiting areas allowing pts to directly contact the
researchers to participate in the study.
Received IRB approval by the University of Wisconsin-Madison Health Sciences
IRB. All participants reviewed an IRB-approved summary sheet about the research
and provided verbal consent. (IRB WAIVED WRITTEN CONSENT).
Study recruitment flyers were also placed in select waiting areas of family clinics.
Major Variables Studied . Four topics explored in focus groups
(and their definition), if 1. Emotions and reactions after an initial hypertension diagnosis
appropriate 2. Young adults knowledge about hypertension and future health risks
3. Young adults attitudes and barriers to hypertension lifestyle modifications
INTEGRATIVE REVIEW 20

4. Cost-benefit analysis of adhering to blood pressure medication

Measurement Tool/Data
Collection Method
Data Analysis
5. Social media use among young adults for hypertension self-management
Young adults hypertension focus group, coding of transcripts
Conventional content analysis used to code interview transcripts.
Included examples of focus group questions

Findings/Discussion Most were surprised and angry about diagnosis, expected to develop HTN at older age,
HTN diagnosis negatively altered their young personal identity, making them feel older
than their peers. Current HTN education materials do not address young adults health
questions.
Four topics explored in focus groups
1.Emotions and reactions after an initial hypertension diagnosis (surprised, scared,
angry) (concerned about negative stigma associated with HTN)(many had prior
experiences with family members who had HTN)
2. Young adults knowledge about hypertension and future health risks (all
participants able to give one complication, Less than half of the respondents
reported receiving HTN education, of those respondents who reported
receiving pamphlets/handout >50% threw them away
3. Young adults attitudes and barriers to hypertension lifestyle modifications
(have to act older than their biological age)
4. Cost-benefit analysis of adhering to blood pressure medication(HTN often
asymptomatic so they dont think they need meds)
5. Social media use among young adults for hypertension self-management
(last part of focus group addressed possible social media solutions to
improve HTN management- Respondents did not like this, concerned about
peers finding out)
DISSCUSSION:
Self-identity as young adult is negatively altered
Touch on all 4 of the topics that were discussed in the focus group and expand on
how they can benefit current practice
State changes that need to be made to improve practice
States strengths, but also states problems/weaknesses with in their study
INTEGRATIVE REVIEW 21

Appraisal/Worth to Need to target interventions when educating and treating young adults with HTN. May
practice have to do multiple education sessions and emphasize that it is ok to ask questions
High-light need for expanded team-based care to increase patient care provider
communication (to help improve practice and health outcomes)