January 18, 2011 / 9:02 PM / 8 years ago

"Storytelling" found to aid blood pressure control

NEW YORK (Reuters Health) - People who have trouble keeping their blood pressure in check might benefit from hearing about other patients’ struggles with the same problem, a preliminary study suggests.

The study, of 299 African-American patients with high blood pressure, looked at the effects of so-called “storytelling” on participants’ blood pressure control. About three-quarters of the people in the study were women.

Researchers randomly assigned half of the patients to watch a series of three DVDs featuring other patients — not actors — recounting their own struggles with learning to rein in their blood pressure numbers. The rest of the patients - who didn’t get any DVDs — served as a comparison group.

DVDs were distributed at the start of the study, three months after the start, and again six months after the start. Periodically, the researchers would ask participants how much time they’d spent watching the DVDs. On average, participants said they watched for a total of nearly 90 minutes over the entire length of the study.

In general, the DVDs didn’t make a difference to people whose high blood pressure was under control.

But the DVDs did seem to help those who had high blood pressure at the start of the study, the research team says. In those men and women, systolic blood pressure — the first number in a blood-pressure reading — dropped by 17 points, on average, after three months. Their diastolic pressure (the second number in a reading) dipped by about 7 points.

That compared with declines of 6 points and 1 point, respectively, among patients with uncontrolled blood pressure who were in the comparison group.

In contrast, patients whose high blood pressure was under control at the outset did not seem to benefit from the DVDs.

The findings, reported in the Annals of Internal Medicine, suggest that at least some people with high blood pressure may respond to hearing from people similar to themselves — rather than just their doctors.

The theory, said lead researcher Dr. Thomas K. Houston, is that “the more you relate to the person in the story, the more engaged you become.”

That’s in contrast to hearing “just the facts” from your doctor, according to Houston, of the University of Massachusetts Medical School in Worcester.

The researchers are not sure why patients who saw the DVDs tended to fare better. (In fact, they had to take the patient’s word that he or she had actually watched the DVDs at all.)

It’s possible that people in the DVD group were more likely to stick with their medication, or make diet and exercise changes, according to Houston. But the study did not measure those behavior changes.

So, many questions remain for future studies.

One is how widely effective any set of collection of stories might be. In this study, the participants and the patients in the DVDs were all from the same inner-city Alabama medical clinic.

“The question is, would these DVDs made in Alabama be useful if you gave them to patients in Chicago, or in LA?” Houston said in an interview. Or would individual medical centers have to create their own videos?

Another question is how long any benefits of storytelling might last.

Houston’s team found that six to nine months after the study’s start, patients’ average blood pressure had started to move upward, though to a lesser degree in the DVD group.

“We would anticipate that the benefit would be likely to wane,” Houston said. He added, though, that any storytelling tactic would only be part of overall care for people with high blood pressure.

“It might help,” Houston said, “by opening the door to people talking more with their doctors.”

In the study DVDs, one of the topics patients discussed was how they had learned to best communicate with their doctors.

An editorial published with the study calls the findings “provocative,” but also says storytelling is not yet ready for the medical mainstream.

“Stories are unlikely to become a routine part of treatment until additional evidence shows that their effect is both sustainable and generalizable,” write Drs. Kimberly R. Myers and Michael J. Green, of Penn State College of Medicine in Hershey, Pennsylvania.

They add that an “intriguing” question is whether online social networks, like YouTube and Facebook, could be used for medical storytelling.

Houston pointed out that such videos need not be Hollywood production value. To create their DVDs, he and his colleagues took a low-cost approach — complete with “bad lighting” and editing by the researchers themselves.

The study was funded by a national program of the Robert Wood Johnson Foundation called Finding Answers: Disparities Research for Change.

SOURCE: bit.ly/eUB2uC Annals of Internal Medicine, online January 17, 2011.

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