Date of Award

May 2020

Degree Type

Dissertation

Degree Name

Doctor of Philosophy

Department

Nursing

First Advisor

Rachel Schiffman

Committee Members

Julia Snethen, W Hobart Davies, Mary Hagle

Keywords

hypertension, self-management, telehealth, veteran

Abstract

Hypertension is the most common diagnosis among Veterans, contributing to approximately 15,000 veterans hospitalized for stroke every year. The high prevalence of hypertension found in the Veteran population suggests a need to better define the risks and benefits associated with the diagnosis and treatment of hypertension. The U. S. Department of Veteran Affairs (VA) home telehealth program provides chronic care management for hypertension to facilitate Veteran access to care. Existing evidence suggests Veterans’ monitoring of blood pressure at home may selectively assist in managing hypertension. This secondary analysis of data used a self-management lens to assign meaning to traditionally demographic variables from a primary study. The purpose of this study was to explore whether the risk and protective factors of age, ethnicity/race, marital status, living arrangement, number of diagnosed chronic illnesses, and number of instrumental activities of daily living impairments, along with the self-management behavior home telehealth utilization rate, contribute to predicting success in maintaining blood pressure targets by Veterans who are participating in home telehealth services to manage hypertension. The sample was 107 Veterans with a mean age of 73.97, years with few participants below the age of 60. The majority of participants were married and living with their spouse or in a living arrangement with others. Most participants were white. Results from this study indicated that success in both outcomes home telehealth utilization rate and maintaining blood pressure targets were partially predicted by age. Age and number of chronic conditions explained 15% of the variance with home telehealth utilization rate and explained 14.4% of the variance with maintaining blood pressure targets. Results also indicated that the outcomes home telehealth utilization and maintaining blood pressure targets were not related; therefore, home telehealth utilization rate was most likely not a mediator between age and maintaining blood pressure targets. Tailored interventions based on age and chronic conditions may impact outcomes for Veterans self-managing blood pressure through VA home telehealth services.

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