Emergency Department Patient Perspectives on Barriers to Hypertension Control in Disadvantaged Communities

Background: Uncontrolled hypertension (HTN) is frequently detected in United States emergency departments (EDs), particularly among patients affected by social determinants of health (SDOH).Community health workers (CHWs) represent a promising strategy to address SDOH-related challenges, yet their role in ED-based interventions is not well defined.This study explored ED patient perspectives on how adverse SDOHs can be a barrier to HTN control to inform the design of a CHW-led ED intervention.Methods: This mixed methods study was conducted at an academic ED in New York City.Patients 18 years with HTN defined as two blood pressure 140/90 readings were eligible.Participants completed the PRAPARE survey (a validated tool to collect SDOH data) and a semistructured interview on barriers to HTN control, access to resources, and potential roles for CHWs.Interviews were audio-recorded, transcribed verbatim and analyzed for themes by two independent investigators.The PRAPARE survey analysis is not reported here.Results: Fourteen participants completed the survey and interview.Thematic analysis revealed key SDOH, including limited health literacy, community violence, and economic instability.Participants identified CHWs as potential navigators who could reduce disparities in HTN control by connecting them to needed services. Conclusion:Preliminary findings suggest CHWs may be well positioned to support HTN management in ED populations facing social adversity.The descriptive analysis of the PRAPARE results and triangulation of quantitative and qualitative findings will be used to guide the design of a tailored CHW-led ED intervention to address the unmet needs of socioeconomically disadvantaged communities.