{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T10:08:05Z","timestamp":1789553285492,"version":"build-2803163510"},"reference-count":45,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"12","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2026,6,16]]},"abstract":"<jats:sec xml:lang=\"en\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p xml:lang=\"en\">Blood pressure\u2013related deaths from cardiovascular disease are higher in rural than in urban areas in the Unites States, especially in southeastern states. However, the barriers and potential solutions to hypertension care are inadequately understood.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p xml:lang=\"en\">We interviewed 62 local community and health systems key informants in 2 rural (Pamlico and Robeson) counties in North Carolina. Probes based on the Consolidated Framework for Implementation Research were used to identify contextual barriers and facilitators affecting existing resources and services for improving hypertension care. Data were analyzed using hybrid deductive and inductive approaches, and organized into themes and subthemes with illustrative quotations.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p xml:lang=\"en\">The prominent barriers of hypertension care emerged across outer setting (economic constraints, insufficient health insurance, food insecurity, wide accessibility of processed food, lack of transportation, digital connectivity gap, limited awareness of partnership and resources, and mistrust), inner setting (provider shortage, weak communication, rural food culture, and mistrust of health systems), and individual level (low health literacy, chronic stress, and a sense of hopelessness). The most cited facilitators were codesigning task\u2010sharing approaches to hypertension care with community outreach that are tailored for rural settings, targeted subsidies for healthy food and health care, and trust building with the community, preferably led by faith\u2010based leaders.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p xml:lang=\"en\">Our findings based on consultations with diverse community and health systems partners show key challenges and highlight potential solutions to improve blood pressure control and cardiovascular health in rural communities in the United States. Concerted efforts to codesign hypertension care programs that are multisectoral, build on local resources, and include community outreach and trust building efforts are likely to be acceptable, effective, and sustainable.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1161\/jaha.125.048469","type":"journal-article","created":{"date-parts":[[2026,6,15]],"date-time":"2026-06-15T12:16:11Z","timestamp":1781525771000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Identifying Contextual Barriers and Potential Solutions to Improving Hypertension Management in Rural Communities in the United States: Qualitative Study From 2 North Carolina Counties"],"prefix":"10.1161","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7454-8376","authenticated-orcid":false,"given":"Tazeen H.","family":"Jafar","sequence":"first","affiliation":[{"name":"Duke University","place":["Durham"]},{"name":"Duke\u2010National University Singapore Medical School","place":["Singapore, Singapore"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7494-1581","authenticated-orcid":false,"given":"Sumedha","family":"Ariely","sequence":"additional","affiliation":[{"name":"Duke University","place":["Durham"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Diana","family":"Silimperi","sequence":"additional","affiliation":[{"name":"Duke University","place":["Durham"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-5838-5702","authenticated-orcid":false,"given":"Michelle","family":"Liang","sequence":"additional","affiliation":[{"name":"Duke University","place":["Durham"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jacqueline","family":"Davis","sequence":"additional","affiliation":[{"name":"University of North Carolina Chapel Hill\u2010Pembroke, Community Health and Wellness Institute","place":["Pembroke"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nancy","family":"Hunt","sequence":"additional","affiliation":[{"name":"University of North Carolina Chapel Hill Health Southeastern","place":["Lumberton"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-1031-8194","authenticated-orcid":false,"given":"Emily","family":"Payne","sequence":"additional","affiliation":[{"name":"Duke University","place":["Durham"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hillary","family":"Hsu","sequence":"additional","affiliation":[{"name":"Duke University","place":["Durham"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kate","family":"Seneshen","sequence":"additional","affiliation":[{"name":"Duke University","place":["Durham"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-2720-4489","authenticated-orcid":false,"given":"Nancie","family":"Deckard","sequence":"additional","affiliation":[{"name":"Duke University","place":["Durham"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8370-6647","authenticated-orcid":false,"given":"Hannah","family":"Lane","sequence":"additional","affiliation":[{"name":"Duke University","place":["Durham"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9586-923X","authenticated-orcid":false,"given":"J. 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