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Focus Groups for the Hypertension Health Action 7 focus groups 2 Villages in At-Bashy Rayon: Acha-Kaindy and Kara-Suu

In the PRA sessions, why did people choose high blood pressure as a health priority? Summary: People in the focus groups definitely recognized that high blood pressure is a problem that affects many people in the village and has serious consequences (thus it was chosen as a health priority in PRA sessions). Specific Answers: ! The number of people with this disease is high. (2) ! High blood pressure has many harmful effects ! Even young people have high blood pressure ! In every house, at least two people have high blood pressure ! High blood pressure can cause infarct ! People need a regimen/treatment ! This is the worst disease ! Your head starts spinning and you cant walk ! Who knows. We didnt know much about HBP, we just agreed with what other people were saying. But we think HBP is a big problem in our village. ! Out of 10 people, probably 7 or 8 have HBP ! We are at a high altitude and we have been eating fatty food since we were born. When a person gets older, high blood pressure just appears. What have you heard about high blood pressure? Summary: Overall, it seemed like people didnt know much about high blood pressure. The groups couldnt really provide a coherent answer to this question. There seemed to be some misconceptions about high blood pressure.

Specific Answers: ! We dont know / We dont know anything about high blood pressure ! We havent heard anything. Who would we hear about it from? (2) ! Maybe it is because of the air / the air and weather affects high blood pressure; even young people have high blood pressure ! We live in a very high altitude, which is why there is a lot of HBP. Doctors came to this village and said many people have HBP. ! Maybe it is due to eating very little meat or vegetables ! Your head starts spinning (2) and you get a heartache ! You get headaches ! People came around and checked blood pressure; then told us that we have high blood pressure ! A doctor came to our houses to check our blood pressure frequently ! We dont know. We just take the medicines that the doctor gives us. ! Your blood gets dense and it cannot circulate. People think if they drink vodka it will thin their blood.

! When a person has an infarct they should keep up a regimen but we cannot keep up this regimen. Regimen = to treat high blood pressure you have to calm down and eat light food. We have to work so we cannot stick to this regimen. ! You fall down and you have to go to the hospital What are the effects/results of high blood pressure? Summary: When we asked this question in an open-ended manner, we got very diverse answers (as shown below). However, when we probed regarding stroke and infarct, it seemed that the groups had heard of infarct and stroke as consequences of high blood pressure. Terrible headaches were frequently mentioned throughout the focus groups (both with this question and with other questions). Specific Answers: ! Headache (2) ! Death ! It gets dark in front of your eyes ! Your head starts spinning; your eyes spin ! Impaired vision and hearing ! Your heart beats fast ! Your kidneys start to hurt; it feels like your kidneys are inflated and pulsating ! Back pain ! Your neck hurts ! You cant walk ! You faint (2) ! If you faint you will fall down and hurt yourself (2); you can fall down and die (2) ! It can affect your memory ! You can have an infarct (3) ! Stroke (1) ! Whatever illness you have, it can lead to high blood pressure. ! You fall down when your blood pressure is very high ! People die because too much blood goes to their head. This causes them to die. ! If you dont stick to a regimen it leads to infarct and death How do people know that they have high blood pressure? How do they find out? Summary: The most common answer was that they would develop a very bad headache and dizziness. These symptoms would prompt them to go to the FGP/FAP, where they would be told they have high blood pressure.

Specific Answers: ! You faint ! You cant walk ! You have a terrible headache; then you go to the FAP and find out your BP is high (4) o If you have a terrible headache, you need to lie down. You go to the doctor and the doctor checks your blood pressure. They tell you that you have HBP. ! You have double vision; your head starts spinning (2); you feel nauseous

! You cannot stand up ! When you have symptoms (such as those mentioned above) you go to the FGP/FAP to get your blood pressure checked and they tell you that you have high blood pressure ! When the symptoms get really bad we call the FGP/FAP and they prescribe some medicines ! Your eyes and head start spinning. The doctors said if we have really bad headaches or feel like we will faint, it is HBP. The doctors just look at the symptoms and tell us that we have high blood pressure. As soon as we are told we have high blood pressure, we buy medicines. ! The effects of high blood pressure (headache, dizziness, etc.) dont always happen. It just happens from time to time When people have been told that they have high blood pressure, are they worried about it? Do they feel like they should do something about it immediately? Summary: Everyone answered, of course we are worried. In fact, bringing up the topic of worrying caused the groups to start talking about all their worries (both related to blood pressure and not related). The groups indicated that overall they are willing to take immediate action to lower their blood pressure (including slaughtering animals to get money for treatment). Specific Answers: ! Yes, of course we worry. We worry about everything because we have no money. We worry about poverty. We quarrel with our children when they ask for money. Before (during the Soviet times) we didnt worry about anything. Now we dont even have water pumps. During the Soviet times you could buy anything; you could buy a lot of food for only 5 soms. Now we have a lot of problems. We havent bought new clothes since the breakup of the Soviet Union. We use all of our money for food. Our 1,000 som pension doesnt help because prices have gotten much higher. We worry a lot about our small pensions. ! Of course we worry. We are willing to slaughter our only goat to get money for treatment ! Yes, of course we worry. But the doctors will just prescribe medicine. We know we should take the medicines that doctors prescribe. ! Of course we are worried. Of course we are willing to take medicine. ! Before, you couldnt find this disease among young people, but now very young people are getting it. ! Yes of course we are worried. We feel we should act immediately. We have our blood pressure checked by nurses. ! Of course, but what can we do? It is difficult to pay for treatment. If one day your BP suddenly gets very high you could die. People with high blood pressure worry a lot. Do you feel like you know what to do about your high blood pressure? If someone has high blood pressure, what can be done about it? What can people do to reduce their blood pressure? Summary: For the most part, the groups spontaneously mentioned the need to take medicine. They also mentioned that they try to just be calm, lay down, or relax. Stress and worrying was a major them that came out of this question. One concerning answer was that doctors told them to drink 100 grams of vodka to lower blood pressure. As evidenced by the comments below, there seems to be some misconceptions regarding ways to treat high blood pressure (ie, tea drinking, not walking, soup consumption [unless maybe this relates to salt intake]).

Specific Answers: ! Take medicine; go to the doctor and they will give you medicine; drug regimen (4) ! Be calm (3); lay down (2) ! Keep your nerves in tact ! Go on a diet ! Drink 100 grams of vodkathe doctor told them to do this o Women take medicine for HBP, but men drink vodka ! Avoid quarrelling with children ! Whatever we hear from our neighbors, we do [*there seems to be a strong word-of-mouth effect] ! The doctors say not to eat heavy foods (3) ! When you get medicine you learn how to treat HBP ! Dont drink tea ! We do whatever the doctor says we should do ! Dont walk so much ! When we asked one group who told them about things they could do to lower their BP, they said when you have a disease you become your own doctor. ! I dont know what to do. I have problems within the family and with my children. How can I not think about it? ! Drink green tea ! When you get older people tell you not to eat heavy food, but we cannot live without meat ! Take medicine and lay down and it will pass ! You must turn to your doctor and they will give you medicine ! You shouldnt drink soup or red tea; soup makes your blood pressure high; if you boil mutton in water and then drink the remaining broth as a soup, this will give you high blood pressure How many people in this group have high blood pressure? How many are taking medicines? Summary: In most of the groups at least half had high blood pressure. There were varying answers regarding the number of people in the group who take medicines. However, the common theme throughout the focus groups was that people usually only take the medicines when they are feeling bad or feel that their blood pressure is very high (ie, they dont take medicines consistently). In this question, and in others, people mentioned their worries about side effects of the drugs. Also, concerns about efficacy and cost of the drugs were mentioned.

Specific Answers: ! One group8 out of 10 had high blood pressure; in that group, 4 people were currently taking drugs. One group said they thought out of 15 people with HBP, usually 3-4 are taking drugs. ! In one group, a man commented that he uses medicines but he thinks that they dont work. He still gets bad headaches. He stopped using them consistently. He thinks that if he takes them consistently there will be bad side effects. He feels resigned to the fact that due to old age, he cannot do anything about his high blood pressure. It is caused by worrying a lot. ! One group3 out of 8 people have high blood pressure and all of them are taking medicines (at least whenever they have symptoms) ! In one group, 6 out of 7 people have high blood pressure; 4 of those people take medicines. One lady commented that she takes medicines only when her BP gets really high. Three people said they take medicines when they have a headache.

! One group6 out of 7 people have high blood pressure; Out of those, only one man said he takes medicine regularly (but he thinks it doesnt help). The rest just take medicine when they think they have HBP. Sometimes there is money and sometimes there is not. ! One groupall 8 people in the group have high blood pressure; out of this group, two older ladies take medicines sometimes. One man doesnt have access to medicines because you cannot purchase them in this village. ! One group4 out of 8 people in the group have high blood pressure; only one of those takes medicine occasionally What factors make high blood pressure more likely? Summary: Almost every group mentioned worrying as the top cause of high blood pressure. Without our prompting, they mentioned stress/worrying right away when we asked this question. Stress, worrying, and conflicts within families were major themes that came out of the focus groups. People in the focus groups seemed to correctly identify stress as a cause of high blood pressure. Specific Answers: ! Worrying [this was frequently mentioned] (4) o We worry about money, food, our pensions ! One group said that they had heard of overweight and a diet high in salt as risk factors, but they said they dont use much salt now. Also, they commented that even very thin people have high blood pressure. ! When life is not correct. When you think too much. When you lack things in life. ! The older they are, the more likely it is that they will have high blood pressure; Age ! The food you eat (2) ! The weather ! Being angry What other behaviors or life factors can lead to heart disease and stroke? Summary: Again, worrying and stress were two of the first things mentioned when the groups answered this question. One group correctly identified poor diet as a potential factor. One group identified (without prompting) smoking as a risk factor. One person had heard on the radio that diabetes leads to infarct. Overall, though, without prompting, the groups did not mention smoking, overweight, or diabetes. Specific Answers: ! Worrying about poverty; worrying strongly about something ! When you think a lot about your family; the psychological climate in the family ! Quarrels in the family ! When things in life are just not enough; when you lose a sheep you get HBP from worrying ! Diet/food ! We have heard that smoking is harmful for your health but we smoke anyway. We cannot stop. One man commented that he knew smoking was harmful for his lungs, so he stopped and started using chewing tobacco ! They are caused by high blood pressure (2); a person falls down and too much blood goes to their head

! High altitude ! One person said they heard on the radio that diabetes leads to infarct ! One group indicated that they had heard of diabetes and smoking as risk factors o But the women in this group said we dont smoke and we still have HBP If someone with high blood pressure is not doing anything about it (not doing anything to lower their blood pressure), why is that? If people with high blood pressure dont take treatment, what are some of the reasons? Summary: The high cost of drugs was mentioned in four of the focus groups. Other answers were: 1) not believing in the efficacy of drugs, 2) worrying about side effects, 3) drugs not available in the village, 4) using other means to lower BP, and 5) ceasing use of medicines when BP goes down. Specific Answers: ! One woman said that her husband does not believe in taking medicine. He says he doesnt really know whether or not medicine works ! Some people dont trust in medicines ! People dont want to go to the doctor. They just want to die at home. ! High cost of medicines; there are families who cannot afford to buy medicines (4) ! Some people believe that medicines are effective o One group commented that they do trust that medicines are effective ! We need more humanitarian aid medicine ! People worry about the side effects ! We just lay down and try to be calm ! There is no pharmacy here so we cannot buy HBP medicines; drugs are not available in this village; we just take aspirin; You can only buy HBP drugs in the center. We cannot reach the center; the doctor talks to us about needing to take medicines but we cannot buy them here ! Strong-willed people think they will just drink tea and their high blood pressure will go away ! One group commented that they dont know anyone who refuses to take medicines. Whenever they have high blood pressure they turn to doctors for advice and the doctors prescribe medicines. ! We cant answer for other people. Each person has to decide for themselves. ! Stupid people dont take medicine ! We just drink green tea and it lowers our blood pressure ! People would take medicines if they were available for free through humanitarian aid, but they wont buy them ! It is that persons will; If I die, then I die. It is my business. ! One person commented that some people dont want to go to the doctor because it costs money even to go to the clinic. But another person clarified that it only costs money if you go to a private clinic (200 soms). ! If people take medicines their blood pressure gets very low. If their blood pressure gets low they stop taking their medicines. ! One woman commented that she takes medicines but doesnt feel that they are lowering her blood pressure (she takes Atenelol) ! The doctor tells us that if our BP gets lower (or within the normal range) we should stop taking the medicines. We just do what the doctor says.

! Instead of taking drugs people drink vodka or herbal treatment such as Kokomerin or Zveraboi; Our people think that if you drink 50 grams of vodka it will normalize your blood pressure; but one lady in the group commented that she thinks vodka makes BP even higher Do you know what treatment for high blood pressure costs? Summary: There was a wide range of answers to this question, as it depends upon whether the person takes drugs consistently or only when they feel bad. It definitely seemed as though the cost of drugs in the villages is much higher than the cost reference sheet we looked at. Also, in the second village we visited, the drugs were not available in the village, so when answering the question, people were factoring in the cost of transportation to At-Bashy. See below for specific answers.

Specific Answers: ! Following are the answers from group one: o Isoptin; 1 package (48 tablets) costs 140 soms; she takes 2 tablets per day o ; 10 tablets costs 70 soms; they take 2 tablets per day o (Enalapril); 20 tablets; this woman got them for free from humanitarian aid but she thinks this amount would cost 50 soms; 20 tablets would last her for 10 days o This group replied that they think the average cost of HBP medicines is about 300 soms per month ! Following are the answers from group two: o 10 tablets costs at least 100 som o One woman pulled out a bag full of medicines and showed it to me. She had Isoptin, Nitroksilin, Atenelol, Cefuroxime Axetil. She said that 10 tablets costs 100 soms and she uses the medicines whenever she feels bad. The medicines help with the headache immediately. o We dont know the average monthly cost, we just buy the medicines when we need them. Whenever we have HBP we just buy the medicines no matter what the cost is. We will agree to buy them no matter the cost because there is no other option. o The average monthly cost can be between 300 and 500 soms. ! Following are answers from group three: o One woman said the last time she bought blood pressure medicines it cost her 300-400 soms o One lady said she pays 400-500 soms per month. Sometimes she takes the medicines regularly and sometimes she only takes them when she feels bad. This woman is only 42 years old. ! Following are answers from group four: o 180 soms per month o 105 soms per month ! Following are answers from group five: o Much money o First, you must pay for transportation to the center (this is 60 soms); then you pay maybe 150-200 soms for the medicines; in total you can pay up to 300 soms o 20 tablets lasts 10 days; you need 60 tablets per month and this costs 60 soms (but the woman who said this gets her medicines for free) ! Following are answers from group six: o Our children bring us medicines from the center so we dont know the exact cost

o o

These drugs are not available here When HBP occurs it is costly

If you have high blood pressure, has your doctor ever talked to you about drug treatment? Summary: The groups unanimously said that the FGP/FAP talks to them about the need to take medicines.

Specific Answers: ! Yes, the doctor prescribed medicines ! We talk with the doctor about our high blood pressure ! The doctor also talks about stress and nervousness as causes of HBP ! Yes, the doctor talks to us about needing to take drugs ! Yes, the doctor tells us to take drugs but they tell us to only take them when headaches occur Do you think that treatment for high blood pressure can be short-term or is a lifetime treatment? If you are taking drug treatment, do you take your drugs every day? If not, why? Summary: Most people are only taking their drugs when they feel bad or are having a hypertension crisis (extreme headaches, dizziness, fainting). When asked, most people thought they should just take drugs when they feel bad (and not take them consistently). They commented that it is dangerous to take the drugs consistently because your blood pressure could get dangerously low. Also, fear of side effects was mentioned a couple of times. There seems to be two problems: 1) the appropriate long-term (lower-dose) drugs are not available at the village level, and 2) there needs to be greater patient education so that people understand they have to take the drugs consistently for the long-term (even when their blood pressure goes down). It seems like there is a very low level of awareness regarding the proper use of medicines, side effects, etc.

Specific Answers: ! We always keep our medicines with us and when we get a headache, we just take them. However, they indicated that they understand it is a lifetime medicine. It depends upon what the doctor says. For people with high blood pressure, the doctor sometimes tells them to take the medicines every day, but when their blood pressure goes down, the doctor says it is okay to stop taking the medicines, so they stop. When they have a bad headache again they start taking the medicines again. When we realize that our blood pressure has gone down we stop taking medicines unless we get a headache again. One woman in the group said that she consistently takes medicine for her high blood pressure. She pays 500 soms a month and she thinks this is a normal amount of money to pay for her health. ! When we feel bad and think we may have high blood pressure, we go to the doctor. The doctor tells us to take medicines for a certain amount of time. One man commented that he just tries to relax and calm down when he feels that he has high blood pressure. We trust the Family Medicine Center. They know well how to treat high blood pressure. The FMC doctor tells them that when their blood pressure goes down again they can stop taking their medicines. However,

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when asked specifically, this group commented that they understand that the medicines have to be taken consistently for your lifetime. One man commented that he used to take blood pressure medicines consistently, but he heard that there are side effects (its not good for your internal organs) so he stopped taking them consistently. When probed, he said that he had read this in the newspaper. One man said he stopped taking his medicines regularly because he was afraid that he would develop stones in his liver. One group commented that they take medicine only when their blood pressure gets really high. We would die if we constantly took medicine. If you constantly took medicine, your blood pressure would get too low. If we took medicines constantly, we wouldnt be able to walk. It is dangerous. We just take the medicines when we feel bad and dont take them when we dont feel bad. We know that our blood pressure is high because we get a bad headache, we dont feel good, we are in a bad mood. After we take the medicines we feel better. We go to the doctor and ask if we should continue to take the medicines. If the doctor measures our blood pressure and it is lower, the doctor says it is okay to stop taking the drugs, so we stop. *This group mentioned concerns regarding side effects of the medicines. Who knows if it is a lifetime drug or not. We just use drugs when we have HBP. If we feel well we do not take medicines. These drugs are short-term; we only take them whenever our high blood pressure occurs. One woman replied that she takes medicines consistently. She has been taking them for three years now. She gets them for free from the local doctor through humanitarian aid. We only take drugs when our blood pressure gets high [most common answer]

What would you be willing to pay for high blood pressure treatment if it would lower your blood pressure and reduce your risk of heart disease and stroke? Would you be willing to pay 80-100 soms per month for treatment? Summary: Overall, the groups seemed very willing to pay 100 soms per month for drugs. However, cost was mentioned as a possible issue for some people/families.

Specific Answers: ! We would be willing to pay 100 soms per month. Our pension is 600-1000/month so we would be able to pay for the drugs. We cannot speak for other people in the village, but we would be willing and able to pay 100 soms per month. ! Some people can and some people cant afford to purchase medicines. We have to buy them from our pensions. ! One group commented that most people would be willing to pay between 400 and 500 soms per month for drugs. Of course, we are willing to pay 100 soms per month. We are already spending at least that much. ! The amount of money we would be willing to pay depends upon how bad we feel. Only a little medicine costs a lot of money. There is no work for the youth so they have no money to buy drugs. ! The amount of money people are willing to spend varies by person. It depends on whether or not you have to take the medicines consistently or not. ! Yes, most people would be willing and able to pay 100 soms/month because they have their pensions

! Those with HBP would be willing to pay 100 som/month. The people who really suffer would be willing to pay 100 som/month. Some families may not be able to afford this. They only go to the doctor when they are close to death. Last year a 48-year old man died of HBP. Eight years ago he had an infarct but he couldnt afford medicine. What does it cost if someone has to go to the hospital for heart problems/infarct? Summary: The answers ranged from ~3,000 soms to ~8,000 soms.

Specific Answers: ! Much money (2). 1 calf (5,000 soms). It could even be more. ! One woman commented that she sold a cow for 10,000 soms to pay for her operation and even that was not enough. ! It costs between 5,000 and 8,000 soms if you have to go to the hospital for infarct. You have to spend at least 7 days in the hospital, and then you have to go to the therapy department. ! Much money. 1,150 soms just for the bed. But with the health security card it may cost less. 2,000 soms for the medicines ! The cost depends upon which medicines you are given. One lady said that she was hospitalized for diabetes and had to pay 3,000 soms. ! 120 soms for transportation to the hospital; 900 soms to be admitted; then you have to pay for the medicine What would convince people to spend money on treatment for their high blood pressure? Summary: Overall, it seems that it is not necessary to convince people to spend money on treatment. The barriers to proper treatment seem to be related more to cost, availability of the proper drugs in the villages, and education regarding the proper use of drugs. Specific Answers: ! Those who have high blood pressure will not refuse to buy treatment. It is not necessary to convince. Mostly people with livestock who are very busy are the ones who dont take medicines. Also, people who had high blood pressure and were taking medicines but then had an infarct--they no longer believe that medicines work. ! You dont need to convince. Those who think about their health of course will spend the money. If you have high blood pressure, tell us what are some of the barriers/obstacles to lowering your blood pressure? What are some reasons it is difficult to lower your blood pressure? Summary: This might have been a confusing question because we got very inconsistent and incoherent answers to this question. Specific Answers: ! None, if we take medicines our blood pressure goes down (2) ! You cannot root out the disease, it just keeps occurring

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High altitude The air. Only God knows. Heavy air Age

Are you currently taking or have you ever tried taking any herbal treatment for your high blood pressure? Summary: Several groups mentioned the use of a grass called Kokomerin. Also, a couple groups mentioned drinking green tea to lower BP. Specific Answers: ! We havent tried this. Only those who know about this should use it. ! One lady in a focus group had tried an herbal grass treatment. People also mentioned that they think green tea can lower BP (2). They think these herbal treatments may work. ! Yes, we have tried herbs. We collect a grass from the mountains called Kokomerin. For some people this grass helps. (2) ! We have tried Kokomerin but it doesnt work If we tried to get people with hypertension together frequently to discuss topics/information related to prevention of hypertension/heart disease (and to measure blood pressure), do you think people would be interested in this? Summary: People seemed very positive and enthusiastic about the idea of hypertension clubs. All the groups said they would be interested in these clubs and would participate. I think one of the major selling points for the clubs is the opportunity to get your blood pressure checked on a consistent basis. Many people mentioned that they wanted to get their blood pressure checked frequently.

Specific Answers: ! Yes, we would be interested in a hypertension club. We would go to club meetings. Of course people would be interested if they had high blood pressure. Those who suffer from HBP would do anything to get their blood pressure checked, so they would be very interested in getting their blood pressure checked regularly. Even people who are not members of the club would come to club meetings just to get their blood pressure checked. ! Of course we are interested. We would definitely attend meetings. This would be very useful. ! One lady commented: Okay, we would go to the meetings, but then we would come home to family quarreling and we would have high blood pressure again. ! Yes, would be interested in these clubs. We would attend (2) ! We would be willing to go because it is for our health, and it is free. ! Yes, we would be interested. We would be willing to go to meetings even daily because we want to get our blood pressure checked. ! Of course we are interested. We would like to go and get our blood pressure checked. Even those not in the club would go to meetings just to get their blood pressure checked.

Would you be more interested in meeting in the hypertension club for a short time (like 4-5 sessions) or for a longer time (like 6-12 months)? Summary: Every group said they would be interested in the longer-term option because the 4-5 meeting/short-term option would pass by very quickly and if they were busy during that time, they would miss out. The groups said they would be willing to make the commitment to attend meetings over the long-term. Specific Answers: ! Group 1: We think longer-term is better because if we are busy during the period of time when the 4-5 sessions are going on, we would miss out on everything. We think that people would be willing to go for 6 months. ! Group 2: We are more interested in the longer-term option. We think it would be more beneficial for the club to meet for a longer period of time. ! Group 3: We like the idea of a longer time period for club meetings (such as 6 months or more). The more consultation and information, the better. People would be able to make time to go to meetings. Health is important. ! The longer the better. 4-5 meetings would pass very quickly and sometimes people would not be able to attend. ! One group said they would be interested either in a short-term or long-term club, but they think long-term is better because they want to get their blood pressure checked every day. ! One group said they would be interested in weekly meetings, and they are more interested in the longer-term option. The four weeks would pass so quickly. With the longer-term model for the clubs, if a person misses one meeting he can just attend another. If we talk about life stress during the focus groups, do you think we should have separate focus groups for men and women? Do you think that life stresses are different for men and women? Summary: For the most part, the groups thought that stress should be talked about in groups of men and women together. Specific Answers: ! We dont really know if stress is different for men and women. We think it would be better to talk about stress together, men and women. *Note: this group didnt recognize/understand the word for stress. Baktygul had to explain the word to them. ! We think it would be better to have men and women together for stress reduction exercises ! One group said that stress is different for men and women and that they would be interested in having separate sessions for men and women. They said it may even be useful to separate the groups into young and old. ! It would be better if we talked about stress together. Women need to understand what makes men stressed and vice versa. For old people, our stress cannot be cured. But the youth really need to learn to deal with stress. Many families divorce/split up over stress.

As a part of the hypertension clubs, would you be interested in working on how to deal with stress (for instance by learning relaxation techniques)? Summary: The groups seemed very interested in talking about stress management techniques during club meetings. Given the frequency with which the groups mentioned stress and worrying, I think that stress management techniques would be very interesting for club members, and potentially very helpful.

Specific Answers: ! Of course they would be interested. (3) ! Yes, we would be interested in this. If we listen to music we can de-stress ! One woman commented, there is no way we can get rid of stress.